There have been calls to consider reproduction as the sixth vital sign. This would imply that reproduction can give us insights into the health of an individual that are just as important as the five other vital signs (heart rate, blood pressure, oxygenation levels in blood, body temperature and pain level). Which begs the question: what might we be able to learn about the long-term health of an individual if we studied fertility as a future indicator of health?

There is mounting evidence that infertility is not a disease in and of itself but rather a symptom. It has been well-documented that chronic conditions such as obesity, diabetes and even cancer often lead to infertility. But what if infertility was not necessarily the end result but rather a warning sign? “A study of over 64,000 women of childbearing age in the USA has found that infertility is associated with a higher risk of developing cancer compared to a group of over three million women without fertility problems, although the absolute risk is very low at just 2%.” 

Thus far the pervading opinion has been that the pathway flows in one direction. It is the strain obesity or diabetes puts on the body of the patient that renders the patient infertile. It has not been until fairly recently that clinicians have begun to consider whether pathways that can result in obesity or cancer are mechanisms that result in infertility.

Why is this important? Well, if infertility was proven to be a warning sign then it could be used as an indication for intervention. This would present a unique opportunity to identify high-risk individuals much earlier in life when intervention could have more impact.

We do not adequately factor in aspects of reproductive development and health (such as the age at puberty, the menstrual cycle and disorders that occur during pregnancy (pre-eclampsia, gestational diabetes or pregnancy-induced hypertension)) into risk assessment for subsequent cardiovascular health. Infertility and cardiovascular disease share common risk factors, such as: early menopause, PCOS, late menarche and underlying biologic mechanisms, such as inflammation. What if infertility could foretell worsened Cardiovascular Disease risk? We will discuss where and how this is being studied.

Currently, reproductive medicine physicians treat patients for a short period of time before the patients transition to other practitioners for future care. An interdisciplinary patient care approach would allow for a more nuanced treatment of patients, which could reveal insights on the link between fertility and overall health.

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