First contact: the intersection of demographics, knowledge, and appraisal of treatment at the initial infertility visit

Abstract

Objective: To determine the impact of the initial infertility visit on treatment-related knowledge, patient anxiety, and appraisals of treatment.

Design: Prospective survey.

Setting: Academic medical center.

Patient(s): Two hundred thirty-four English-speaking women aged 18-50 years attending their first infertility visit.

Intervention(s): Participants completed a survey assessing health literacy, knowledge, anxiety, and appraisals of the treatment process before and after their infertility visit.

Main outcome measure(s): Knowledge of infertility and treatment and anxiety and appraisal scores.

Result(s): Most participants were white and earned >$100,000/year and had at least a college education. Baseline knowledge of reproductive anatomy, assisted reproductive technology (ART), and fertility factors was modest but improved after the initial visit. Factors associated with higher knowledge included higher education and income, white or Asian ethnicity, and English as a primary language. Patient appraisals of treatment represented by the positive (Challenge) and negative (Threat and Loss) subscale scores on the Appraisal of Life Events (ALE) scale changed over time Negative appraisals of treatment and anxiety scores decreased and positive appraisals of treatment increased after the initial visit. Lower knowledge was associated with higher positive appraisal scores; lower health literacy was associated with higher anxiety and appraisal scores (positive and negative) after the visit. Black women had higher Challenge scores compared with white and Asian women. Hispanic women had higher anxiety scores than non-Hispanic women.

Conclusion(s): Infertility patients have modest baseline knowledge of fertility and infertility treatment. The initial infertility visit can improve this knowledge and decrease both negative appraisals of treatment and anxiety levels. Differences in knowledge and appraisal were seen across ethnic groups and other demographic variables. Physicians should individualize patient counseling to improve patients' knowledge and provide realistic treatment expectations while also reducing patient anxiety.

Keywords: Anxiety; appraisal; infertility; knowledge; treatment.