Optimizing utilization of emotional support during infertility treatment

The psychological distress of infertility influences decision-making and treatment discontinuation. Yet, only 10-34% of patients with infertility pursue counseling. Historically, barriers included logistics of scheduling appointments and sufficient coping resources. The objective of this study was to identify barriers to counseling for women with infertility in a clinic with embedded psychological support; and determine if those barriers were dependent upon screening scores for anxiety or depression. Cross sectional retrospective chart review. Female patients presenting for initial infertility consultation were screened for anxiety and depression with the Generalized Anxiety Disorder-7 Item Scale (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) as standard of care. Subjects were recruited at follow up appointments at least 3 months after initial consultation. An 11-item survey designed to assess barriers, needs, and desires for psychological treatment was administered. Demographic data and medical history were obtained via chart review. The survey results were analyzed as a population and divided into 2 groups: those with a positive screen for anxiety or depression (score ≥5 on either scale) and those with a negative screen. Non-parametric Mann-Whitney test was used for continuous variables (reported as median and inter-quartile range) and the Fisher’s Exact test was used for categorical variables. A p-value of < 0.05 was considered significant. The sample consisted of 68 participants. On a 1-5 Likert scale, emotional stress 3 (2-4) had a higher median than physical stress 2 (1-3); there was a positive correlation between emotional and physical stress (r= 0.616; p<0.001). There were no differences in the survey items for barriers, needs, or desires between those that screened positive for anxiety/depression compared to those who did not. The primary barrier to treatment was social/emotional (65%); second was logistical (45%). The most cited barriers included alternative sources of support, scheduling conflicts, and patient perception that her stress level did not warrant treatment. Despite 50% identifying counseling as the primary preference for support, it was only utilized by 7%. There were no significant differences in barriers to treatment for women who screened positive for anxiety/depression compared to those who did not. Also, women endorsed emotional distress associated with infertility, regardless of a positive or negative screen for anxiety or depression. Despite this, few established with embedded psychological support in the clinic, reporting social/emotional reasons over logistical barriers. Although 1/2 of women reported desiring counseling, they questioned if their distress level warranted treatment. This demonstrates that women may benefit from education and normalization of psychological support regardless of severity of mood symptoms. Universal referral or integration of emotional support into medical care may be beneficial to target all women and optimize overall outcomes.