Article

Time costs of fertility care: The hidden hardship of building a family

Department of Urology, University of California, San Francisco, California.
Fertility and sterility (Impact Factor: 4.59). 02/2013; 99(7). DOI: 10.1016/j.fertnstert.2013.01.145
Source: PubMed

ABSTRACT

OBJECTIVE: To determine the time that infertile couples spend seeking and utilizing fertility care. DESIGN: Prospective cohort. SETTING: Eight community and academic infertility practices. PATIENT(S): A total of 319 couples presenting for a fertility evaluation. INTERVENTION(S): Face-to-face and telephone interviews and questionnaires. MAIN OUTCOME MEASURE(S): Participants recorded diaries of time spent on provider visits, travel, telephone, and miscellaneous activities. Participants also recorded time off from work due to the physical and mental stress related to fertility care. Linear regression was used to assess relationship between fertility characteristics and time spent pursuing care. RESULT(S): Diaries were completed by 319 subjects. Over an 18-month time period, the average time spent on fertility care was 125 hours, equating to 15.6 days, assuming an 8-hour workday. For couples utilizing cycle-based treatments (CBT), overall time spent pursuing care averaged 142 hours, versus 58 hours for couples using other therapies, with the majority of time spent on provider visits (73 hours). After multivariable adjustment for clinical and sociodemographic characteristics, possessing a college degree and intensity of fertility treatment were independently associated with increased time spent pursuing fertility care. Furthermore, couples that spent the most time on care were significantly more likely to experience fertility-related stress. CONCLUSION(S): Over the course of 18 months of observation, couples pursuing fertility treatment dedicated large amounts of time to attaining their family-building goals. This burden on couples adds to the already significant financial and emotional burdens of fertility treatment and provides new insight into the difficulties that these couples face.

Download full-text

Full-text

Available from: Patricia P Katz, May 07, 2015
  • Source
    • "For couples with a calculated prognosis over 30%, a tailored expectant management (TEM) of 6–12 months does not compromise ongoing birth rates compared to starting medically assisted reproduction (MAR) immediately (Steures et al., 2008; Custers et al., 2012). Furthermore, TEM is more cost-effective, has lower multiple pregnancy rates, and minimizes the significant physical and psychological burdens that accompany MAR (Verhaak et al., 2002; Verberg et al., 2008; Brandes et al., 2009; Wu et al., 2013). Therefore, national Dutch guidelines have formulated recommendations for TEM (NVOG, 2004; NHG, 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: STUDY QUESTION Do couples who were eligible for tailored expectant management (TEM) and did not start treatment within 6 months after the fertility work-up, have different experiences with the quality of care than couples that were also eligible for TEM but started treatment right after the fertility work-up?
    Full-text · Article · Nov 2015 · Human Reproduction
    • "The absence of pregnancy, or the experience of miscarriage, accounts for many other consequences, including psychological distress (Bak et al., 2012), economic constraints (Wu et al., 2013) and social stigmatization (Slade et al., 2007). Furthermore, infertility and sperm quality have been suggested as being markers of overall male health in addition to lifestyle and/or social factors, and men presenting a low semen volume, low percentage of motile and morphologically normal sperm appear to have higher mortality odds (Jensen et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND Infertility affects between 10 and 16% of couples worldwide. Twenty to 30% of cases of infertility are due to a male factor, 20–35% to a female factor, and 25–40% are due to both male and female factors. In ∼10–25% of cases, the precise underlying cause remains unclear. IVF or ICSI followed by embryo transfer can be very appropriate treatment options in cases of female tubal damage, ovulatory failure or male-factor infertility. While the use of IVF has been reported to be suitable for many infertile couples, normal IVF cycles can fail in some cases. While ICSI can represent a powerful alternative in cases of IVF failure, complete fertilization failure can still occur in 1–5% of ICSI cycles. This can be due to a variety of factors and while commonly attributed to deficiency of sperm factors, it is very likely that abnormalities in crucial oocyte factors could also play a key role.
    No preview · Article · Sep 2015 · Human Reproduction Update
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Infertility is a couple-based fecundity impairment, although population level research is largely based upon information reported by female partners. Of the few studies focusing on male partners, most focus on the utilization of infertility services rather than efforts to estimate the prevalence and determinants of infertility as reported by male partners. Data from a nationally representative sample of men aged 15-44 years who participated in the 2002 National Survey of Family Growth (NSFG) were used to estimate the prevalence of infertility and determinants of longer time-to-pregnancy (TTP) using the novel current duration (CD) approach. Using backward recurrence time parametric survival methods, we estimated infertility prevalence (TTP > 12 months) and time ratios (TR) associated with TTP as derived from males' reported CD of their pregnancy attempt. The estimated prevalence of infertility was 12.0% (95% CI: 7.0, 23.2). Longer TTP was associated with older male age (35-45 vs. 17-24 years) (TR: 2.49; 95% CI: 1.03, 6.03), biological childlessness (TR: 1.53; 95% CI: 1.07, 2.19) and lack of health insurance (TR: 1.73; 95% CI: 1.02, 2.94) after controlling for the differences in couples' age and other socioeconomic factors. The prevalence of infertility based on male reporting is consistent with estimates of infertility in the US found in prospective cohort studies and CD studies based on female reporting. Our findings suggest that male partners can reliably inform about couple infertility. Interventions and services aimed at reducing couple infertility should include attention to male factors associated with longer TTP identified in this study.
    Full-text · Article · Jul 2013 · Andrology
Show more