Prevalence of infertility and help seeking among 15 000 women and men

“Participants were also asked questions that comprise the validated Patient Health Questionnaire-2 (PHQ-2) (Kroenke et al. , 2003), a composite measure of depression experi-encedinthe2weekspriortointerviewandquestionsonsatisfactionwithsex life and relationship in the past year.”

“Infertility is experienced by an estimated 48.5 million couples world-wide (Mascarenhas et al. , 2012) and around 1 in 7 couples in the UK (National Institute for Health and Clinical Excellence, 2013).”

“Infertility is defined by the International Committee for Monitoring Assisted Reproductive Technology (ICMART) and WHO as the ‘failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse’ (Zegers-Hochschild et al. , 2009).”

“Hull et al. (1985) Prevalence of infertility and help seeking estimated it to be around one in six while NICE cites estimates of one in seven (National Institute for Health and Clinical Excellence, 2013).”

“A marked trend for delaying the timing of first birth has been seen in developed and, more recently, developing countries (Gyimah, 2003; Mathews and Hamilton, 2009; Rosero-Bixby et al. , 2009; Mills et al. , 2011).”

“Infertility is associated with psychological distress (Cousineau and Domar, 2007; Greil et al., 2011) and patientsfindtheprocessofundergoinginfertilitytreatmentanditsuncer-tainoutcomestressful(Sbaragli etal.”

“A large body of literature describes the trend among women in developed countries to delay having children (Schmidt et al. , 2012) and it is proposedthatthischangingfertilitytempoisbecomingaglobalphenom-enon (Rosero-Bixby et al. , 2009; Sobotka, 2010).”

“, 2014) and the widening intervals between the key reproductive events of first sex, first cohabitation and first birth (Wellings et al., 2013).”

“A marked trend for delaying the timing of first birth has been seen in developed and, more recently, developing countries (Gyimah, 2003; Mathews and Hamilton, 2009; Rosero-Bixby et al. , 2009; Mills et al. , 2011).”

“However, prevalence estimates of lifetime infertility vary widely, in part because there is no agreed or consistent definition of infertility (Gurunath et al. , 2011)andbecause studypopulations varybyage range,unitofmeasure-ment and relationship status.”

“…that a problem exists (White et al. , 2006), fear of being labelled infertile (BuntingandBoivin,2007),concernsaboutthecostoftreatment (Eisen-berg et al. , 2010), lack of intent to conceive (Greil and McQuillan, 2004) and the physical and psychological burden of treatment (Verberg et al. , 2008).”

“, 2011) and patients find the process of undergoing infertility treatment and its uncertain outcome stressful (Sbaragli et al., 2008; Volgsten et al., 2008; Schmidt et al., 2013).”

“Interventions to encourage help seeking include raising public aware-nessaboutreproductiverisksandstrategiestominimisethem(Macaluso et al. , 2010), generalpractitionerstaking opportunities to discuss fertility with patients (Davies, 2015), greater access to fertility treatments (Bunting and Boivin,…”

“Researchers taking a life course perspective (Morgan and Rackin, 2010; Berrington and Pattaro, 2014) have observed discrepancies between individuals’ fertility intentions and their subsequent family size, highlighting the complex interaction of childhood socialization with personal and structural…”

“Influences on postponement for women include the increase in women’s participation in further education (Andersson et al. , 2008; Nı´ and Beaujouan, 2012) and in career development (Martin, 2000; Morris et al., 2011), the absence of a ‘suitable’ partner (Proudfoot et al. , 2009), partner’s…”

“The experience of infertility can cause those affected personal distress (Schneider and Forthofer, 2005; Greil et al. , 2011), significant treatment costs (Bell, 2010) and, in some contexts, ostracism and discrimination (Cui, 2010).”

“…al. , 2008; Nı´ and Beaujouan, 2012) and in career development (Martin, 2000; Morris et al., 2011), the absence of a ‘suitable’ partner (Proudfoot et al. , 2009), partner’s expectations (Iacovou and Tavares, 2011) and perceptions of how parenthood will reduce individual autonomy (Lief-broer, 2005).”

“…include the increase in women’s participation in further education (Andersson et al. , 2008; Nı´ and Beaujouan, 2012) and in career development (Martin, 2000; Morris et al., 2011), the absence of a ‘suitable’ partner (Proudfoot et al. , 2009), partner’s expectations (Iacovou and Tavares, 2011)…”

“Researchers taking a life course perspective (Morgan and Rackin, 2010; Berrington and Pattaro, 2014) have observed discrepancies between individuals’ fertility intentions and their subsequent family size, highlighting the complex interaction of childhood socialization with personal and structural…”

“Previous researchhasfoundassociationsbetweenundergoingtreatmentforinfer-tility and sexual dissatisfaction, particularly among women (Millheiser et al. , 2012; Wischmann, 2010; Marci et al. , 2012).”

“Earlier estimates of women experiencing infertility range from around 1 in 5 (Bhattacharya et al. , 2009; Cabrera-Leo´n et al. , 2015) to around 1 in 10 (Evers, 2002) with the Na-tionalWomen’sHealthStudyreportingabout1in6(Oakley etal.”

“Previous researchhasfoundassociationsbetweenundergoingtreatmentforinfer-tility and sexual dissatisfaction, particularly among women (Millheiser et al. , 2012; Wischmann, 2010; Marci et al. , 2012).”

“A consequence of postponement of parenthood is the potential for impaired fertility (Balasch, 2010) and the risk that deferral of parent-hood will rule it out (Sobotka, 2006; Leridon, 2008).”

“Studies have found that women in later age cohorts are more likely to seek help than women in earlier ones and that women are seeking help at older ages than was previously the case (Oakley et al. , 2008; Wilkes et al. , 2009).”

“Infertility is associated with psychological distress (Cousineau and Domar, 2007; Greil et al., 2011) and patientsfindtheprocessofundergoinginfertilitytreatmentanditsuncer-tainoutcomestressful(Sbaragli etal.”

“A consequence of postponement of parenthood is the potential for impaired fertility (Balasch, 2010) and the risk that deferral of parent-hood will rule it out (Sobotka, 2006; Leridon, 2008).”

“…et al. , 2010), generalpractitionerstaking opportunities to discuss fertility with patients (Davies, 2015), greater access to fertility treatments (Bunting and Boivin, 2007)and an acknowledgement of the psychosocial impacts of infertility, including the long-term effects, by health practitioners…”

“Studies have found that women in later age cohorts are more likely to seek help than women in earlier ones and that women are seeking help at older ages than was previously the case (Oakley et al. , 2008; Wilkes et al. , 2009).”

“A Danishstudyshowsa relationship betweenunsuccessfulARTandseveredepressivesymptomsayearafter initiating treatment (Lund et al. , 2009) and another, also Danish, found women who did not have a child after fertility treatment were more likely to commit suicide than those who did (Kjaer et al. , 2011).”

“The experience of infertility can cause those affected personal distress (Schneider and Forthofer, 2005; Greil et al. , 2011), significant treatment costs (Bell, 2010) and, in some contexts, ostracism and discrimination (Cui, 2010).”

“…explanations for not seeking (or pursuing) help for infer-tilityhavebeensuggested,including notunderstanding oracknowledging that a problem exists (White et al. , 2006), fear of being labelled infertile (BuntingandBoivin,2007),concernsaboutthecostoftreatment (Eisen-berg et al. , 2010), lack of…”

“…that a problem exists (White et al. , 2006), fear of being labelled infertile (BuntingandBoivin,2007),concernsaboutthecostoftreatment (Eisen-berg et al. , 2010), lack of intent to conceive (Greil and McQuillan, 2004) and the physical and psychological burden of treatment (Verberg et al. , 2008).”

“Previous researchhasfoundassociationsbetweenundergoingtreatmentforinfer-tility and sexual dissatisfaction, particularly among women (Millheiser et al. , 2012; Wischmann, 2010; Marci et al. , 2012).”

“ADanish study shows a relationship between unsuccessful ARTand severe depressive symptoms a year after initiating treatment (Lund et al., 2009) and another, also Danish, found women who did not have a child after fertility treatment were more likely to commit suicide than thosewho did (Kjaer et al.”

“…of women sought medical help for infertility is close to that reported by an international review which estimated that 56% of women in more developed countries sought help (Boivin et al. , 2007), and by a Finnish study (Tera¨va¨ et al. , 2008) which found that 57% of all subfertile women did so.”

“, 2006), fear of being labelled infertile (Bunting and Boivin, 2007), concerns about the cost of treatment (Eisenberg et al., 2010), lack of intent to conceive (Greil and McQuillan, 2004) and the physical and psychological burden of treatment (Verberg et al.”

“A large body of literature describes the trend among women in developed countries to delay having children (Schmidt et al. , 2012) and it is proposedthatthischangingfertilitytempoisbecomingaglobalphenom-enon (Rosero-Bixby et al. , 2009; Sobotka, 2010).”

“…et al. , 2010), generalpractitionerstaking opportunities to discuss fertility with patients (Davies, 2015), greater access to fertility treatments (Bunting and Boivin, 2007)and an acknowledgement of the psychosocial impacts of infertility,…”

“The experience of infertility can cause those affected personal distress (Schneider and Forthofer, 2005; Greil et al. , 2011), significant treatment costs (Bell, 2010) and, in some contexts, ostracism and discrimination (Cui, 2010).”

“A Danishstudyshowsa relationship betweenunsuccessfulARTandseveredepressivesymptomsayearafter initiating treatment (Lund et al. , 2009) and another, also Danish, found women who did not have a child after fertility treatment were more likely to commit suicide than those who did (Kjaer et al. , 2011).”

“Earlier estimates of women experiencing infertility range from around 1 in 5 (Bhattacharya et al. , 2009; Cabrera-Leo´n et al. , 2015) to around 1 in 10 (Evers, 2002) with the Na-tionalWomen’sHealthStudyreportingabout1in6(Oakley etal.”

“A consequence of postponement of parenthood is the potential for impaired fertility (Balasch, 2010) and the risk that deferral of parenthood will rule it out (Sobotka, 2006; Leridon, 2008).”

“…fertility with patients (Davies, 2015), greater access to fertility treatments (Bunting and Boivin, 2007)and an acknowledgement of the psychosocial impacts of infertility, including the long-term effects, by health practitioners and the availability of appropriate support (Hinton et al. , 2012).”

“…the increase in women’s participation in further education (Andersson et al. , 2008; Nı´ and Beaujouan, 2012) and in career development (Martin, 2000; Morris et al., 2011), the absence of a ‘suitable’ partner (Proudfoot et al. , 2009), partner’s expectations (Iacovou and Tavares, 2011) and…”

“,2008;Schmidt et al. , 2013).”

“Another cross-sectional population survey showed that the ageadjusted odds of experiencing infertility were significantly higher among females who first gave birth at age 35 or older compared with those who did so before the age of 25 [9].”

“Current studies of male infertility often employ cross-sectional population study designs (e.g. Datta et al., 2016 above), or are observational studies of those men who present to infertility clinics.”