People with disabilities and fertility levels.

3rd of December: International Day of Persons with disabilities. The annual observance of the International Day of Disabled Persons was proclaimed in 1992 by the United Nations General Assembly. It aims to promote the rights and well-being of persons with disabilities in all spheres of society and development and to increase awareness of the situation of persons with disabilities in every aspect of political, social, economic, and cultural life. Unfortunately, the global crisis of COVID-19 is deepening pre-existing inequalities, exposing the extent of exclusion and highlighting that work on disability inclusion is imperative. In our article we investigate the connection between people with disabilities and fertility levels and what everyone can do in order to stop the discrimination against them. An example of this discrimination towards them is when they are too often stereotyped as needing special protection, including measures that curtail their ambitions for intimate relationships and family life. It is inaccurate to assume that being disabled means having no sexual or reproductive interests or being sexually inactive, celibate, or asexual. For example, the sexual interests of people with physical disabilities such as spina bifida or cerebral palsy may be underestimated based on false assumptions about their sexual capabilities. People with sensory disabilities such as blindness may be burdened by others’ false assumptions about their parenting abilities. And people with intellectual disabilities may be looked at merely as potential victims of sexual predation or exploitation, rather than as people with naturally sexual interests or capabilities who need not only protection but also sex education and recognition of their agency. Assumptions like these usually are the reason why people with disabilities unjustly receive less access to medically indicated reproductive care than other people of similar age and sex. This day is devoted in raising awareness for all the false accusations and assumptions towards them but also to raising the issue of better healthcare resources and sex education, for them and all. So, let’s state a very important fact. Can I conceive as a person with disabilities? Many physical disabilities on their own won’t impact fertility, but some autoimmune and connective tissue disorders, as well as multiple sclerosis and stroke, may. Also, some people with disabilities may have difficulty or discomfort when trying to conceive. In any of these situations, assisted reproductive technology (ART) procedures like IVF can help. Pregnant women with disabilities may be more likely to experience certain complications (like more urinary tract infections) or issues around accessibility. They are also twice as likely to deliver their newborns via C-section— and those with spinal cord injuries or musculoskeletal disabilities may not be offered epidurals. People with disabilities may have some challenges when it comes to postpartum care (e.g., breastfeeding), but working with providers who have the right training can surely help. Reproductive health among women with disabilities is still highly understudied; however, some studies have shown that they have a significantly higher risk of having adverse pregnancy outcomes compared to women without disabilities. A study using Medical Expenditure Panel Survey annualized data reported that women with complex activity limitations and social restrictions were 55% times more likely to have miscarriages compared to women without these complications. In another study, which uses data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, women with intellectual and developmental disabilities had a higher risk of having a pregnancy affected by preterm birth, low birth weight, and stillbirth. Similar studies also show that women with the above disabilities had a higher risk of early labor, preterm birth, and preeclampsia, and their infants were more likely to have low birth weight. The very first study of pregnant women with developmental or intellectual disabilities was conducted in 2015 and has found high rates of pregnancy complications including fetal death, preeclampsia, and preterm birth. The researchers analyzed hospital discharge records for 1,706 women with intellectual and/or developmental disabilities including autism, cerebral palsy, and Down syndrome. An estimated 40 percent of all people with autism also have an intellectual disability. The elevated rates of pregnancy complications included preeclampsia, preterm birth, fetal death (after 20 weeks), C-section delivery, and prolonged hospitalization after delivery. The conclusions drawn from recent research on the subject indicate a non clear connection between people with disabilities and fertility levels. However disabilities can make conception more difficult, and individuals with disabilities should take appropriate steps to increase their chances of conception. People with disabilities need to be equally informed about their fertility levels and support during the process of conceiving, just as any other prospective parents do. They also need appropriate information about fertility issues before they attempt to conceive. Some disabilities can cause problems for pregnant women, so care providers should be well versed in disabilities and disabilities care. When disabilities do affect a person's fertility, the severity of the disabilities will generally determine how easily a pregnancy can proceed. Another aspect we would try to cover in this article is how assisted reproductive technology (ART) is associated with an autism spectrum disorder. Evidence suggests that for pregnancies conceived with ART, the increased risk for autism disorder is, in large part, due to the higher likelihood of adverse pregnancy and delivery outcomes. This means, using ART may lead to factors that are known to put children at risk for autism, such as being born a twin or multiple (triplets, quadruplets, etc.), being born too early, or being born too small. Also, children conceived using ART were more likely to be diagnosed with autism if ICSI was used compared to conventional IVF. Overall, children conceived using ART were about two times more likely to be diagnosed with ASD compared to children conceived without using ART. The bottom line is that the reality of conceiving, being pregnant, and giving birth as a person with disabilities is complex, but if you have a good support system, access to accurate information, and a highly qualified medical team, then you’ll be alright. Besides, all people with fertility issues deserve the above, and here in MEDIPASS, they can have it and so can you. As we always say, the fertility journey is not a journey you should do alone.