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In Reply: The social policies Drs Chavkin and Johnson discuss are laudable goals; there are indeed areas in which the United States lags far behind many other developed nations.¹ Despite the fundamental importance of these policies, I am skeptical that US society has the political will to institute them and emulate the support of such family values demonstrated in Europe. However, this should be tried.

As noted in the Clinical Crossroads article, the American Society of Reproductive Medicine has promoted fertility through a program aimed at raising awareness of 4 major causes of preventable infertility: sexually transmitted disease, extremes of body weight, cigarette smoking, and most importantly, reproductive aging.² This initiative is designed "to prevent people from becoming infertility patients."

The natural biology of ovarian senescence may prevent successful childbearing if women wait until they are older. Yet there does not appear to be enough of a premium on childbearing . . . [Full Text of this Article]

Robert J. Stillman, MD
robert.stillman@integramed.com
Shady Grove Fertility Center
Rockville, Md