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By Jacky Boivin, PhD
Fall 2007
 
We know that parenthood is one of the most desired goals in adulthood, and that most people have life plans that include children. However, since surprisingly few seek medical advice for fertility problems, one of our research goals was to understand this inconsistency.
 
Problem context
Most people reading this magazine are aware that not all couples desiring a pregnancy will achieve one, and that 9—15% of couples of childbearing age are currently experiencing fertility problems. Although this percentage expresses the potential need for fertility treatment, it does not tell us the demand for such services, or how many people with a fertility problem actually find and use medical services to solve their problem.
 
One of our surveys1 showed considerable variability in demand for medical services relating to fertility. Depending on the country, anywhere from 42% to 76% of couples sought medical advice, the average was about 56%. Even fewer couples actually undergo treatment - less than 25%.
 
There may be many reasons why a significant number of couples are not willing to undergo medical treatment. Some reasons may include for example the financial resources available to the couple, or their chances of success with treatment. However, even when we take these factors into account, the percentage seeking medical advice for fertility problems is still far lower than expected, given the importance placed on parenthood.  
 
The psychology of seeking treatment
A second research project2 disclosed three main differences between the women who had sought medical advice for their fertility problems, and those who had not.
 
Women who sought medical advice suspected they had a problem conceiving either because they had tried without success for a long time, or they knew a problem already existed (e.g., previous vasectomy, fertility problems in a previous relationship). While this finding might seem obvious, not all women were quick to act when they suspected a problem. Roughly 20% of women who already met the medical definition of infertility3 never contacted a medical doctor for advice, even though they knew they would never conceive on their own. For this group of women, fearing that doctors would tell them they would never get pregnant actually stopped them from getting the help they needed.
 
Another important finding was that women who sought medical advice knew more about fertility and infertility, and were more informed about the availability of medical services and how to get help. Knowledge clearly plays an important role in decision-making, and maximising access to accurate and relevant information is an important objective which encourages people to access medical services.
 
Finally, one’s personality did not really influence decision-making regarding treatment. In fact, there was no notable difference whether a woman was a tense or nervous person, or an optimistic and active problem solver. What was important was support from family and friends, especially if they endorsed seeking treatment as a way of solving the couple’s fertility problem. It could be that taking such an important step is easier if the couple knows that their social network of family and close friends will support them.
 
In light of our findings we decided that it was important to raise issues related to seeking medical advice, and to join patient advocacy groups to raise public awareness about fertility problems and how to best get help when natural conception is not successful. We wrote a leaflet (see below) and we continue to welcome feedback about the leaflet at This email address is being protected from spambots. You need JavaScript enabled to view it. .
 
The related leaflet was sponsored by the ACT taskforce, which is an international group
formed to help people having difficulty conceiving. The ACT Pathway, which describes how to get help for fertility problems, can be found at http://www.assistedconception.ca/.
 
Should I seek medical help?
Most people want to have children at some point in their lives and expect to get pregnant quickly. However, as time passes without success, the couple must decide whether they will seek medical advice. The leaflet referred to above is about this decision-making process. It explains when you should seek medical advice, and addresses your uncertainties. It is intended for any woman or man trying to start a family.
 
Do I have a fertility problem?
Men and women are willing to seek medical advice once they realise that they might have a problem. If you have not been able to get pregnant after one year of regular unprotected intercourse, then your doctor will most likely want to carry out medical tests. The ACT Pathway explains the symptoms to look for, and discusses whether medical counsel should be explored before you have tried for one year.
 
Why should I seek medical advice?
Once you suspect that there is a problem, you need to weigh the pros and cons of seeking medical advice. There are several good reasons to seek medical counsel. First, if there proves to be no medical problem, you will be reassured. And if there is a problem, you can then determine how to address it. Finally, by taking immediate action, early detection and early treatment will lead to increased chances of a successful pregnancy.
 
What are the disadvantages of seeking medical advice?  
People’s opinions about seeking help vary depending on their beliefs, values and attitudes towards medical treatment. For instance, some people might feel embarrassed discussing private matters with a doctor. Others may be concerned about their family’s reaction, while still others might think that treatment is unnatural. It is most important at this stage to obtain accurate information. Our booklet provides a step-by-step guide; it lists what solutions can be offered at each step. There are also numerous websites that address your concerns. One way to address your worries is to read the ACT Pathway and discuss it with your medical doctor.
 
Will the doctor want to help me?
Sometimes people worry that they will not receive medical help because of personal circumstances. Some worries include for example, being too old, being over- or under-weight or having poor lifestyle habits (e.g. smoking). Some also worry that they may not get medical help because they had an abortion in the past, or a miscarriage, or because they already have a child or children. For two reasons it is important to seek medical advice, even if you have such concerns. First, it is important to determine what the doctor thinks in your particular case. Second, the doctor may be able to help you deal with the health issue in question, especially if this is the cause for a delay in getting pregnant.
 
Will the doctor tell me I can never have children?
Men and women are sometimes reluctant to seek medical advice because they are afraid of being told that they will never have children. The very thought of it makes people delay a long time before seeking advice. In some cases it stops them from getting any medical help. Being fearful is understandable when having children is so important to you, but it is important to know that definitive or absolute infertility, where you can never conceive, is very rare. Even in these exceptional cases, medical intervention may still help couples achieve a pregnancy. If being scared is stopping you from getting help, keep in mind that getting medical advice will ensure that you make a fully informed decision.
 
Is medical intervention for me?
Some people want to have children, but are not sure they want to have medical treatment to achieve that goal. These people may think that treatment is unnatural, too expensive, complicated or painful, or they may have had bad experiences with other health problems. Others think that if they were meant to have children, then it would have happened naturally. However, getting medical help can be viewed as the natural thing to do. People with this view think that a fertility problem should be treated like any other health problem. In other words, one should consult a doctor and seek advice about possible solutions to the problem, and then decide the best course of action. Seeking medical advice is entirely up to you but before deciding one way or the other, make sure you have accurate information.
 
The following are useful websites to obtain accurate and reliable information before making a fully informed decision about seeking medical advice:
 
Assisted Conception Task Force: www.assistedconception.net
 
International Consumer Support for Infertility: www.icsi.ws
 
About the author
Jacky Boivin, PhD is Reader in Psychology at Cardiff University, Wales, UK and Honorary Fellow at the Cardiff Assisted Reproduction Unit & Department of Obstetrics and Gynaecology, University Hospital Wales, UK. She has authored and co-authored numerous articles on the psychological aspects of infertility.
 
References
1. Boivin, J., Bunting, L., Collins, J.A., & Nygren, K-G. (2007). New Debate: International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Human Reproduction. Advance Access published on March 21, 2007. doi:10.1093/humrep/dem046
 
2. Bunting, L., Boivin, J. (2007).  Decision-making about seeking medical advice in an internet sample of women trying to get pregnant. Human Reproduction. Advance Access published on April 7, 2007.. doi:10.1093/humrep/dem057
 
3. One year (six months if >36 years old) of regular unprotected sexual intercourse without a pregnancy.

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