Infertility Definitions - Patients' Perspectives
Keywords:
Infertility, definition, perspective, miscarriages, religion.Abstract
Background: The patients' perspective of the definition of infertility may differ from the traditional medical definition.
Objective: To explore patients' perspectives regarding the definition and treatment of infertility.
Methods: 343 infertile patients attending the infertility and IVF unit completed anonymous comprehensive questionnaires.
Results: Time to conception of <1, 1, 2 or more than 3 years was defined as infertility by 6%, 54%, 22% and 18% of the patients, respectively. The time period by which primary infertility was defined was longer in the ultra-orthodox, compared to other less observant sectors: 1.9±0.9 and 1.5±0.9 years, respectively (p<0.001). The time period by which secondary infertility was defined was longer according to religious piety: 1.6±1.2; 1.8±1.0; 2.0±1.0 and 2.6±1.6 years in secular, traditional, orthodox and ultra-orthodox patients, respectively (P<0.001). The number of existing children after which couples will still wish to attend infertility treatment significantly correlated with the religious devotion: 2.4±1.9; 3.2±2.0; 4.6±2.5 and 5.5±2.3 children in secular, traditional, orthodox and ultra-orthodox couples, respectively (P<0.001). Regarding the number of miscarriages that requires medical evaluation and treatment, 15% defined it after one miscarriage, 51% after two, 27% after three and 7% after four times or more.
Conclusions: patients' subjective definition of infertility differs from the common medical definition, and correlates significantly with the degree of patients' religious devotion.
References
Practice Committee of the American Society for Reproductive Medicine. 2008. Definition of infertility and recurrent pregnancy loss. Fert Steril; 90(5 Suppl): S60. http://dx.doi.org/10.1016/j.fertnstert.2008.08.065
Guttmacher AF. Factors affecting normal expectancy of conception. J Am Med Assoc 1956; 161: 855-60. http://dx.doi.org/10.1001/jama.1956.02970090081016
Gnoth C, Godehardt D, Godehardt E, Frank-Herrmann P, Freundl G. Time to pregnancy: results of the German prospective study and impact on the management of infertility. Hum Reprod 2003; 18: 1959-66. http://dx.doi.org/10.1093/humrep/deg366
Wang X, Chen C, Wang L, Chen D, Guang W, French J. Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertil Steril 2003; 79: 577-84. http://dx.doi.org/10.1016/S0015-0282(02)04694-0
Adashi EY, Cohen J, Hamberger L, Jones HW Jr, de Kretser DM, Lunenfeld B, Rosenwaks Z, Van Steirteghem A. Public perception on infertility and its treatment: an international survey. The Bertarelli Foundation Scientific Board. Hum Reprod 2000; 15: 330-4. http://dx.doi.org/10.1093/humrep/15.2.330
Dick ML, Bain CJ, Purdie DM, Siskind V, Molloy D, Green AC. Self-reported difficulty in conceiving as a measure of infertility. Hum Reprod 2003; 18: 2711-7. http://dx.doi.org/10.1093/humrep/deg504
Van Balen F, Trimbos-Kemper T, Verdurmen J. Perception of diagnosis and openness of patients about infertility. Patient Educ Couns 1996; 28: 247-52. http://dx.doi.org/10.1016/0738-3991(95)00852-7
White L, McQuillan J, Greil AL, Johnson DR. Infertility: testing a help seeking model. Soc Sci Med 2006; 62: 1031-41. http://dx.doi.org/10.1016/j.socscimed.2005.11.012
Daniluk JC, Koert E. The other side of the fertility coin: a comparison of childless men's and women's knowledge of fertility and assisted reproductive technology. Fertil Steril. 2013; 99(3): 839-46. http://dx.doi.org/10.1016/j.fertnstert.2012.10.033
Larsen U. Research on infertility: which definition should we use?. Fertil Steril 2005; 83: 846-52. http://dx.doi.org/10.1016/j.fertnstert.2004.11.033
Bunting L, Boivin J. Decision-making about seeking medical advice in an internet sample of women trying to get pregnant. Hum Reprod 2007; 22: 1662-8. http://dx.doi.org/10.1093/humrep/dem057
Thoma ME, McLain AC, Louis JF, King RB, Trumble AC, Sundaram R, Buck Louis GM. Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach. Fertil Steril 2013; 99(5): 1324-1331. http://dx.doi.org/10.1016/j.fertnstert.2012.11.037
Gurunath S, Pandian Z, Anderson RA, Bhattacharya S. Defining infertility--a systematic review of prevalence studies. Hum Reprod Update 2011; 17(5): 575-88. http://dx.doi.org/10.1093/humupd/dmr015
Barden-O'Fallon J. Associates of self-reported fertility status and infertility treatment-seeking in a rural district of Malawi. Hum Reprod 2005; 20: 2229-36. http://dx.doi.org/10.1093/humrep/dei008
Stirrat GM. Recurrent Miscarriage. Lancet 1990; 336: 728-33. http://dx.doi.org/10.1016/0140-6736(90)92215-4
Sabarre KA, Khan Z, Whitten AN, Remes O, Phillips KP. A qualitative study of Ottawa university students' awareness, knowledge and perceptions of infertility, infertility risk factors and assisted reproductive technologies (ART). Reprod Health 2013; 10: 41. http://dx.doi.org/10.1186/1742-4755-10-41
Cardozo ER, Neff LM, Brocks ME, Ekpo GE, Dune TJ, Barnes RB, Marsh EE. Infertility patients' knowledge of the effects of obesity on reproductive health outcomes. Am J Obstet Gynecol 2012; 207(6): 509.e1-509.
Cardozo ER, Dune TJ, Neff LM, Brocks ME, Ekpo GE, Barnes RB, Marsh EE. Knowledge of obesity and its impact on reproductive health outcomes among urban women. J Community Health 2013; 38(2): 261-7. http://dx.doi.org/10.1007/s10900-012-9609-1
Rodriguez D. Female fertility: a conceptual and dimensional analysis. J Midwifery Womens Health 2013; 58(2): 182-8. http://dx.doi.org/10.1111/j.1542-2011.2012.00234.x
Lind T, Lampic C, Hammarström M, Rodriguez-Wallberg K. Young women's perceptions of fertility-related information and fertility distress before surgery for ovarian cysts. Acta Obstet Gynecol Scand 2013; 92(11): 1290-6. http://dx.doi.org/10.1111/aogs.12228
Read SC, Carrier ME, Boucher ME, Whitley R, Bond S, Zelkowitz P. Psychosocial services for couples in infertility treatment: What do couples really want? Patient Educ Couns 2013 Nov 5. pii: S0738-3991(13)00466-7.
