Barriers to access and utilization of infertility treatment services among Iranian infertile women: a cross-sectional study

Infertility is a critical public health issue that reduces the quality of life for many women and has become increasingly prevalent among Iranian couples in recent years. This study aimed to investigate the barriers that infertile women face in accessing and utilizing infertility treatment services. This is a quantitative cross-sectional study that was conducted on 450 infertile women with primary or secondary infertility in Tehran in 2023. The context included 5 large public and private centers providing Infertility treatment services. The data were gathered through interviews using a structured questionnaire developed mainly based on Saurman’s conceptual model and Hosseini Esfidarjani’s study questionnaire and then analyzed by descriptive statistics and also Spearman’s correlation, ANOVA and logistic regression model. Among the barriers to access, the highest average score is related to financial affordability barriers (8.66±15.22) and integration (81±11.45), and in the barriers to utilization, it is related to personal and cognitive issues (11.7±12.9) and service quality (5.5±6.9). According to Spearman’s correlation and ANOVA yesy, statistically significant associations was observed between access barriers and type of insurance, spouse’s employment status, ethnicity, place of residence, creating a break or gap between diagnosis and treatment, as well as the history of changing the treatment center. Also, a statistically significant associtions was observed between utilization barriers and type of insurance, employment status of the couple, creating a break or gap between diagnosis and treatment. In both dimensions, a negative correlation was observed between monthly income and barriers to access and utilization. However, according to the logistic regression analysis, only medical center where provided the ITSs was significantly related to the barriers to access and utilization of ITSs. Also an association was found between the place of residence (Cof = −2.26, p = 0.038) with access barriers, so that women living in rural areas faceed more access barriers. According to these findings, the access and use of infertility treatment services among infertile women is strongly influenced by affordability, factors related to the health system (accommodation and quality of services) and other cultural and socio-economic factors. Therefore, the development of policies and support mechanisms by the government, continuous education and support of the patient and providing a culturally safe environment can help in improving the access and utilization of infertility treatment services.