New Publications | 11.05.2021Why Do Infertile Couples (Not) Make Use of Reproductive Medicine?

Source: © Flora Panzner / Adobe Stock

Not all couples with fertility problems seek medical help. Studies which report on the proportion of users now exist for many countries. However, these studies are beset with many conceptual and methodological problems, which is why no figures are reported here. Studies that view the use of medical support as a process show that many persons in this situation consult a doctor, but only few actually undergo reproductive medical treatment.

Why couples do or do not make use of medical fertility support has not yet been clearly explained. At the same time, there has recently been a rise in the number of quantitative studies on the determinants of those seeking medical help. The following is a report on the article, which for the first time summarises findings from these studies and takes a critical look at content-related and methodological problems. It analyses 39 studies from 11 countries in the period from 1990 to 2019. A further objective is to provide a comprehensive overview of the state of research and to ascertain what is already known.

Heterogeneous Research Landscape

The research field is, by its nature, interdisciplinary. The studies examined were gathered from different research areas such as sociology, psychology, social epidemiology and public health. However, the research interests, methodological strategies and theoretical approaches vary depending on the discipline, ultimately resulting in a heterogeneous and fragmented research landscape. Most of the studies considered here have no theoretical underpinning, which makes comparison difficult. Moreover, most research only looks at women, so little is known about men and couples.

Principal Focus on Economic Factors

Evaluation of the studies revealed five categories of factors which influence the uptake of medical support: Socio-demographic variables (such as age, ethnic origin or migration background), socio-economic factors (including income, health insurance or level of education), reproductive history (existing children or previous illnesses, for example), personal attitudes (such as on the desire to have children or on reproductive medicine) and psychological factors (such as stress or depression).

The evaluations reveal that a large number of the studies deal with socio-economic factors. The reason for this is believed to lie in the fact that fertility treatment is usually expensive and is only covered partially, or not at all, by health insurance.

Interaction of Multiple Factors in Search for Answers

Only few studies exist on personal attitudes and psychological factors. However, these studies reveal that factors such as religious beliefs, the importance of parenthood or attitudes towards treatment play an important role in understanding the decision to seek medical help, especially the different stages from the first consultation to actually receiving the medical treatment.

The existing research shows that the interplay of economic, social and cultural factors and different attitudes is of great importance in understanding who continues treatment to the end and who does not. Therefore, multivariate studies are needed in which the model is developed with theoretical underpinning and the national context (legislation, culture, structure of the health system) is taken into account. In the future, more cross-national and cross-gender comparisons will be needed in particular. Furthermore, the use of medical assistance should be understood as a process that begins with consultations with doctors and initial examinations, and that leads only in a few cases to the actual use of reproductive treatment such as in vitro fertilisation.

1. Passet-Wittig, Jasmin; Greil, Arthur L. (2021): Factors associated with medical help-seeking for infertility in developed countries: A narrative review of recent literature. Social Science & Medicine 277(113782).

2. Passet-Wittig, Jasmin; Greil, Arthur L. (2021): On estimating the prevalence of use of medically assisted reproduction in developed countries: A critical review of recent literature. Human Reproduction Open 1: 1–18.