DELAYED REFERRALS AND LATE PRESENTATION TO ENDOCRINE CLINICS FOR INFERTILITY DIAGNOSIS: A RETROSPECTIVE-PROSPECTIVE CROSS-SECTIONAL STUDY

Abstract

Infertility is a global reproductive health concern, that is defined as the failure to conceive after 12 consecutive months of unprotected intercourse (1). On a global scale, infertility affects 17.5% of the adult population, emphasizing the urgency of accessible and affordable fertility care for the affected population (2). A notable percentage of 22% of the population in Pakistan is dealing with infertility and despite this significant number, 40% of the affected population does not seek medical help, owing to the fact that there is limited awareness, increased fear of stigma, financial constraints, and deeply rooted cultural norms (3,4). While infertility is often viewed as a gynaecological problem, with common causes including ovulatory dysfunction, fallopian tube disorders, endometriosis, or chromosomal abnormalities (5,6), Oftentimes the underlying cause is endocrine-related, including, PCOS, hyperprolactinemia, hypothyroidism, hyperthyroidism, hypogonadotropichypogonadism, etc.(7). Endocrine clinics are often the first point of contact for these patients therefore they play a significant role in early diagnosis and appropriate referral. Timely diagnosis and prompt medical care is vital in improving fertility outcomes however, many couples face substantial delays in reaching out to an endocrine clinic for diagnosis and treatment of infertility caused by endocrine dysfunctions. One study unveiled that a significant number of couples wait around 3.2 years to obtain an infertility diagnosis (8). This delay is driven by several contributing factors,including patient-related barriers, healthcare provider-related factors, and systemic issues within the healthcare delivery system. Among these are, seeking folk therapy before medical consultation, approaching other medical consultants before reaching the endocrine clinic, lack of awareness and lower education level, financial constraints,accessibility and safety of treatment and the fear of being stigmatised(8, 9). These delays can result inmissed therapeutic windows, especially in older women, and increase risk of developing psychological disorders therefore timely management is essential (10). This study aims to explore the reason behind delayed diagnosis and intervention of infertility in an endocrine clinic setting. Understanding these delays can aid in improving timely access to fertility care, especially for patients whose primary issues stem from endocrine dysfunction.Infertility is more common in developingcountries because people there are less knowledgeable about the causes of infertility and the possible treatments that may be required. In Pakistan, infertility was reported by 22% of the people[11].Thepsychopathology of the infertile women is noticeably higher and manifests as self-blame, depression, anxiety, tension, and suicidal ideation [12]. Delay in the diagnosis of infertility is a significant concern. Due to the fact that hormonal imbalances are often the underlying cause of infertility, endocrine clinic play a crucial role in many healthcare settings in the diagnosis of infertility. However, significant delays have been experienced by many patients before reaching the endocrine clinic. While various factors are responsible for this delay, one of the important factor is failure of gynecologist and physicians to refer patients to an endocrine clinic for evaluation. According to studies, primary healthcare providers frequently delay referrals as they rely too much on empirical treatments, and under-estimate endocrine-clinic causes [13].It is important to understand the reasons behind the delays to improve patient education and accessibility. There is no data on the causes of delay in reaching endocrine clinic for infertility diagnosis. Therefore, our study aims to systematically evaluate the causes of this delay in an endocrine clinic by assessing patient presentation trends. Understanding these delays will help develop strategies to strengthen primary care training and improve referral guidelines.Delays in reaching an endocrine clinic for infertility diagnosis is a significant concern experienced by many individuals. The causes and extent of these delays remain unexplored at Jinnah Postgraduate Medical Centre (JPMC), Karachi.