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
Over my almost 30 years in clinical practice, I have used Chai Hu Long Gu Mu Li Tang extensively for a wide array of clinical presentations ranging from chronic headaches to anxiety, insomnia, and prescription drug withdrawal symptoms if these situations fit the appropriate patterns – all with extremely positive clinical outcomes.
There’s no doubt that many of your patients visit your practice because they are in pain. And there’s certainly no doubt that curcumin from turmeric (Curcuma longa) can be incredibly effective in stopping that pain, whether due to chronic conditions like arthritis or acute pain from intensive workouts. But your patients may also benefit from curcumin for other reasons.
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Low back pain is defined as pain the posterior superior iliac spine (PSIS), and it can be acute or chronic, localized or radiating. It is a common ailment for adults in the United States, with a lifetime prevalence as high as 65-80%. Whether or not an MRI is available to provide definitive knowledge of a structural issue, acupuncture can be an effective treatment for low back pain.
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