Knowledge, attitudes, and perceptions of infertility: a national survey

Abstract

The negative psychosocial impact from infertility on patients and couples is well-established; however, little is known about the general public’s knowledge and perception of infertility. The purpose of this study was to assess the knowledge and attitudes of the general U.S. population regarding the causes, prevalence, and emotional effect of infertility, and to investigate the relationships between prior infertility history, obstetric history, birth control use, and race on these beliefs. Internet survey. A 46-question survey was developed by the authors in Qualtrics. One-thousand respondents were recruited for a small monetary incentive to complete the survey via Amazon’s Mechanical Turk (MTurk) in February 2018. Individuals were eligible if they were American residents and aged 18 to 69 years at the time of the survey. Responses were analyzed with Chi-squared test, Fisher exact test, and logistic regression where appropriate, using SAS software, Version 9.4. Nine-hundred ninety-three (99.3%) respondents completed the survey. Respondents predominantly identified as non-Hispanic White (79%), followed by Black or African American (7.8%), Hispanic White (6.8%), and Asian (6.6%). 73% of respondents were between age 21 and 40 years. 68% of the respondents were female, and of those, 67% had previously been pregnant, 44% had experienced a miscarriage, and 19% had a history of pregnancy termination. 24% of respondents reported that they and/or their partner had a history of infertility. 53% of respondents believed more than 20% of individuals will experience infertility in their lifetime, with individuals with a history infertility estimating a higher incidence of infertility in the population than those without that history (OR 2.0, 95% CI 1.5-2.7). The majority of respondents feel that infertility treatment should be covered by insurance (70%) and that women undergoing fertility treatment should have paid time off to for those appointments (54%). Commonly believed causes of infertility included past use of birth control pills (48%), alcohol and/or drug use (75%), having had an abortion (45%), and prior use of an intrauterine device (48%). 45% of respondents felt that race had an effect on fertility. Respondents were more likely to identify their own race as having the highest rate of infertility (OR 8.0, 95% CI 4.9-12.8) and to identify a different race as having the lowest rate of infertility (OR 0.5, 95% CI 0.3-0.8). Among a national sample of adults in the United States, knowledge and perceptions about the causes and incidence of infertility vary. Misperceptions about the causes of infertility are common, and this diminished health literacy may predispose individuals to inequity in access to fertility care. Providers may benefit from learning of these common misperceptions and the associated risk factors in order to tailor patient education and community outreach programs to improve health literacy, eliminate misperceptions around the diagnosis of infertility, and improve access to care.