Infertility has long been a common disease afflicting the couples who want to have their own child, which may also bring in mental burdens impacting their daily life negatively. Notably, the development and maturation of assisted reproductive techniques brings new hope for infertile couples, however, the capacity of healthcare facilities and the service they provided vary from one to another. In this questionnaire, we addressed the potential problem-causing questions in the aspect of fertility care procedure and infrastructure, and the use of TCM.
The first concern on infertility resources comes from the accessibility. in 689 respondents, only 4.6% of them worked in specialized reproductive hospitals with relatively higher focus on infertility management. the majority of respondents working in infertility field were studying gynecologist (64.3%), whereas 10.2% of them were majoring in reproductive endocrinology. Moreover, only 28.9% of participants worked fully focused on infertility diagnosis and management. Based on the data revealed by NHCPRC, the population of infertility patient has reached over 40 million, becoming the one of the three major disease like cancer can cardiovascular diseases in China. Through the infertility fields have been developed rapidly, the demand in infertility field still outweighs the healthcare system’s capacity, and the unevenly distribution can exacerbate the condition of not being able to get helps.  The lack of andrologist who specialized in male infertility has dragged on the development of this field, only 36.6% of respondents replied their hospitals were able to counsel male patients by specialized andrologists, meanwhile male and female from the infertile couple are supposed to be examined simultaneously. Additionally, assisted reproductive technique such as IUI and IVF-ET are the solution to subfertility on many circumstances, however only a few of hospital were able to perform IUI and IVF- ET, 22.1% and 17.3%, respectively.
Secondly, the quality of infertility care services was heterogeneous, and more standardized procedure were expected in healthcare system. As mentioned above, the heterogeneity of educational background and speciality were observed in infertility healthcare practitioners. For instance, only the top 2.3% of respondent got their doctor’s degree, and only 25.3% of practitioners in this survey received advanced training in infertility diagnosis and management field. The lack of advanced trained practitioners and high intellectuals may impede the quality control of infertility services. Besides, the lack of proper surveillance of assisted reproductive procedure is jeopardizing the developed parts of infertility healthcare system. Less than half of interviewed doctors claimed they had their own general practice guideline for infertility diagnosis and management, while 33.2% of them did not have a guideline or not knowing about it. Meanwhile, in the hospitals that are capable for IVF-ET, 10.5% of practitioners voted for no such an ethics committee was established, and 14.5% of them stated the condition was unclear (p<0.01).
As an alternative to the western medicine, costly emotionally and financially, TCM can offer less invasive and money saving way to manage infertility. TCM scopes for the imbalance within each individual based on his pulse, complexion, and emotional wellbeing. As the place where TCM originated, we found a broad application of TCM in infertility field in China, especially for adjuvant. 91.5% of practitioners prescribed TCM as an adjuvant in managing infertility, while 86.2% of them have prescribed TCM solely in infertility management. Due to the complex herbal components, variety of formulas have been applied and a systemic review suggest the pregnancy rates of infertility patients can be improved 2-fold within 4 months comparing with western medical management . The broad applications of TCM on infertility with diverse regimens were reflexed in our survey. Therefore, larger scale clinical trials on TCM in infertility management are expected to further elucidate the potential mechanisms of how they benefit and unravel their value as the alternative holistic therapy.
Based on the current condition in infertility field reflexed by our survey and other literature report, a larger survey on etiology of infertility were expected to be conducted to gain detailed information on the demographic distribution of this disease, which may feed up the policy makers decision. Furthermore, the relevant guidelines on infertility diagnosis procedure and management should be made and enforced with intensification to ensure the quality of service.