Hinton, L., Kurinczuk, J. J., & Ziebland, S. (2012). Reassured or fobbed off? Perspectives on infertility consultations in primary care: a qualitative study. The British journal of general practice : the journal of the Royal College of General Practitioners, 62(599), e438-e445. https://doi.org/10.3399/bjgp12X649133
Hinton L, Kurinczuk JJ, Ziebland S. Reassured or fobbed off? Perspectives on infertility consultations in primary care: a qualitative study. Br J Gen Pract. 2012;62(599):e438-e445. doi:10.3399/bjgp12X649133
Hinton, L., et al. "Reassured or fobbed off? Perspectives on infertility consultations in primary care: a qualitative study." The British journal of general practice : the journal of the Royal College of General Practitioners, vol. 62, no. 599, 2012, pp. e438-e445.
Infertility affects 9% of couples in the UK. Most couples who visit their GP because they are worried about their fertility will ultimately conceive, but a few will not. Treatment usually happens in secondary care, but GPs can have an invaluable role in starting investigations, referring, and giving support throughout treatment and beyond.
Aim
To inform clinical practice by exploring primary care experiences of infertility treatment among females and males, and discussing findings with a reference group of GPs to explore practice experience.
Design and Setting
A qualitative patient interview and GP focus group study. Interviews were conducted in patients homes in England and Scotland; the focus group was held at a national conference.
Method
An in-depth interview study was conducted with 27 females and 11 males. A maximum variation sample was sought and interviews were transcribed for thematic analysis. Results were discussed with a focus group of GPs to elicit their views.
Results
Feeling that they were being taken seriously was very important to patients. Some felt that their concerns were not taken seriously, or that their GP did not appear to be well informed about infertility. The focus group of GPs highlighted the role of protocols in their management of patients who are infertile, as well as the difficulty GPs faced in communicating both reassurance and engagement.
Conclusion
Simple things that GPs say and do, such as describing the 'action plan' at the first consultation, could make a real difference to demonstrating that they are taking the fertility problem seriously.
It is not known whether infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have a higher risk of birth defects than infants conceived naturally. We obtained data from three registries in Western Australia on births, births after assisted conception, and major birth defects in infants born between 1993 and 1997. We assessed the prevalence of major birth defects diagnosed by one year of age in infants conceived naturally or with use of intracytoplasmic sperm injection or in vitro fertilization. Twenty-six of the 301 infants conceived with intracytoplasmic sperm injection (8.6 percent) and 75 of the 837 infants conceived with in vitro fertilization (9.0 percent) had a major birth defect diagnosed by one year of age, as compared with 168 of the 4000 naturally conceived infants (4.2 percent; P<0.001 for the comparison between either type of technology and natural conception). As compared with natural conception, the odds ratio for a major birth defect by one year of age, after adjustment for maternal age and parity, the sex of the infant, and correlation between siblings, was 2.0 (95 percent confidence interval, 1.3 to 3.2) with intracytoplasmic sperm injection, and 2.0 (95 percent confidence interval, 1.5 to 2.9) with in vitro fertilization. Infants conceived with use of assisted reproductive technology were more likely than naturally conceived infants to have multiple major defects and to have chromosomal and musculoskeletal defects. Infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have twice as high a risk of a major birth defect as naturally conceived infants.
Related research
Infertility Distress · Anxiety and Depression in Infertility
The care of infertility patients offers providers the unique opportunity to optimize health in the preconception phase. Assisting women to preemptively achieve a healthier lifestyle may not only improve fertility and pregnancy outcomes, but also diminish the psychological burden of infertility. The study sought to characterize modifiable lifestyle factors within an infertility population and address patient needs for lifestyle-based counseling before and after initial reproductive care consultation. Survey Patients presenting for an initial infertility consultation responded to a 26-item survey regarding clinical demographics, prior medical care, complementary medicine use, and perception of lifestyle habits and fertility prior to their visit. A follow-up 11-item survey was administered to determine the impact of the initial consultation. Questions were both structured and open-ended. Chi-squared, Spearman’s correlation, Mann Whitney U, Wilcoxon signed rank and McNemar’s tests were used for analysis. A total of 108 women (35.3 4.67 y) completed the preconsultation survey from 2016-2017; 26 women completed the follow-up questionnaire. Almost half (49.1%) were trying to conceive (TTC) for ≥12 months, with 14% trying for ≥2 years. Time TTC had a strong positive correlation with stress (r=0.48, p< .001) and a negative correlation with feeling control over fertility (r=-.21, p= .03). A longer time TTC correlated with greater likelihood of changing one’s lifestyle to be more fertility friendly (r= .26, p= .006), but those who made lifestyle adjustments also experienced more stress (p< .001). Participants who were up-to-date on their primary medical and dental care felt a greater sense of control (general practitioner: p= .01, dentist: p= .02) and less stress (dentist: p= .005) over their fertility. BMI had a negative correlation with interest in counseling on lifestyle (r= .2, p= .04). Women with a higher BMI were interested in weight management guidance (p= .005), but not in diet or physical activity counseling. Most respondents were interested in guidance on diet (88%), physical activity (84.3%) and mental health (75.9%), and 46% of women still desired direction on these factors after the initial visit. Prior to initial consultation, infertility patients may experience high levels of stress and feelings of uncertainty. A greater emotional burden is often encountered among women who spend a longer time TTC. Women may feel empowered if providers encourage them to engage with their primary care team earlier and offer methods to optimize their overall health and wellness. These interventions may help to alleviate anxiety and promote women’s sense of control during their infertility treatments. Fertility centers should consider the development of a mind-body program to optimize preconception health and enhance quality of life for women seeking fertility care.
Infertility Distress · Anxiety and Depression in Infertility
By identifying psychological concerns early in the infertility treatment process, patients can be referred for behavioral health interventions rather than allowing conditions to emerge, worsen, or further impact their health. The aim of this study was to assess the psychological impact of infertility over time for men and women. Longitudinal prospective cohort study. Couples and individuals with a reproductive specialist consultation were recruited to complete two questionnaires: prior to initial consultation and at 12 months. PROMIS Anxiety and Depression 4-item short forms and Fertility Quality of Life (FertiQoL) were administered at both time points. We analyzed the relationships between FertiQoL, Anxiety, and Depression at 12 months, fertility-related events and outcomes (infertility diagnoses, medical treatments for infertility, pregnancy/parenting status), and sociodemographic characteristics (gender, age, race, education, relationship satisfaction) using hierarchical linear modeling to account for nonindependence of the participants who were part of a couple. We considered a two-tailed alpha level of 0.05 to be significant. A total of 88 women and 63 men provided data at both time points; mean age 34 years. At baseline, mean (SD) anxiety scores were 50.6 (8) for women, 48.4 (8) for men; depression scores were 46.8 (6) for women and 44.9 (4) for men. Baseline FertiQoL scores were 68.9 (15) for women and 79.8 (12) for men. By 12 months, 54% of participants were pregnant or parenting a child (birth or adoption/fostering). Those who were pregnant/parenting by 12 months reported significantly better FertiQoL scores and had lower depression at 12 months. Higher anxiety at 12 months was related to baseline anxiety and lower relationship satisfaction. Likewise, higher depression at 12 months was related to baseline depression and lower relationship satisfaction. Neither infertility diagnoses (male-factor, femalefactor, or unexplained) nor invasive medical treatments (IUI or IVF) were related to anxiety, depression, or FertiQoL scores at 12 months. Baseline psychological status is predictive of subsequent anxiety and depression during ongoing infertility treatment, with scores worsening over time. It is imperative that early identification of needs and provision of treatment resources be provided to patients. Embedding behavioral health services within the clinic promotes ease of access to care and reduces stigma of seeking treatment. After this research was conducted, the addition of a clinical health psychologist in the clinic has afforded opportunities to implement screening measures and promote early intervention.
Bernot G et al., 2025·European Journal of Obstetrics & Gynecology and Reproductive Biology
Fertility treatment pathways are complex and lengthy. The current prevalence of infertility makes it a public health issue. The involvement of general practitioners and the training of fertility instructors to provide therapeutic education have been suggested as ways of involving patients in the process and improving the therapeutic trajectory of these patients, who often have co-morbidities. To describe the activity of trained fertility instructors; to assess the interest of doctors in the fertility chart provided by women; and to describe the outcomes of their fertility care pathway. 66 French fertility instructors were interviewed in June 2024. The 15 general practitioners who had received additional training were also interviewed. The records of all couples who received fertility counselling and treatment between 1 January 2022 and 31 December 2023, the study cut-off date, were analysed. Doctors declared that the women had gained a clear understanding of their menstrual cycle, which was useful for diagnosis and treatment follow-up. The chart was particularly useful for diagnosing the causes of infertility and identifying when in the cycle to take medication. Only 4 of the 551 women were lost to follow-up. Of the remaining 547 women, 204 (37%) became pregnant. Of these, 75% had a live birth or an ongoing pregnancy at study cut-off. The involvement of fertility instructors and general practitioners improved the couple s ability to interact with doctors and to adhere to infertility treatment. The fertility chart provided by the women proved to be useful in the diagnosis and treatment process.
Boltz MW et al., 2017·J Am Board Fam Med·Free full text on PubMed Central
To explore the relationship between the type of clinician (generalist vs subspecialist) initially seen by infertile women, the treatment received, and the time to pregnancy. We analyzed mixed-mode questionnaire data from 867 women with primary infertility enrolled into a retrospective cohort through population- and fertility clinic-based sampling. We compared women presenting first to generalist providers with women presenting first to fertility subspecialists, with the main outcomes of receiving in vitro fertilization (IVF), time to pregnancy, and live birth. The first contact for most (84%) women with infertility was a generalist provider. Only 8% of women sought care first from a fertility subspecialist, and these women were older and had been trying longer to conceive. Women who presented first to a generalist provider were less likely to receive IVF (adjusted odds ratio, 0.48; 95% confidence interval, 0.28-0.82), were equally likely to achieve pregnancy, and had similar times to pregnancy (adjusted hazard ratio, 1.11; 95% confidence interval, 0.80-1.53) compared with women who presented first to a subspecialist. Generalist providers are frequently the first point of care for women with difficulty conceiving and are uniquely positioned to promote the balanced management of infertility.
Mental Health and Psychosocial Care › Psychosocial Support › Counseling and Therapy
Lisa Hinton, Sue Ziebland, Jenny J Kurinczuk
L Hinton, Susan Ziebland, S Ziebland, Jennifer Kurinczuk, J Kurinczuk
PMID 22687237 22687237 DOI 10.3399/bjgp12X649133 10.3399/bjgp12X649133 Hinton et al. 2012, Hinton 2012
Cite this article
Hinton, L., Kurinczuk, J. J., & Ziebland, S. (2012). Reassured or fobbed off? Perspectives on infertility consultations in primary care: a qualitative study. The British journal of general practice : the journal of the Royal College of General Practitioners, 62(599), e438-e445. https://doi.org/10.3399/bjgp12X649133
Hinton L, Kurinczuk JJ, Ziebland S. Reassured or fobbed off? Perspectives on infertility consultations in primary care: a qualitative study. Br J Gen Pract. 2012;62(599):e438-e445. doi:10.3399/bjgp12X649133
Hinton, L., et al. "Reassured or fobbed off? Perspectives on infertility consultations in primary care: a qualitative study." The British journal of general practice : the journal of the Royal College of General Practitioners, vol. 62, no. 599, 2012, pp. e438-e445.
