Health-seeking behavior for infertility: A systematic review and meta-analysis

Health seeking is an essential determinant of infertility resolution and reportedly comes at a high financial, social and psychological cost. We estimated the pooled proportion of health seeking for infertility and the factors associated. We included English language articles on the health-seeking behaviour (HSB) of heterosexual couples for infertility globally, from PubMed, Scopus, Embase and PsycINFO (until 1 May 2024). We used Appraisal tools for Cross-Sectional Studies and Newcastle-Ottawa scale for cohort studies. Pooled proportion of HSB, the types, and factors associated were the outcomes. We used the random effects model to estimate the pooled proportions and describe the pattern of care seeking and the factors associated.

Twenty-five studies were included for analysis. The pooled proportion of HSB was 60 % (95 % CI: 53-67) (I² = 99.89 %, p = 0.00), which varied widely (25 % - 98 %) across studies. Majority were cross-sectional surveys (23, 92 %), from high-income countries (15, 60 %), conducted among women (19,76 %), using self-reported infertility (24, 96 %). Drugs, surgery, traditional or complementary medicine, and assisted reproductive technology were the predominant types of health seeking. Higher education, older age, higher income and having healthcare insurance were most frequently associated with seeking care for infertility.

Fewer studies from the lower- and middle-income countries and mostly among women indicate a skewed epistemic positioning of the existing research. Notably, two out of five diagnosed with infertility are not seeking healthcare. The review findings provided critical insights for policymakers and health care providers for addressing the barriers that prevent equitable health-seeking behaviors.