Demographic and Lifestyle Factors Influence Who Receives a Medical Evaluation for Infertility and Who Does Not

Boston researchers conducting a prospective cohort study found that women who already had children, who were older, current smokers, or had a higher BMI were less likely to report having a medical evaluation for infertility than younger, slimmer, non-smoking, childless women.

Using data from the Nurses’ Health Study II, researchers at Harvard’s TH Chan School of Public Health and Brigham and Women’s Hospital identified a number of demographic and lifestyle factors associated with whether or not a particular woman having trouble conceiving receives a medical evaluation for infertility or not.

The Nurses’ Health Study II began in 1989 with 116,430 female registered nurses between the ages of 25 and 42 returning a mailed questionnaire on their health and lifestyles.  Every two years, they answer a follow-up questionnaire, with about 92% of the original group continuing to participate. On each questionnaire from 1989 to 2001, and then again in 2005 and 2009, the were asked “if they had tried to become pregnant for more than one year without success.” Then, they were asked the cause of their infertility. The questionnaire permitted them to choose from several different diagnoses, report multiple diagnoses or that the cause of their infertility was not found, or report that that the cause of their infertility was not investigated.

The subjects of this study were the 7,422 women who reported experiencing infertility after the first questionnaire cycle. Women were eligible to enter this analysis until menopause. About 65% of the women reporting infertility also reported having had a medical evaluation for infertility.

Certain indicators of better access to health care were significantly predictive of whether or not a woman would have had a medical evaluation for her infertility. Women who lived in states with comprehensive insurance coverage, had a high household income, or had a recent physical exam were all more likely to report receiving an infertility evaluation.

In addition, demographic characteristics influenced the likelihood of a woman receiving an infertility evaluation.  Older women and women who had already had children were less likely to have an infertility evaluation, while women whose husbands had a graduate level education were more likely to be evaluated.

Lifestyle choices also played a part. Women who exercised frequently, took multivitamins, and who had never smoked were more likely to have had a medical evaluation for their infertility.

Owen Davis, MD, President of ASRM commented, “This study shows that even within a group whose members have a high degree of medical knowledge and a professional connection to the medical system, there are a host of subtle factors that influence who receives a medical evaluation for infertility and who does not.  No doubt there is a degree of self-selection at work; individuals’ temperaments and personal health philosophies, as well as their economic and family situations, affect their decision to seek fertility care and whether or not they receive it.  Women who practice a healthy lifestyle, in addition to those women who have more comprehensive insurance or better financial resources, may be more likely to pursue an infertility diagnosis. As practitioners, we can try to recognize the potential personal, individual barriers patients face to seeking fertility care and work to create a treatment environment where they see more options beyond the barriers.”