Are prior pregnancy outcomes relevant for models of fertility-specific distress or infertility helpseeking?

Abstract

Women with prior pregnancy but no live birth are inconsistently termed as either 'primary infertile' or 'secondary infertile' in psychosocial studies of infertile women. The goal of this study was to discover whether infertile women who had experienced pregnancies but no live births were more similar in attitudes and behavior to infertile women who had not experienced pregnancies or to those who had live births. We used the National Survey of Fertility Barriers (NSFB), which contains self-reported data from a probability-based sample of US women aged between 25 and 45, to accomplish our goal. In this cross-sectional analysis, infertile women who had not experienced pregnancies were compared on the basis of fertilityspecific distress (FSD) and medical help-seeking for infertility to women who had had pregnancies with live births and women with pregnancies but no live births. Women were interviewed by telephone in their homes. Data of 1,027 women who had had an infertility episode within the past 10 years were analyzed using multiple regression and logistic regression. Infertile women who had never been pregnant experience higher levels of FSD and were more likely to seek treatment than infertile women who had been pregnant, regardless of the outcome of the pregnancy.

Fertility and Infertility: Toward an Integrative Research Agenda

“…Thus, much of this work emanated from a more interpretivist social science tradition, drawing on primarily qualitative methods of inquiry. Exceptions here include quantitative analyses of incidence/prevalence and unmet need for treatment (Frank 1983;Larsen 1994;Morgan 1991;Boivin et al 2007), as well as a series of more recent studies documenting perception of infertility as a problem (Greil et al , 2011(Greil et al , 2016; Johnson and Fledderjohann 2012) and patterns of medical help-seeking (Greil and McQuillan 2004;Stephen and Chandra 2000;White et al 2006). Even though fertility and infertility research tend to use different methods and epistemologies, both are incorporating new approaches over time.…”

“…The subjective definition emphasizes individual perception of having a fertility problem, regardless of medical indication. Research indicates some disconnection between definitions: some women self-identify without meeting medical criteria, while others meet the criteria but do not perceive it as a problem (Greil et al 2011;Leyser-Whalen et al 2018;White et al 2006). Women may also "anticipate" future infertility because they expect to not meet reproductive goals due to career or educational demands (Martin 2010) or consider themselves to have "reproductive failure" because they have not yet met overall fertility goals (Sundby 2002).…”

“…2001) having wanted children" (Johnson et al 2014) Sterility childless due to inability to conceive (e.g., Leridon 2008;Preston et al 2001) but still allows for comparisons among subgroups (e.g., unable to conceive due to social reasons such as lack of heterosexual partner versus unable to conceive because of a biomedical problem). Greil et al ( , 2011 also use the term "infertility episode" to emphasize the fact that (medically defined) infertility may not be a permanent condition. Infertility may continue over months or years, but also be woven among other reproductive states or events such as pregnancy, miscarriage, abortion, or live birth, thus having an episodic quality in contrast to being a permanent state.…”

“…By "fertility," we refer to "the incremental processes by which living members of a population produce live births" (Preston et al 2001, p. 92). By "infertility," we refer to both the dominant Western biomedical definition-no conception within 12 months of having unprotected, heterosexual sex (ASRM 2008)-as well as subjective definitions, which include a sense of self as having a fertility problem, whether or not one has a medical condition, or not reaching fertility expectations for (additional) children because of biological or social barriers (Greil et al 2011;Johnson et al 2014;Leyser-Whalen et al 2018;Sundby 2002).…”

Ethical and Psychosocial Impact of Female Infertility

“…Although pregnancy loss is devastating, this study shows no significant differences of infertility-specific distress between women who had not had a live birth and women who had live births. The authors in this study suggest that the psychosocial primary/secondary infertility distinction is based on conception, rather than birth [19]. …”