Multidimensional barriers and facilitators to treatment seeking for infertility among women in the United States: a systematic review

Objective

To provide a comprehensive review of the literature that examines facilitators and barriers to infertility treatment seeking among women who experience infertility in the United States.

Evidence Review

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and has a registered protocol. Studies were included if they reported factors specifically influencing treatment-seeking patterns of women for infertility as defined above. The search was conducted in January 2020 in 4 databases and updated in February 2021. We used a combination of free texts, index, and truncated terms. The following terms and concepts were used: infertility [or] subfertility, woman [or] women [or] female, patient acceptance of health care [or] help-seeking [or] health-seeking behaviors [or] treatment seeking. The search terms were purposely used to include variations of terms that were synonymous with treatment seeking. Included studies must have been original research studies written in English that explicitly discussed the relationship of variables that influenced treatment seeking among women in the United States. Quality assessment was conducted using the critical appraisal tool from the Joana Briggs Institute.

Results

The final sample included a total of 23 articles (6 qualitative, 17 quantitative) that examined facilitators and barriers that influenced treatment seeking among women who experienced infertility in the United States. These articles were synthesized using the health-seeking model developed by Chrisman. Findings suggest there are multifactorial facilitators and barriers that influence treatment seeking. Common facilitators to treatment seeking were high desire for parenthood, especially when their partners also agreed; high social support encouraging treatment; and advanced health literacy. Common barriers to treatment seeking were internalized stigma, having access limited by professional careers, low or no social support supporting treatment seeking, and negative perceptions of the clinical environment.

Conclusion

Overall, many of the facilitators and barriers found were a dynamic blend of perceptions of the biologic, clinical, and social implications of disease and treatment access. Many of these facilitators and barriers were influenced by social cues and perceived access to care. More research is needed to further elucidate variations in treatment seeking among diverse samples of racial and ethnic, gender, and sexual minority groups.