January 27, 2021
By Leanna Mantella, MD

Editor’s Note: This is a review of research[i] published in 2018 in Global Reproductive Health titled, “Fertility awareness and quality of life: assessment and impact of fertility problems and infertility.” Dr. Leanna Mantella wrote this review as a fourth-year medical student while participating in the FACTS online elective taught through Georgetown University School of Medicine. To learn more about this and many other cutting-edge topics in fertility awareness and women’s health, save the date now for our next virtual CME conference coming up May 14-15, 2021!

Why This Matters

For many couples, infertility is a silent struggle. Sadly, this fact is well known to the one in eight couples in the United States faced with the inability to conceive. These individuals often feel a sense of guilt and shame, pondering their role in this difficult, emotional journey to achieve a pregnancy. For some patients, assisted reproductive technology (ART) can help, but it is not without cost, as it is frequently an expensive and arduous process.

Much research has been conducted in the area of infertility, generating novel methods to achieve pregnancy and identify risk factors that may contribute to infertility. Yet, in medical training, we seldom expand on the prominent effects of infertility on a couple. It almost seems that in the process of medicalizing the diagnosis of infertility, its very real psychological toll has been diminished. Fortunately, research is being conducted to delve deeper and identify factors that contribute to infertility, fertility awareness, and quality of life, including this study by Bayoumi et al which examines several practical tools to address these important areas.

A Fertility Status Awareness Tool

The FertiSTAT[ii] is a fertility status awareness tool that identifies potential risk factors for infertility based on lifestyle habits and medical conditions. It was created in the United Kingdom and validated for use in the United States, Canada, United Kingdom, and Australia. The FertiSTAT is a user-friendly one-page survey with questions about twenty-two risk indicators, including age, stress, smoking, previous medical diagnoses, and more.

The aim of this survey was to create a tool that would give women the avenue to receive personalized guidance, so they may take control of their fertility. The FertiSTAT promotes more open dialogue between women and their physicians. It enables women to recognize and learn about changes they can make to promote health and fertility, particularly by identifying preventable risk factors and acting proactively. The FertiSTAT has the potential to facilitate targeted education, awareness, and promotion of public health initiatives to increase awareness about reproductive health and fertility.

Measuring Quality of Life

The FertiQoL[iii] is the first international survey designed to measure quality of life in men and women with fertility problems. Like the FertiSTAT, the FertiQoL was developed in the United Kingdom. It has been translated to forty-four languages and validated for use in the United States, Canada, Australia, New Zealand, and the United Kingdom. This is a short survey with twenty-four questions about overall life, physical health, and fertility treatment-related quality of life. The questions assess emotional well-being, mind-body connection, relationships, and social quality of life.

Many people are surprised to learn that patients with infertility have similar rates of depression as those diagnosed with cancer. Yet, those facing the inability to conceive are well acquainted with this. The development of a standardized approach to assess quality of life in this population is valuable for the individual men and women, each couple, and the medical community. The recognition of the psychosocial impact of infertility has the potential to help medical and mental health professionals identify and address the needs of patients who struggle with infertility in a more comprehensive way.

Addressing Psychosocial Aspects of Infertility

Both of these tools are used to facilitate open dialogue and more effective communication between patients and physicians as well as other medical professionals. The diagnosis of infertility can be a devastating burden for men, women, and couples. As I continue to prepare for a career in family medicine, it is my goal to give patients all the tools available to educate them on primary disease prevention, but also provide them with the treatment they may need during their most vulnerable times. Resources like the FertiSTAT and FertiQoL will enable me to address infertility more effectively from the primary care setting.

Editor’s Note: Countless women and men struggle not only with the inability to conceive but also with the emotional, social, spiritual, and, for many, financial burden of coping with this reality. In an effort to support these individuals and couples in a more wholesome way, and aware that emotional health itself impacts fertility, organizations like Organic Conceptions have emerged to address the prevalent psychosocial aspects of infertility. The FACTS online fertility awareness elective incorporates teaching on this important topic which affects so many people and, yet, too often remains unaddressed.

Author Bio: Leanna Mantella, MD is a graduate of Georgetown University School of Medicine class of 2020. She is currently in family medicine residency at the University of Toronto and has a particular interest in women’s health and mental health. In 2019, FACTS published her interview with a couple that uses the Lactational Amenorrhea Method.

[i] Bayoumi RR, van der Poel SZ, Koert E, Boivin J. Fertility awareness and quality of life: assessment and impact of fertility problems and infertility. Global Reproductive Health. 2018;3(4):e21. doi:10.1097/GRH.0000000000000021.
[ii] Bunting L, Boivin J. Development and preliminary validation of the fertility status awareness tool: FertiSTAT. Hum Reprod. 2010;25(7):1722-1733. doi:10.1093/humrep/deq087.
[iii] Boivin J, Takefman J, Braverman A. The Fertility Quality of Life (FertiQoL) tool: development and general psychometric properties. Fertil Steril. 2011;96(2):409-415.e3. doi:10.1016/j.fertnstert.2011.02.046.


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