Medically Defined Infertility Versus Self-Perceived Fertility Problem: Implications of Survey Wording for Assessing Associations with Depressive Symptoms

Abstract

Objective: To examine how measures of infertility based on medical criteria and based on self-perception relate to depressive symptoms among women with infertility. Background: Survey-based studies of depressive symptoms have used either measures of self-reported infertility based on meeting medical criteria or measures of self-perceived fertility problems, but seldom both. It is, therefore, not known which type of measure is more closely associated with depressive symptoms. Materials and Methods: Using ordinary least-squares multiple regression, this study compares associations between a measure of meeting medical criteria for infertility and a measure of self-perceived fertility problems with a common measure of depressive symptoms. Data come from the National Survey of Fertility Barriers, a population-based survey of 4,711 U.S. women. Results: Both meeting medical criteria for infertility and self-perception were associated with depressive symptoms after controlling for a number of relevant variables, but the coefficient for the self-perception measure was slightly higher than the coefficient for medical criteria. Conclusion: If possible, both medical criteria and self-perception measures should be used in studies of the consequences of infertility for psychosocial outcomes. If only one measure can be used, self-perception of a fertility problem is an acceptable measure.

Self-Perceived Infertility is Not Always Associated with Having Fewer Children: Evidence from German Panel Data

“…Even though measures of self-perceived infertility do not perfectly map on to measures of medically defined infertility, the use of measures of self-perception as the sole measure of infertility is a common practice in survey research (Lazzari et al, 2022 ; Passet-Wittig et al, 2020 ). In a study using the NSFB, which includes measures of both self-perceived infertility and medically defined infertility, Lowry et al ( 2020 ) found that 67% of the women responded consistently regardless of the measure used. Among those who did not give consistent responses, the vast majority (75%) met criteria but did not self-identify as infertile.…”

“…In the case of women without children (zero-parity), those aged 15–24 are most likely to have higher rates of self-perceived compared to medically defined infertility (Chandra et al, 2014 ). Lowry et al ( 2020 ) showed that self-perceived infertility explains more of the variance in depressive symptoms than medically defined infertility. Thus, for studies primarily seeking to understand the lived experience and consequences of infertility, it is generally reasonable to rely upon survey questions that indicate whether people perceive themselves to be infertile (Lowry et al, 2020 ; McQuillan et al, 2022 ).…”

Is perceived inability to procreate associated with life satisfaction? Evidence from a German panel study

“…According to medical criteria, infertility is defined as the failure to become pregnant within 1 year of regular intercourse without contraception ( Zegers-Hochschild et al, 2017 ). Perceived inability to procreate provides a subjective proxy for infertility that is useful in population-based surveys ( Lowry et al, 2020 ). People can perceive barriers to procreation even if they do not meet medical criteria for infertility, and they can meet medical criteria without perceiving a problem ( Chandra et al, 2013 ).…”

“…Studying only those individuals with a formal diagnosis of infertility limits the analyses to those who medicalize fertility barriers, but people vary in the extent to which they consider an inability to procreate to be a medical problem ( Bell, 2016 ). Therefore, using a subjective measure of infertility works as well or better than using a measure using medical criteria alone ( Lowry et al, 2020 ).…”

“…Perceived inability to procreate provides a subjective proxy for infertility that is useful in population-based surveys (Lowry et al, 2020). People can perceive barriers to procreation even if they do not meet medical criteria for infertility, and they can meet medical criteria without perceiving a problem (Chandra et al, 2013).…”