A hospital that provides fertility services is an important facility in any society. It can help patients conceive and carry healthy babies to term, providing a foundation for future generations. However, equal access to infertility care remains a challenge worldwide. In low-income countries, for instance, infertility services are rarely included in national universal health coverage benefit packages. The costs associated with fertility care can be prohibitive for many individuals and prevent access to services.난임병원
Inequities and disparities in access to infertility services adversely affect poor, uneducated and marginalized groups. A lack of affordable or accessible fertility care may exacerbate inequalities in other medical and social sectors. In the USA, for example, the 2006-2010 National Survey of Fertility & Reproductive Health indicates that only 5% of women who had incomes 400% above poverty received infertility treatment. Moreover, only 15 states provide insurance coverage for infertility treatment.
The NYU Reproductive Endocrinology & Infertility (REI) Fellowship program has established an integrated REI clinic within Bellevue Hospital Center in Manhattan, NYU Langone Health System. The clinic is operated by REI fellows and supervised by REI attending physicians. Patients are evaluated and treated in a half-day clinic, with 6-7 new and 3-4 follow-up patients seen per session. The patient population is representative of the HHC community itself, with an average age of 32 at first visit and a median time trying to conceive of 4.5 years.
During clinics, the fellows learn the complexities of diagnosis and treatment of the full spectrum of female and male reproductive endocrinology and infertility. The process of evaluating and managing patients also exposes the limitations of current testing and treatment methodologies. The clinic’s team is able to identify common etiologies of infertility including diminished ovarian reserve, tubal dysfunction and uterine factors, as well as male factor infertility.
In addition to learning about the prevention, diagnosis and management of infertility, the fellows have an opportunity to hone their medical knowledge and coping skills. They also gain an appreciation of the societal and personal impact that infertility can have on patients, their families, and their communities.
A key challenge is maintaining a balance between educating the fellows through autonomous practice and ensuring appropriate supervision. This is an age-old tension in graduate medical education, and the degree to which this is achieved varies widely between programs. This variation in clinical experience also varies by country, resulting in a wide range of fellows who enter the workforce with varying degrees of independence.
As the world continues to face challenges related to infertility and other sexual and reproductive issues, we need to find creative solutions to expand access. We must continue to develop cost-effective, sustainable models for infertility care, and work with global partners to develop international norms and standards that support the delivery of quality care. This will require commitment, collaboration and leadership at multiple levels — within and between countries, across all health sectors. Ultimately, the goal is to reduce the number of people who do not have access to effective infertility treatment and the devastating sequelae of infertility such as isolation, loss of hope, or even death by suicide.서울아이앤여성의원