Unveiling the hidden struggles: Survey reveals worrying knowledge gap and emotional toll of infertility amidst record-low birth rates in Asia

• A survey conducted in seven Asian markets, including India, revealed that respondents, on average, spent 6.8 years on their fertility journey, with 3.6 years dedicated to trying to conceive naturally.^1,2
• In Indonesia, Japan, Korea, Singapore, and Vietnam, at least 70 percent of respondents expressed a low to moderate level of knowledge about infertility and conception.¹
• Unexpected emotional burden and fear emerged as primary factors causing delays in seeking medical treatment. The journey was marked by a rollercoaster of emotional highs and lows.^1,2

NEW DELHI, Nov. 7, 2023 /PRNewswire/ -- Today, Ferring Pharmaceuticals released a white paper report titled "Real Voices, New Insights: Eureka Moments for Fertility in Asia" integrating findings from a multi-country survey ("EUREKA") across seven countries in Asia involving over 1,465 respondents who were considering, receiving, or have completed fertility treatments.^1,2 Supported by publications and experts' opinion, the insights reported can help guide couples, the public and governments to better understand the infertility journey in light of the declining births crisis emerging in many Asian countries, including here in India.

"Many Asian countries are facing an unprecedented decline in birth rates. As a leader in reproductive medicine, Ferring is committed to building families worldwide and supporting the journey to parenthood. The EUREKA survey is one of the first in our region involving seven countries highlighting the increasing importance to understand the emotional journey of many couples to increase education and community awareness" said Alex Chang, Senior Vice President of Asia Pacific, Middle East, and Africa, Ferring Pharmaceuticals.

The journey of conception is long for many couples in Asia
The white paper reported that the fertility journey of survey respondents– from deciding to have a baby, diagnosis, treatment to eventual conception – took an average of 6.8 years, out of which, an average of 3.6 years trying to conceive naturally,^1,2 which is more than three times the duration recommended by the World Health Organization in defining infertility warranting medical consultation.³ In India, this was even longer, where respondents took 4.5 years trying to conceive naturally.

Notably, those living in countries and regions such as Japan, Korea, Taiwan and Singapore – where fertility treatments are covered by national health schemes either through reimbursements or subsidies, reported an average of 1.6 years after diagnosis to start treatment.^1,2 Age and duration impact conception success.⁴ It is thus important to raise awareness on seeking professional advice sooner as waiting may lead to a lower chance of successful conception owing to older age.

Associate Professor Sadhana Nadarajah, Head and Senior Consultant, Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, said that "[a] woman's age is an important determinant of fertility. With increasing age, both egg quality and quantity decline, especially after 35. By the age of 40, only 20–30 percent of those who wish to have a baby will be able to do so."

Echoing the role that age plays in one's fertility journey, Dr Chen Mei-Jou, President of Taiwanese Society for Reproductive Medicine, mentioned that "there is an obvious and significant difference in terms of the success rate of IVF treatment at the ages of 35, 38 and above 40. In Taiwan, the biggest problem encountered by fertility physicians is that patients often seek help very late into their fertility journey, and some may have even waited for years after trying to conceive naturally."

Knowledge gaps inevitably delay the fertility journey
It was identified that there was a general lack of understanding and lots of misconceptions of infertility. Many were unfamiliar with key fertility concepts, inadvertently delaying taking the first step towards family planning.  

At least seven out of 10 respondents from Indonesia, Japan, Korea, Singapore and Vietnam self-reported low-to-moderate knowledge of infertility and conception before they were diagnosed with fertility issues. They had limited knowledge about key fertility concepts and wished they had known earlier:¹

• How infertility affects both genders
• How age impacts the quantity and quality of eggs, or ovarian reserve, which influences the overall chances of natural conception
• How the success of fertility treatments can be age-dependent despite medical advances

Interestingly, a high proportion (65 percent) of respondents from India self-reported good knowledge of infertility and conception which was different from the other countries surveyed. However, similar to respondents from other markets, they displayed limited knowledge of key fertility concepts including common myths that:

• Fertility issues are more common in women.
• Egg count and quality remaining the same regardless of age.
• Infertility is not an issue if you already have a child.

Associate Professor Sadhana Nadarajah, Head and Senior Consultant, Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, mentioned that "couples need to know when and how to seek fertility assessment. More can be done to create greater awareness such as via social media platforms and public forums."

Respondents from the survey also indicated that they depended heavily on online platforms and channels as a key source of fertility-related information which was identified in the report to be at high risk of misinformation and bias.^1,2  

Emotional support is critical
The report also highlighted findings on the emotional rollercoaster the respondents underwent. Regardless of treatment outcomes, the diagnosis and treatment of infertility was a highly emotional experience. Psychological factors are among the most frequently cited reasons for patients dropping out of fertility treatments, often in the earliest stages of treatment.⁵ In Asia, the EUREKA survey found that couples often struggled with high levels of emotional strain:^1,2 

• Unexpected emotional burden was a major pain point for respondents in their treatment journey and fear was often cited as a primary reason against starting treatment for those who did not proceed. In India, around 1 in 4 cited unexpected emotional burden, fear and being burdened by the lack of success as top barriers during their treatment journey. Other pain points included concerns on unexpected costs and social stigma.
• At all timepoints, there was a fluctuation between positive and negative emotions. Even for respondents who achieved successful conception, considerable negative emotions continued to persist. The prolonged mix of emotions can be of significant burden to the couple and their motivation to continue.

Katy, a 38-year-old from Singapore, shared that "the period of trying to achieve pregnancy is something that is hard to forget. All the injections, reviews, waiting, hope and anticipation. In many cases, couples would have to try again and again to succeed, and it gets even harder with each failure."

While countries and regions including Singapore, Japan, Korea, and Taiwan have started recognizing the growing need to increase access to infertility treatments through various national financial coverage schemes, emotional support remains a missing piece for many. At present, mental health remains underprioritized in the treatment of infertility and the provision of emotional support from various sources is critical.

About the White Paper - Real Voices, New Insights: Eureka Moments for Fertility in Asia
Everyone has a right to build a family, even in the face of biological and social barriers. The decision to have children is a personal one and we support families of all shapes and sizes. Having the right information empowers people to make the right decision at the right time, and demystifying infertility allows thoughtfulness and empathy to grow within communities and workplaces to better support their friends, families, and employees. The "Real Voices, New Insights: Eureka Moments for Fertility in Asia" white paper was commissioned by Ferring in collaboration with Weber Shandwick to provide insights into the journey towards parenthood based on EUREKA – a large scale survey conducted across the Asia Pacific region, supported by various peer-reviewed publications and experts' opinion. It provides a concise, reliable, and informative resource that could be used to guide more couples in realizing their dreams of building a family. The full white paper is now available at https://re.ferring.com/eureka.

About Ferring Pharmaceuticals
Ferring Pharmaceuticals is a research-driven, specialty biopharmaceutical group committed to helping people around the world build families and live better lives. Headquartered in Saint-Prex, Switzerland, Ferring is a leader in reproductive medicine and maternal health, and in specialty areas within gastroenterology and urology. Ferring has been developing treatments for mothers and babies for over 50 years and has a portfolio covering treatments from conception to birth. Founded in 1950, privately-owned Ferring employs over 7,000 people worldwide. The company has operating subsidiaries in more than 50 countries and markets its products in over 100 countries.

Learn more at www.ferring.com, or connect with us on Twitter, Facebook, Instagram, LinkedIn and YouTube.

References
¹ "Ipsos Pte Ltd, Singapore (2022). Study on key Asian insights in family building dreams (EUREKA), unpublished"
² "Ipsos Limited, Taiwan (2022). Infertility patient and partner survey: 1000 Dreams in Taiwan (EUREKA), unpublished"
³ World Health Organization. Infertility. Available at: https://www.who.int/news-room/fact-sheets/detail/infertility
⁴ ASRM. Age and Fertility – A Guide for Patients: Available at: https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/factsheets-and-info-booklets/age-and-fertility/. Accessed Mar 2023.
⁵ Sax MR & Lawson AK. Women 2022; 2:68–75.