Time costs of fertility care: the hidden hardship of building a family

Abstract

OBJECTIVE: To determine the time costs of seeking and utilizing fertility care among infertile couples.DESIGN: Prospective cohort.MATERIALS AND METHODS: Fertility outcomes and key demographic and medical data were determined through interviews and medical record abstraction. The infertility cohort was assembled from 8 community and academic reproductive endocrinology clinics. Interviews were conducted at enrollment, and at 4, 10, and 18 months. Monthly cost diaries were completed by study participants. Participants recorded in their diaries time spent on provider visits, travel, telephone, and “other” (e.g. lab testing, support groups, internet research, picking up medications). Participants also recorded paid time off of work due to the effects or side effects of fertility tests or treatment, or to being upset or distressed about their fertility problems or experiences.RESULTS: Diaries were completed by 361 subjects. The mean time spent on visits, travel, telephone, and “other” was 153 hours (Range 0-203). Assuming an 8 hour work day, an average of 19.1 days was spent on these activities. The greatest amount of time was spent on provider visits (mean 62.5 hours), “other” (mean 39.3 hours), travel (mean 38.6 hours), and phone calls (mean 12.3 hours). The total time expenditure was significantly greater for IVF (176.5 hours) compared to IUI (148.0 hours) and no cycle-based treatment (102.5 hours). The mean paid time off of work for at least one member of the couple due to fertility treatment or treatment-related distress was 16.6 days and 6.6 days, respectively.CONCLUSION: Over the course of an 18-month period, couples pursuing fertility treatment devoted nearly 3 work-weeks to fertility diagnostic evaluations, provider visits, and other fertility related activities. The time spent pursuing fertility care and time off work adds to the already significant financial and emotional burdens of fertility treatment. OBJECTIVE: To determine the time costs of seeking and utilizing fertility care among infertile couples. DESIGN: Prospective cohort. MATERIALS AND METHODS: Fertility outcomes and key demographic and medical data were determined through interviews and medical record abstraction. The infertility cohort was assembled from 8 community and academic reproductive endocrinology clinics. Interviews were conducted at enrollment, and at 4, 10, and 18 months. Monthly cost diaries were completed by study participants. Participants recorded in their diaries time spent on provider visits, travel, telephone, and “other” (e.g. lab testing, support groups, internet research, picking up medications). Participants also recorded paid time off of work due to the effects or side effects of fertility tests or treatment, or to being upset or distressed about their fertility problems or experiences. RESULTS: Diaries were completed by 361 subjects. The mean time spent on visits, travel, telephone, and “other” was 153 hours (Range 0-203). Assuming an 8 hour work day, an average of 19.1 days was spent on these activities. The greatest amount of time was spent on provider visits (mean 62.5 hours), “other” (mean 39.3 hours), travel (mean 38.6 hours), and phone calls (mean 12.3 hours). The total time expenditure was significantly greater for IVF (176.5 hours) compared to IUI (148.0 hours) and no cycle-based treatment (102.5 hours). The mean paid time off of work for at least one member of the couple due to fertility treatment or treatment-related distress was 16.6 days and 6.6 days, respectively. CONCLUSION: Over the course of an 18-month period, couples pursuing fertility treatment devoted nearly 3 work-weeks to fertility diagnostic evaluations, provider visits, and other fertility related activities. The time spent pursuing fertility care and time off work adds to the already significant financial and emotional burdens of fertility treatment.