An Exploration of the Mental Health Experiences of Young Women with Diminished Ovarian Reserve

Abstract

Infertility is a reproductive disease resulting in the inability to conceive. One in six individuals will experience infertility in their lifetime. Diminished ovarian reserve (DOR) reduces the quantity and/or quality of a female's oocyte pool and is a known cause of infertility. Although this occurs during normal ovarian aging in the late 30s and early 40s, DOR can also impact younger women, increasing their risk for psychological distress from an unexpected diagnosis. The purpose of this dissertation is to develop a deeper understanding of the mental health experiences of young women with DOR through the generation of three manuscripts. Manuscript one examined the concept of infertility-related stress. Attributes included loss of identity, relational strain, isolation, stigma, anxiety, depression, and reduced self-esteem. Consequences included decreased quality of life, premature discontinuation of treatment, relational strain, anxiety, depression, and reduced self-esteem. Manuscript two reviewed strengths and limitations of the Fertility Quality of Life (FertiQoL) tool and described its psychometric properties and utility in research and clinical practice. Findings indicated the FertiQoL is a sound measurement with satisfactory face, content, convergent, and structural validity, and adequate internal consistency. Manuscript three investigated the mental health experiences of young women with DOR through a phenomenological approach. Participants described several reactions to DOR, including shock, loneliness, anxiety, and depression. Two main themes emerged: 1) Young women with DOR feel like a “forgotten community” coping with an invisible disease; and 2) Not all fertility clinics are created equal. Participants perceived the DOR diagnosis as devastating and hopeless, urging others to find providers with DOR expertise. This study established how young women with DOR perceive their mental health and identified a significant need for holistic and goal-concordant infertility health care. Women with DOR should be educated about their diagnosis, afforded transparent and realistic treatment expectations, offered mental health resources, and counseled about potential psychological consequences during and beyond their infertility journey.