BASIC FERTILITY INVESTIGATION IN A LOW RESOURCE SETTING IS VALUABLE AS A MARKER FOR OVERALL HEALTH

Abstract

Infertility is considered a harbinger of overall health and future morbidity and cardiovascular mortality. However, the vast majority of couples in low resource settings do not seek infertility treatment in a timely fashion due to lack of insurance coverage. While the Medicaid plan does not cover for infertility treatment in Michigan, it does cover the initial infertility workup for few visits. Retrospective, cohort study at a university hospital infertility clinic comparing the results of the infertility workup in low resource settings on Medicaid vs private insurance groups. We performed a retrospective chart review of patients after IRB approval. New patients who visited a university health clinic at from 07/2019 –02/2020 were studied. A total of 117 patients were studied (Medicaid = 79; Private =38). All patients had infertility workup inclusive of preconception labs (TSH, Rubella immunity), hormonal profile (AMH, day 2 E2, FSH, and for PCOS, if indicated), day 2-4 TVUS and follicle count and day 4-12 SIS. We collected data on new non-infertility diagnosis that resulted from the workup. The new non-infertility diagnosis studied included ones with long term health implications: hypertension, diabetes, pre-diabetes, thyroid disease, endometrial hyperplasia and cancer, hydrosalpinx, PCOS, and Vitamin D deficiency. Statistical analysis was performed with SPSS V24.0. The demographics of the patients in Medicaid vs Private groups were not significantly different. The mean age in years was 33(+6.2) ; mean BMI was 32.8 (+8.5). The results of the new non-infertility diagnosis in the two groups is represented in Table 1.Tabled 1Table 1New non-infertility diagnosisMedicaid (n =79)Private (n =38)P-valueDiabetes/ Pre -diabetes25.3% (n=20)23.6% (n=9)1PCOS24.0% (n=19)13.1% (n=5)0.26Premature ovarian failure1.2% (n=1)0.02% (n=1)1Hydrosalpinx5% (n=4)0%0.52Endometrial hyperplasia+ cancer2.5% (n=2)0%0.81Vitamin D Deficiency65.8% (n=52)47.3% (n=18)0.08 Open table in a new tab There was no significant difference in the newly diagnosed morbidities between the groups. The findings are still important in that 93.1% of all patients received a non-infertility diagnosis. Among them, 55% had at least two such diagnoses which carried a future health implication. This analysis did not take into account the diagnoses of obesity/ smoker and the weight loss and smoking cessation counseling that are a part of our infertility work up. Infertility is not a unique disease of the reproductive axis but is often linked with metabolic diseases. Hence, a basic infertility workup should be undertaken in all patients with infertility, irrespective of their ability to afford fertility treatment post work-up.