I wish I had known sooner: stratified reproduction as a consequence of disparities in infertility awareness, diagnosis, and management

Abstract

ABSTRACT Infertility affects one in eight couples in the US, yet many couples report feeling blindsided by the diagnosis. Lack of awareness about infertility can lead to missed opportunities for prevention, delays in diagnosis, and greater emotional distress when a diagnosis is made. This paper reports on the results of interviews with 54 American women experiencing infertility, conducted via phone between 2013 and 2015 with participants from across the country. The interviews explored whether differences in infertility awareness were related to patient trajectories for time to diagnosis and initiation of treatment. Interview data indicated a significant lack of informational resources for these women concerned about fertility. Older participants expressed regret that they were not educated about age-related fertility decline, while patients with infertility secondary to medical conditions often reported delays in diagnosis and lack of counseling about fertility implications. Participants’ data also revealed that infertility was consistently absent from sex education curricula and that minorities may be more likely to experience delayed diagnosis of infertility and lack of appropriate fertility counseling. These findings suggest that the inequitable distribution of health information and education about reproduction is one mechanism by which experiences of infertility can become racially stratified.