Editor's Note: This is the first in a two-article series from Dr. Pourhassani on infertility and acupuncture practice.Article #2 will appear in the December digital issue.
Is infertility a disease? Or is it a symptom, or condition of an underlying health condition, disease process, and/or iatrogenic in origin? Are we miseducating the public by referring to infertility as a disease in order to obtain insurance funding for expensive treatments?
In order to obtain payment from health insurance companies, infertility must be categorised as a disease associated with billable ICD codes. The World Health Organization defines infertility based on the ICD (International Classification of Diseases) as "a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse."1 That is a very broad definition.
Dickey, et al., in an article titled, "Infertility Is a Symptom, Not a Disease,2 stated: "The facts are that infertility and its frequent companion, anovulation, are not diseases; they are symptoms of underlying, sometimes serious disease in one or both marital partners. "We are warned in this article of the potential of overlooking underlying health conditions for the immediate desire to obtain a pregnancy.
Surgeries and medication may also cause infertility. Potential iatrogenic causes of infertility include:
For insurance billing, in cases of post-vasectomy fertility,8 instead of using the sterilization code for the wife's visit, the American Society of Reproductive Society recommends using: N97.8 Female infertility, other specified origin (includes male factor); and Z31.81 Encounter for male factor infertility in female patients.
Most insurance companies do not include acupuncture coverage for infertility. We do not have insurance coverage for acupuncture as an adjunct to IVF, either. Adjunct acupuncture for IVF cycles is provided in order to retrieve more eggs, increase the thickness of the endometrial lining, increase live birth rates, and reduce miscarriages.
I am left with a few questions: When acupuncturists treat infertile men and women, are we not addressing underlying cause/s of infertility? Once a pregnancy is achieved in an infertile woman, is our work done? And what are repercussions of believing one has a disease, when it is really a symptom of an underlying condition which requires attention?
References
Structured water (H3O2) can be considered a fourth state of water between liquid and solid. It has the hexagonal structure of ice; however, missing a critical bond, it behaves more like a gel than a solid, but retains some of its crystalline structure.
In the past five years of my clinical practice, I have seen an astonishing upsurge in the chronic use of proton-pump inhibitor (PPI) medications for the gastrointestinal issue diagnosed by allopathic medicine as GERD. It is not uncommon to encounter patients taking these prescriptions for five-plus years.
Working with chronically ill patients entails acknowledging the reality that not all patients will survive their diagnosis. Chinese medicine and acupuncture play a crucial role in palliative and end-of-life care, addressing medication and disease side effects, alleviating pain associated with death, reducing anxiety and stress, and helping patients find peace during the dying process.
