O-158 The evolution of the quality of life of women and men during the fertility clinic trajectory: a longitudinal survey
Authors: Dias L , De Loecker P , D'Hooghe T.M , Luyten J , Peeraer K , Dancet E 
Published: June 2022

Abstract

Study question
How does the overall quality of life (QoL) of infertile women and men evolve during the diagnostic workup and during intrauterine insemination (IUI)?

Summary answer
The diagnostic workup affects the overall QoL of neither women nor men but both partner’s QoL is diminished by the time of their third IUI.

What is known already
Overall quality of life (QoL) is increasingly acknowledged as the ultimate measure of health care quality. The WHO defines ‘overall QoL’ as an individual’s perception of their position in life in relation to their context, goals, expectations, standards and concerns. Infertility threatens the life goal of becoming parents. Value preference studies concluded that cost analyses should consider a decrement in women’s QoL for ‘being infertile with the desire for a child’. The short-term QoL costs or benefits of the fertility clinic trajectory, before potentially achieving the long-term benefit of a live birth, have yet to be examined.

Study design, size, duration
Two cohorts consulting a Belgian fertility clinic were studied longitudinally. Cohort 1 (C1) included 36 women and their partners (response rate 54%), who were surveyed before their first consultation (T1) and three months later, towards the end of their diagnostic workup (T2; 2017-2019). Cohort 2 (C2) included 23 women and their partners (response rate 64%), who were surveyed during their diagnostic workup (T1) and at the time of their third IUI (T2; 2020-2021).

Participants/materials, setting, methods
Dutch- or English-speaking heterosexual couples first consulting a fertility clinic were eligible. Overall QoL was assessed with the valid and reliable linear analogue scale (LAS; range: 1-100; the higher, the better QoL; Moons et al., Eur J Cardiovasc Prev Rehabil, 2006). Paired samples t-tests assessed the evolution in the overall QoL of women and of men. Linear models examined whether already being parents and male factor infertility affected change scores.

Main results and the role of chance
Women and men of both cohorts were on average in their early thirties and couples had tried to conceive naturally for, on average, 19 (C1) and 16 (C2) months. Most individuals (65.4% in C1; 87% in C2) did not yet parent a child. A considerate proportion of couples had been diagnosed with (amongst others) male factor infertility (34.6% in C1; 26.0% in C2).
The diagnostic workup did not affect the overall QoL of women (T1: 78.8±8.1 vs. T2: 75.8±9.7, p = 0.147) or men (T1: 80.8±7.9 vs. T2: 79.2±8.7, p = 0.206). The evolution in overall QoL throughout the diagnostic workup did not depend on parenthood status or male factor infertility (p &gt; 0.05).
By the time of their third IUI, women’s overall QoL had diminished (T1: 80.9±9.9 vs. T2: 74.0±15.0, p = 0.018). This evolution was not affected by parenthood status or male factor infertility (p &gt; 0.05). Similarly, men’s overall QoL had diminished by the time of their third IUI (T1: 82.0±7.2 vs. T2: 78.1±9.6, p = 0.042). This reduction in men’s QoL was not affected by parenthood status (p = 0.759) but was especially observed (p = 0.028) among men without male factor infertility (T1: 82.9±7.9 vs. T2: 77.0±11.0, p = 0.008).

Limitations, reasons for caution
The rather small sample sizes were sufficient for examining the effect on QoL of time and two potential determinants (parenthood status, male factor infertility) according to the rule of thumb of including minimally five individuals per variable. Recruitment is still ongoing to increase the power of these cohort studies.

Wider implications of the findings
Fertility nurses/midwives should inform couples pursuing their life goal of parenthood that the fertility clinic trajectory will require short-term sacrifices. The diagnostic workup affects the overall QoL of neither women nor men, but both partner’s overall QoL is slightly diminished by the time of their third unsuccessful intrauterine insemination.

Trial registration number
not applicable