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INFORMATION FOR

Planned Parenthood of Southern New England, Inc.

Achieving Fertility: Exploring the Expansion of Infertility Services at Planned Parenthood of Southern New England, Inc.

Background

Infertility is defined as the inability to conceive after one year or longer of unprotected sex (CDC 2019). Infertility can create both biological challenges, and emotional, financial and psychological hardship because of the stress and resources required to reach one’s intended fertility goals. Additionally, availability of insurance coverage can limit access to fertility services, exacerbating the emotional burden of infertility. To address these barriers and the potential for expansion of its services, Planned Parenthood of Southern New England(PPSNE) is seeking to assess their patients’ needs for access to infertility services, and potential opportunities for expansion of their services to include fertility care. PPSNE is specifically interested in seeking to meet the reproductive needs of the following groups of patients: 1) Low-income individuals, 2) Individuals insured through Medicaid or high-deductible insurance plans, and 3) LBGTQ+ individuals and couples. The organization’s priority is to ensure that clients are able to maintain their desired health status. To ensure this objective is met, the goal of this project is to identify the unmet needs associated with reaching fertility in Connecticut and Rhode Island.

Key Findings

  • PPSNE patients desire fertility services and believe PPSNE would be an appropriate source of care.
  • Of the 56 Planned Parenthood affiliates contacted, only 5 sites across the United States offered their own fertility services to clients. Other sites refer to external providers for fertility services.
  • PPSNE should begin fertility service expansion by providing fertility education and information on insurance coverage for fertility services for all patients.
  • As an exploratory step PPSNE can support availability of full spectrum fertility services through developing a strong internal (Planned Parenthood affiliates) and external referral network.

Objectives

  1. Assess the need for fertility services among PPSNE clients.
  2. Explore the opportunities for PPSNE to broaden reproductive services to include such care.
  3. Make recommendations on the pathways by which PPSNE can support access to fertility services for high priority client groups.

Methods

Qualitative Data:

  • Four 30- to 45-minute semi-structured interviews with reproductive health care and fertility care providers to analyze resources needed for the provision of different aspects of infertility care and learn about patient experiences.
    • Convenience sample, with recruitment conducted throughout the course of the project period (15 weeks). Study team members reached out to providers both at Yale New Haven Hospital and PPSNE.
    • Interviews were audio recorded, transcribed, and analyzed using Dedoose® software.
  • Affiliate phone calls were conducted with 55 Planned Parenthood sites across the U.S to gather information about fertility services provided.

Quantitative Data: Online surveys were sent to 1,000 current PPSNE female clients ages 18-42y who had received a well-woman exam at a PPSNE center between July and December 2018, using the PPSNE patient portal. Survey was designed to assess patient’s experience with pregnancy and infertility and demand for services. 351 clients started the survey; 342 of the respondents completed over 50% of the survey.

  • The survey measured 26 different variables; they were coded using categories reflective of the responses received.
  • Survey outputs were analyzed in SAS to observe the frequency of certain factors among the survey sample

Results

Patient Survey: results revealed that 19.3% of respondents indicated having difficulty getting pregnant at some point in their life. For this group, the top three reasons for not seeking extra measures to become pregnant were:

  • Financial concern (19.6%)
  • Not knowing what to do (18.6%)
  • Not knowing where to go (16.5%)
  • Other factors included issues with insurance coverage (12.4%), fear of stigma (4.1%), partner concerns (3.1%), and distance to provider (2.1%).

Affiliate Phone Calls: revealed that of the 56 sites contacted, only five locations provide counseling, screening and/or testing themselves (See figure on right).

  • One center offers just education and referrals
  • Seven affiliates offer referrals only
  • One affiliate offers education only

Key Informant Interviews: discussion with providers revealed the following three themes regarding achieving fertility amongst the PPSNE population:

  • Fertility is time sensitive and inherently unique to the individual
  • Fertility care is not “one size fits all”
  • Fertility care is more than a procedure- it is comprehensive care

Recommendations

  • PPSNE could begin by rolling out support for patients on their paths to achieving fertility by providing education and referrals. Services that educate patients about the etiologies of infertility and the availability of financial and psychological support would empower patients to take more control of their health.
  • Staff should be trained on how to support patients experiencing infertility, and how to discuss these topics with them.
  • PPSNE should expand partnerships with mid-level providers and fertility specialists to provide effective networks to care for their patients.
  • PPSNE could rapidly roll out education services, while strengthening networks and relationships to also offer referrals. If PPSNE chooses to move toward counseling, screening and/or testing for infertility services, a longer timeline would be needed.

Limitations

  • Qualtrics survey was only sent to women 18-42 years old, meaning that responses excluded the perspectives of older women who may have had problems achieving fertility in the past
  • No qualitative data was able to be collected from PPSNE clients through focus groups
  • Did not conduct cost-effective analysis to provide information related to the cost of building infertility service infrastructure for PPSNE and extending services for PPSNE clients.
  • Unable to follow up with medical directors at Planned Parenthood affiliates providing fertility services to learn more about the feasibility and scalability of these services.

Acknowledgments

The research team thanks Kafi Rouse, Tim Yergeau, and Susan Lane from PPSNE for their guidance and assistance; the key informants for providing valuable information about fertility services; Shayna Cunningham from the Yale School of Public Health for her guidance; and Abigail Raynor and Dr. Debbie Humphries of the Yale School of Public Health for their support.

References

  1. “Infertility.” womenshealth.gov, March 8, 2017. https://www.womenshealth.gov/a-z-topics/infertility.“Infertility | Reproductive Health | CDC.” CDC, 16 Jan. 2019, https://www.cdc.gov/reproductivehealth/infertility/index.htm.
  2. Chandra, Anjani, and Elizabeth Hervey Stephen. Infertility and Impaired Fecundity in the United States, 1982–2010: Data From the National Survey of Family Growth. no. 67, 2013, p. 19.