Many couples experience fertility problems while trying to start or extend a family. Especially the postponement of births leads to an increased demand for medical help. A large body of research now exists on the determinants of medical help-seeking for infertility. However, the driving factors are still not very well understood.
In their literature review, Jasmin Passet-Wittig (German Federal Institute for Population Research) and Arthur L. Greil (Alfred University) provide a comprehensive review of 39 studies from 11 developed countries, discuss their conceptual and methodological problems and suggest avenues for further research.
They identify five categories of determinants of help-seeking for infertility: socio-demographic variables, socio-economic factors, reproductive history, attitudes and psychological factors. Most knowledge exists on socio-demographic characteristics such as age and race/ethnicity and on socio-economic factors such as income, socio-economic status and health insurance. Fertility treatments are costly and research points to the existence of inequality in access – even in Europe – because treatments are not always (fully) covered by health insurance. There is also preliminary evidence that personal values and attitudes and psychological factors are important for understanding the help-seeking process. Most of the existing findings, however, are based on only two US surveys.
Existing studies have several conceptual and methodological problems. Overall, the interdisciplinary body of research is heterogeneous and fragmented. Findings from different studies are difficult to compare because of differing research designs and methods of analysis. Importantly, the central concepts ‘infertility’ and ‘help-seeking’ are not clearly defined. The authors suggest treating infertility help-seeking as a process and to look at its different stages from talking to a doctor to undergoing IVF treatment. They express a need for multi-country studies to gain a systematic understanding of how legislation, culture and the structure of the health care system relate to individual decisions about medical help-seeking.
From a practical perspective, better knowledge on the use of medically assisted reproduction (MAR) is crucial for health care providers as they try to reduce barriers in access and for designing policies to avoid social inequality in access. Moreover, knowing who seeks treatment can deepen the understanding of fertility researchers interested in (unintentional) childlessness and the contribution of MAR to completed fertility.