Federal Institute for Population Research, Friedrich-Ebert-Allee 4, 65185, Wiesbaden, Germany.
Liberal Arts & Sciences, 1 Saxon Drive, Alfred, NY, 14802, Alfred University, USA.
Soc Sci Med. 2021 May;277:113782. doi: 10.1016/j.socscimed.2021.113782. Epub 2021 Feb 17.
The reasons why people decide for or against seeking medical help for infertility are still far from clear. With advances in reproductive medicine, use of medically-assisted reproduction has increased over the last three decades. Over the same period, an appreciable amount of quantitative studies on the determinants of medical help-seeking for infertility has accumulated. However, to our knowledge this narrative review is the first to summarize and evaluate findings from these studies. This review includes 39 studies carried out in 11 countries, covering the period 1990-2019. We have identified five categories of determinants of help-seeking: socio-demographic variables, socio-economic factors, reproductive history, attitudes, and psychological factors. Each category consists of several variables. Considerable knowledge has accumulated on socio-economic variables, indicating that there is social inequality in access to treatments in several countries. Less is known about marital status, attitudes and psychological factors. Findings on the latter two mostly derive from two US surveys. Overall, the body of research appears heterogeneous and fragmented. Studies differ in central aspects of study design (definitions of the analysis sample and of help-seeking, type of analysis (bivariate or multivariate), set of variables included in multivariate studies) making comparisons of findings difficult. Low comparability is reinforced by country differences in the provision of treatment, legislation on access and treatment coverage. The majority of papers lack a theoretical foundation or reference to any theory. Using a theoretical framework to guide empirical research could help to overcome the problems described above. Single-country studies should include information on legal and cultural context. More studies from countries other than the US are needed as well as multi-country studies in order to develop a systematic understanding of how macro-level structures relate to decisions about medical help-seeking. This review should assist future researchers in their attempt to conduct studies on help-seeking for infertility.
人们决定是否寻求医学帮助治疗不孕的原因仍不清楚。随着生殖医学的进步，在过去的三十年中，越来越多的人使用医学辅助生殖技术。在此期间，积累了相当数量的关于不孕寻求医学帮助决定因素的定量研究。然而，据我们所知，这是第一篇综述和评估这些研究结果的综述。这项综述包括在 11 个国家进行的 39 项研究，涵盖了 1990 年至 2019 年的时期。我们确定了寻求帮助的五个决定因素类别：社会人口统计学变量、社会经济因素、生殖史、态度和心理因素。每个类别都包含几个变量。关于社会经济变量已经积累了相当多的知识，表明在几个国家中，治疗的获取存在社会不平等。关于婚姻状况、态度和心理因素的了解较少。关于后两个因素的发现主要来自两项美国调查。总体而言，研究结果似乎存在异质性和分散性。研究在研究设计的核心方面存在差异（分析样本和寻求帮助的定义、分析类型（双变量或多变量）、多变量研究中包含的变量），使得难以比较研究结果。国家之间在治疗提供、获取和治疗覆盖的立法方面存在差异，进一步加剧了可比性低的问题。大多数论文缺乏理论基础或参考任何理论。使用理论框架来指导实证研究可以帮助克服上述问题。单一国家的研究应包括有关法律和文化背景的信息。需要更多来自美国以外国家的研究以及多国研究，以便系统地了解宏观层面的结构如何与医疗帮助寻求决策相关。本综述将有助于未来的研究人员尝试进行不孕寻求医疗帮助的研究。
