Am Fam Physician. 2024;109(6):497
Author disclosure: No relevant financial relationships.
To the Editor:
The valuable article by Phillips and colleagues states that infertility or impaired fecundability affects approximately one-fourth of women in the United States.1 The authors highlight that health equity issues are multi-factorial, including access to care and the cost of infertility evaluation and treatment.1 Providing family physicians with the necessary tools and confidence can increase access to infertility care for marginalized patient populations.
An under-addressed topic in infertility care is the effect of infertility on mood. Patients undergoing infertility evaluation should be screened and monitored for signs and symptoms of mood disorders. Women who have problems with conception are twice as likely to have a coexisting mood disorder compared with women without fertility issues, and women undergoing fertility treatment have more severe anxiety and depression.2 Anxiety and depression in patients negatively affect the success of fertility treatments.3 Depression in patients' partners is also associated with lower in vitro fertilization (IVF) success rates.4
Mood disorders also affect the pursuit of fertility treatments. IVF places a heavy financial burden on patients; 70% of women go into debt, and women without insurance coverage for IVF are three times more likely to stop treatment after one cycle.1 When covered by insurance, the most common reason for discontinuing treatment despite not having achieved a pregnancy was “psychological burden.” The most stressful parts of the process were identified as “infertility taking too much of a toll on our relationship” and “too anxious or depressed to continue.”5 The most common patient-reported ways to improve their experience with IVF included more information on coping with psychological issues, increased access to psychologists and social workers, and stress-reduction classes.5
Family physicians can enhance infertility evaluation and management by providing psychological and fertility care for our patients.
Editor's Note: This letter was sent to the authors of “Infertility: Evaluation and Management,” who declined to reply.
