Social Infertility: A Narrative Review & Human-centered Design Application
BACKGROUND
Infertility is defined as the failure to become pregnant after 1 year of regular, unprotected sexual intercourse, highlighting physiological roots while omitting social drivers. Social infertility occurs “when social or relational factors, such as being single or in a same-sex relationship, limit one's ability to become pregnant”. While the American Society of Reproductive Medicine released an expanded definition of infertility in October 2023 to include those navigating social infertility, these groups continue to be excluded from most other clinical infertility definitions and consequently, access to fertility services.
In the last few decades, human-centered design has been embraced by healthcare systems, think tanks, and public health organizations to create empathetic and practical solutions for complex problems. Our team employed design-thinking to understand the unique experiences those navigating social infertility face to propose a service design solution.
METHODS
Our narrative review explored traditional infertility definitions, barriers to accessing fertility care faced by those navigating social infertility, and existing service models in the fertility landscape. Based on our review and qualitative interviews with patients and providers (n=8), we developed a service model using other design methodologies, including ecosystem and journey mapping, service blueprinting, and user prototyping.
RESULTS
Narrative Review
28% of LGBTQ+ adults under age 60 would like to have children one day, and 31% of heterosexual single individuals reported they wanted to have children one day without getting married. While the experiences of social infertility are recognized, research is limited, and coverage for fertility services vary by state. There are no interventions designed for this population.
Service Design Solution
We proposed a doula-based organization that matches those experiencing social infertility with a knowledgeable doula to navigate family building and provide emotional support, realistic expectations, and advocacy. Individuals self-identifying as experiencing social infertility (n=2) were recruited to provide feedback on our prototype. Responses were positive with support for the model’s inclusive language and emphasis on the person(s) at the center of their fertility journey.
CONCLUSION
Human-centered design is a collaborative and informed approach that can be employed to address the unique needs of the healthcare system. Those navigating social infertility are an underserved and under-measured population; gaps in access to fertility care for this population and an understanding of their experiences in larger reproductive care systems persist. While our model exists as a prototype, its concept and design principles can spark discussion on the need for inclusive service models addressing social infertility.