“Many have an extreme distrust of reproductive medicine”

Globally, one in six people of childbearing age is at least partially infertile. This is evident from a recently published report by the World Health Organization (WHO). The Geneva-based organization is calling for an urgent improvement in access to fertility treatments.

“The sheer number of people affected demonstrates the need to expand access to fertility treatments and that this issue can no longer be left out of consideration in health research and policy, so that safe, effective and affordable pathways to parenthood are available to all,” he said. . WHO Secretary General Tedros Adhanom Ghebreyesus.

In terms of reproduction, Switzerland is following a restrictive course. Despite efforts, the topic is moving further up the political agenda – even though the World Health Organization defines infertility as a disease. The nursing scientist Madeleine Bernet started the HoPE research project to look at the topic holistically and, if possible, to break legal boundaries with concrete suggestions for improvement.

In Switzerland, the demand for infertility treatments has increased. In 2021, every thirtieth child in Switzerland will be born through artificial insemination. Are we becoming more and more sterile?
Alexander Kwas: To some extent, yes. To a small extent, fertility treatments cause infertility to be inherited. There are several reasons why more treatments are used today. In our society, having children is increasingly postponed. The average age at birth is rising. Then it is usually not so easy to get pregnant right away. On the other hand, there are more and more treatment options, for example new egg freezing procedures. In addition, people have become more aware of the problem and same-sex couples are now also entitled to sperm donation.

How do environmental influences affect fertility?
Alexander Kwas: It is scientifically difficult to find a causal relationship between environmental toxins and a decrease in infertility. But in general, environmental factors certainly have an influence.
Madeline Bernett: From practice I can say that those affected are very sensitive to this topic: for example, they change the induction hob, do without heated seats in the car and do not drink drinks from plastic bottles.

And what is the impact of stress?
Alexander Kwas: There is no scientific evidence that stress has a negative impact on fertility. But even that is difficult to prove. Biologically, however, I don’t believe stress has a major impact on infertility.

Can you prevent infertility?
Alexander Kwas: There is no direct prevention. I advise couples who cannot have children to adopt a healthy lifestyle: a balanced diet, reducing or avoiding alcohol and nicotine.

What does infertility really mean for a man? Are there societal and social differences?
Alexander Kwas: Many men often have trouble measuring their semen using a spermiogram to investigate, they feel threatened in their masculinity. When diagnosed with poor quality sperm, many develop complexes, experience some anger and feel incomplete. Which doesn’t make any biological sense at all. You have virtually no control over how your body works. Men are often forgotten when women have problems and feel helpless. As much as they want to relieve the women of all the injections and treatments.

Are the permitted methods of reproductive medicine sufficient or should more be possible in Switzerland?
Alexander Kwas: In Switzerland, the laws on reproductive medicine are still very restrictive. Many go abroad for treatment options that are not allowed in Germany. I think there is no doubt that egg donation, for example, is allowed under good guidelines. But above all, the importance of reproductive medicine in society is important.

How?
Alexander Kwas: On the one hand, many people, in my opinion, still have an extreme distrust of reproductive medicine: they think that we are working with completely unnatural methods, creating an artificial work of the devil à la Frankenstein’s monster. On the other hand, we are often accused of the fact that the treatment methods generate pure money. We – reproductive medicine – are often equated with plastic surgery. I don’t think reproductive medicine should be viewed as a huge business – unless you think of medical care in general as a huge business.

In terms of cost assumption, the two branches of medicine – plastic surgery and reproductive medicine – are practically on par. Very few infertility treatments are covered by health insurance. Should that change?
Madeline Bernett: In terms of costs, I find it very exciting that the people participating in my research feel privileged because they can afford the treatments – especially artificial insemination. Of course, the high costs also pose challenges, but they highlight the injustice that not all those affected have equal access to fertility treatments.
Alexander Kwas: Infertility is defined by the World Health Organization (WHO) as a disease. Patients must therefore also have access to appropriate treatments, as with other diseases. In European comparison, Switzerland is one of the few exceptions that does not contribute to the cost of artificial insemination.

How is that possible
Madeline Bernett: This depends on several factors. The rejection within the population is still noticeable, especially when the topic does not concern you and starting a family was easy to achieve. There is also competition in the field of education. A woman recently told me that her mother was afraid that her daughter would give birth to octuplets as a result of artificial insemination. That showed me: the necessary knowledge is missing. Of course there is a certain complexity to the subject, but society needs to be made aware of artificial insemination, which is very common in Switzerland.

They set up HoPE – a research project that sheds light on the needs of both those affected and professionals. How did the project come about?
Madeline Bernett: The project is being carried out as part of my nursing thesis. I have become aware of the topic because I know many people who are affected. Professionally, I came into contact with the unfulfilled desire to have children through the subject of endometriosis. But I also became aware of the subject because I know those affected. The study aims to capture and describe the perspectives, experiences and needs of affected individuals experienced in fertility treatment and professionals, including nurses, midwives and physicians, who are active in this field. This is intended to discuss the current care in the health care system in order to formulate proposals for possible adjustments. The study also examines the possibility of introducing a specialist nurse or midwife role and makes recommendations in this regard.

What do you hope to achieve with the research project?
Madeline Bernett: My aim is to conduct applied research, ie the results must have a lasting impact on practice. The research project focuses on a group of patients who receive little attention, but who are often burdened and feel alone. The project generates data on the current situation of reproductive medicine in Switzerland from the perspective of those affected and professionals. Another aspect that is very important to me is the promotion of interprofessional collaboration. That is why I work with different professional groups in my project. Of course, when proposing solutions, I have to take into account what is realistic, especially with regard to the shortage of skilled labour.

Was it also not easy to finance your project?
Madeline Bernett: In fact, many of my applications were rejected, partly because the topic was not considered relevant to healthcare. I got start-up funding (funding instrument) from Bern University of Applied Sciences, the rest is funded by donations and personal contributions. The Bernese women’s rights organization Zonta Club Bern gave me a larger “supplementary grant”.

The study has been running since 2022 and is expected to be evaluated in 2025. What do the interim results say?
Madeline Bernett: The planned research consists of two parts, a written survey and interviews. I was able to include 337 people in the mail survey, which is a much larger sample size than expected and once again demonstrates the importance of the topic. More than 20 people and/or couples have also registered for the interviews, which I am very happy with. I’m currently still in the data collection phase, so I can’t say too much yet. However, it becomes clear that infertility represents a very large emotional burden.

Are there any suggestions for adjustments to the healthcare system?
The emotional burden often gets little space. Not because the experts don’t want it, but for structural reasons. A topic that I often encounter during my studies is support after a negative pregnancy test or after a miscarriage. Many women feel left alone and insufficiently guided after such an experience. Those affected often do not know that they can turn to an obstetrician after a miscarriage, for example. There are also good offers such as kindverlust.ch, but the information must reach those affected. Many of those affected also want an exchange with other affected people. I think that setting up such a peer group in an institution would be a measure that could be very beneficial and could be implemented quickly and easily.