When do involuntarily infertile couples choose to seek medical help?
Received 24 September 2007; received in revised form 3 October 2008; accepted 3 October 2008. published online 19 November 2008.
Objective
To estimate the probability of medical consultation for infertility during the course of a pregnancy attempt and to study its determinants.
Design
Pregnancy-based retrospective telephone survey analyzed with a discrete time Cox model.
Setting
Two rural counties in Brittany and Normandy, France.
Patient(s)
A random sample of 901 women from the general population aged 18–60 years reporting 1,460 pregnancy attempts resulting in a live birth between 1985 and 2000 (participation rate, 73%).
Intervention(s)
None.
Main Outcome Measure(s)
Probability of medical consultation for involuntary infertility cumulated over time.
Result(s)
The cumulative probability of medical consultation for involuntary infertility among nulligravid women was 45% after 12 months of involuntary infertility and 75% after 24 months. The probability of medical consultation at any time was half that for parous women (odds ratio 0.4, 95% confidence interval 0.2–0.6). More highly educated women were more likely to have sought medical help for infertility. Only 45% of women who had sought medical advice received infertility treatment.
Conclusion(s)
Our survival approach provides a description of infertility service use during the course of a pregnancy attempt, and confirms that parity and educational level are strong predictors of medical help-seeking behaviors.
aInserm, Institut National de la Santé et de la Recherche Médicale, Unit 822, “Epidemiology, Demography, and Social Sciences,” Le Kremlin-Bicêtre, France
bOffice of Population Research, Princeton University, Wallace Hall Princeton, Princeton, New Jersey
cUniversity Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
dINED, Institut National d'Etudes Démographiques, Paris, France
eGSF-National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany
fInserm, Institut National de la Santé et de la Recherche Médicale, U823 Institut Albert Bonniot, Avenir Team “Environmental Epidemiology Applied to Fecundity and Reproduction,” Grenoble, La Tronche, France
Reprint requests: Caroline Moreau, Ph.D., Inserm, Institut National de la Santé et de la Recherche Médicale, Unit 822, 82 rue du Général Leclerc, 94216 Le Kremlin-Bicêtre, France (FAX: +33(0) 1 45 21 20 75).
C.M. has nothing to disclose. J.B. has nothing to disclose. B.D. has nothing to disclose. A.S. has nothing to disclose. R.S. has nothing to disclose.
Funded by the French Ministry of Health (Direction Générale de la Santé). Caroline Moreau gratefully acknowledges the financial support of NICHD and the Philippe foundation during the research and writing of this article.
ABSTRACT