title: Emotional Impact of Reduced Access to Assisted Reproductive Care.
abstract: OBJECTIVE
  To evaluate the impact of cessation of fertility services on patients with infertility.
  
  
  METHODS
  A cross-sectional, anonymous mail survey was conducted in a university hospital setting. A total of 281 female infertility patients treated from 2003-2006 were mailed surveys. The main outcome measures of the study were the Perceived Stress Scale 10 (PSS-10) and the Impact of Events Scale (IES).
  
  
  RESULTS
  Of the 281 patients, 175 (62.3%) responded to the questionnaire. Of those, 51 (29.1%) reported being affected by the closure. The majority (58.9%) reported a somewhat or very negative impact on their perceived quality of life. Affected patients were more likely than unaffected patients to have an elevated PSS-10 result (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.04-4.3). No significant difference was seen in IES results, with 90.2% of affected and 81.5% of unaffected patients scoring in the high distress range (OR 2.1, 95% CI 0.77-5.65). Self-reported average stress levels were reduced following news of resumption of services (3.3, scale 1-10) as compared to both prior to (5.1) and during (7.4) the closure.
  
  
  CONCLUSIONS
  When fertility services are discontinued, there may be significant emotional distress among the population affected. Health care providers should be aware of the impact infertility has on stress-coping and quality of life and be prepared to offer psychological services.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Tatpati
authors.forename: Susan B A
authors.initials: SB
authors.lastname: Hudson
authors.forename: Shawna L
authors.initials: SL
authors.lastname: Ehlers
authors.forename: Charles C
authors.initials: CC
authors.lastname: Coddington
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D005260:Female; D006271:Health Facility Closure; D006297:Health Services Accessibility; D006801:Humans; D007246:Infertility / Q000523:psychology*; D007247:Infertility, Female; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011788:Quality of Life / Q000523:psychology*; D034121:Reproductive Health Services; D027724:Reproductive Techniques, Assisted; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult