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On the other hand, the study authors state that "for this same audience {the general public} " and according to the Oxford English Dictionary, "the term 'subfertility' is not a word." Subfertility refers to reduced, but not completely absent, fertility. Using that definition, most couples who seek infertility treatment are actually experiencing subfertility, not complete infertility. In fact, as one of the letters' authors remarks, "Moreover, sterility is relatively rare and difficult to define."
There is generally no difference of opinion on the meaning of "sterility," which is defined as the complete lack of fertility. As mentioned in the letters to NEJM's editors, true sterility is very uncommon, especially with today's reproductive technologies. Unfortunately, as mentioned above, many people equate infertility with sterility in all cases.
Reproductive experts emphasize the importance of evaluating both members of a couple rather than either individual in order to arrive at an appropriate and clear diagnostic term. Confusion occurs when these terms are used intermittently. The result could be more people resigning themselves to being "barren" (an unattractive, politically incorrect, older reference to sterility), choosing to seek none of the available technologies, when in fact they could be easily assisted to conceiving the children they desire. Frequent intermingling of these terms and their meanings also adds to the barriers which already exist in communication between those with and those without difficulty conceiving. Perhaps most importantly, the confusion directly effects how people with subfertility (or "relative infertility") feel about themeselves (as described so accurately by Dr. Mark Perloe in this excerpt from his book, Miracle Babies) and their lives. For example, patients who hear "you are sterile" when they are told "you are infertile" have to cope with an even greater loss than is really necessary.
Until a worldwide standard of use is created and adhered to for use of terms relating to conception difficulties, the average patient is best off asking his/her own practitioners about the meaning that they apply to these words. Knowing whether your physician means to say that you are less likely to conceive without assistance or that you will probably not conceive even with assistance is most valuable early on in discussions about treatment.
© Tracy Morris
