Informing the development of a new model of care to improve the fertility-awareness of sub-fertile women in primary health care

Infertility is an important health issue in Australia affecting one in six couples. Increasingly these couples are being referred from general practice to assisted reproductive technology clinics for tertiary level care. Whilst there is general agreement that some infertility can be prevented by addressing modifiable lifestyles and other risk factors, limited research has examined women’s understanding of the fertile period of the menstrual cycle as a possible risk factor for infertility. The aim of this study was to inform the development of a new model care to improve the fertility-awareness of sub-fertile women in primary health care. It was hypothesised that most women who are seeking assisted reproductive technology treatment cannot correctly identify the fertile window of the menstrual cycle, and whilst most general practitioners and practice nurses do not provide fertility-awareness education because of a lack of education and training, practice nurses will show greater interest than general practitioners in delivering fertility-awareness education for sub-fertile women. The study used a mixed methods design and had two phases. Phase 1 measured fertility-awareness knowledge, attitudes and practices of women attending general practice (n = 328) and infertile women on admission to assisted reproductive technology clinics (n = 204). Phase 2 entailed three stages, and included a review of guidelines concerning their recommendations on fertility-awareness education in the primary care of infertile women, measured fertility-awareness knowledge, attitudes and practices of general practitioners’ (n = 278) and practice nurses’ (n = 473) when women first report trouble conceiving, and interviews with general practitioners (n = 11 and focus groups with practice nurses (n = 20) exploring the barriers and enablers, if any, and how best to deliver FA education in general practice. The study found that few women attending general practice (2.1%) and assisted reproductive technology clinics (12.7%) correctly identify the fertile period of the menstrual cycle. Conversely, a high degree of agreement exists between these women groups (92.2% and 94.5%, respectively) and general practitioners’ and practice nurses’ (89.2%) that women should receive fertility-awareness education when first reporting trouble conceiving. These findings strengthen the research evidence that poor fertility-awareness is a modifiable risk factor for infertility, and suggest that general practice is an appropriate setting for an intervention promoting couples’ fertile potential though a better understanding of the fertile time of the menstrual cycle. There was general agreement among general practitioners and practice nurses that greater use of specially trained nurses and midwives in a collaborative team care arrangement with general practitioners would improve both the quality and accessibility of fertility-awareness education in general practice. The study also identified that patient educational materials are needed to guide the delivery of fertility-awareness education in general practice.