Barriers to Early Fertility Consultation in Women with PCOS: A Questionnaire-Based Survey

Authors: Rudri Agrawal

Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility, but many women delay seeking fertility care despite having difficulty conceiving. Delayed consultation may affect reproductive planning and contribute to psychological distress. This cross-sectional survey evaluated patient-reported barriers associated with delayed fertility consultation in women with PCOS and assessed the impact of prior fertility counselling on care-seeking behaviour, psychological burden, and treatment readiness.

The questionnaire-based study was conducted over 12 months among women with PCOS presenting for fertility care. A total sample size of 500–600 participants was planned to allow evaluation of factors associated with delayed consultation and the effect of counselling on fertility-related outcomes. Women with infertility and PCOS diagnosed according to current international evidence-based guidelines were enrolled after at least one fertility consultation. Participants completed a structured questionnaire assessing the time between attempting pregnancy and seeking fertility consultation, perceived barriers to early care, sources of fertility information, and previous exposure to fertility counselling. Counselling was classified as structured (evidence-based and focused on appropriate timelines) or non-structured. Delayed consultation, defined as seeking fertility care more than 12 months after attempting pregnancy, was the primary outcome. Secondary outcomes included anxiety levels and treatment readiness. The final analysis included 548 women with PCOS. Delayed fertility consultation was reported by 56.8% of participants (n = 311). The most commonly reported barriers to early consultation were reassurance that spontaneous conception would occur despite ongoing ovulatory problems (44.9%), prolonged focus on weight loss before specialist referral (41.6%), misinformation about fertility timelines in PCOS (37.8%), and dependence on non-medical sources of information such as social media or peer advice (34.1%). Women who received structured fertility counselling before specialist consultation had lower odds of delayed care-seeking compared with women who received non-structured or no counselling (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.38–0.71; p < 0.001). After adjustment for age, body mass index (BMI), education level, and infertility duration, delayed consultation was independently associated with higher anxiety scores (adjusted OR 1.89, 95% CI 1.36–2.62) and lower treatment readiness (adjusted OR 1.67, 95% CI 1.21–2.29).

The study findings were limited by the self-reported nature of counselling exposure and perceived barriers, which may introduce recall bias. Additionally, the cross-sectional design does not establish causal relationships, and findings may not be generalizable to all healthcare settings.

In conclusion, delayed fertility consultation is common among women with PCOS and is frequently linked to reassurance-based postponement, lifestyle-related delays, and misinformation. Structured fertility counselling may help promote earlier care-seeking, reduce anxiety, and improve readiness for fertility treatment.

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