Infertility Services in Family Planning Care Toolkit

Toolkit/Guide
Achieving Pregnancy Basic Infertility Services Title X Family Planning Program
Last Reviewed
Source
RHNTC

Welcome to the Toolkit

Basic infertility services are a core component of family planning services, the Title X Program, and the Quality Family Planning Recommendations (QFP). Basic infertility services are part of the broader scope of services centered on supporting clients in achieving a healthy pregnancy, and supporting individuals and couples to achieve their reproductive and family building goals.

This toolkit is framed by the core Title X values of quality, access, and equity. Persisting structural barriers (e.g., unaffordable services, racism, inequitable insurance coverage) limit access to infertility services. Racial and socioeconomic disparities exist both in the burden of infertility (i.e., who experiences infertility, treatment outcomes) and in access to services for evaluation and treatment of infertility.This toolkit is designed to support family planning programs and staff in delivering quality, accessible, and equitable infertility services. This means: providing  that align with nationally recognized standards of care (quality); connecting clients to specialized clinical services and a broad range of resources in support of infertility treatment and care, and reproductive and family building goals (accessible)2; and providing services in a manner that is   and  (equitable).

This toolkit is intended to help family planning agencies and staff, including Title X providers, understand the scope of basic infertility services, and to strengthen and guide their provision of infertility services and referrals to support clients experiencing infertility.

Illustration of a provider and patient

Use this toolkit as a guide to provide and strengthen infertility services within your family planning practice.

This toolkit recommends the following steps:

  1. Assess your program’s infertility services
  2. Train and prepare staff to deliver basic infertility services
  3. Integrate infertility prevention and education into client care for all
  4. Provide quality, accessible, equitable, and inclusive infertility services
  5. Strengthen referrals for additional services and supports for clients with infertility

Conduct a systematic review of your agency’s current infertility services and practices, and identify gaps and opportunities for improvement. Prioritize strategies for quality improvement over time to strengthen infertility services, as well as to provide appropriate referrals for medical, social, emotional, and/or spiritual services to support clients experiencing infertility. 

Action Steps
Supportive Resources

Review the Title X Program Handbook for a summary of expectations on providing infertility services.

Title X Program Handbook

Review current professional guidelines and recommendations on infertility care.

Providing Quality Family Planning Services (QFP)

Infertility Workup for the Women’s Health Specialist

Assess site policies and protocols for infertility services relative to the Title X Program Handbook and professional guidelines.

Basic Infertility Services Site Self-Assessment

Incorporate infertility services into policies and procedures.

Basic Infertility Protocol Job Aid

Identify an improvement goal and strategies to enhance infertility services.

Plan-Do-Study-Act Worksheet

Equip family planning staff with a foundational understanding of infertility, including: definitions of infertility and common causes and risk factors; evaluation and treatment for infertility; the emotional burden of infertility and infertility treatment; the prevalence of and disparities in infertility; and barriers, disparities, and inequities in infertility care. Family planning staff should be knowledgeable and skilled in providing inclusive and culturally affirming infertility services that support the family building goals of all clients, including LGBTQ+ clients.

Action Steps
Supportive Resources

Train staff on foundational concepts of infertility and infertility services, including achieving healthy pregnancy.

Basic Infertility Services in Family Planning Settings Webinar

Providing Basic Infertility Services and Achieving Pregnancy in Title X Settings Clinician Cafe Website

Introduction to Reproductive Anatomy and Physiology eLearning

Review with staff common factors associated with and causes of infertility, such as polycystic ovarian syndrome (PCOS), untreated chlamydia and gonorrhea, pelvic inflammatory disease (PID), endometriosis, and thyroid disease; as well as unexplained infertility and iatrogenic, or medically induced, infertility.

Providing Basic Infertility Services in a Title X Setting: A Case Study

Polycystic Ovarian Syndrome (PCOS) Throughout the Lifespan Clinician Cafe Website

STIs, PID, and Infertility Podcast

Train staff on infertility evaluation and treatment options.

Treating Infertility: Frequently Asked Questions

Providing Basic Infertility Services in Title X Settings Podcast

Train staff on barriers, disparities, and inequities in infertility and infertility care, including the impact of bias and racism.

Infertility as a Reproductive Justice Issue eLearning

Provide staff with ongoing training and support to apply principles of cultural humility and to mitigate the impact of implicit bias in client care.

Cultural Competency in Family Planning Care eLearning

Orient staff to the emotional aspects of infertility and infertility treatment and train staff to provide trauma-informed education, counseling, and referrals for clients who experience infertility. 

Providing Trauma-Informed Care in Family Planning Clinics Webinar

Family planning providers can support reproductive well-being, fertility, and fertility preservation by focusing on infertility prevention through: screening for and treating conditions that may influence fertility; and providing quality preconception health services.

Action Steps
Supportive Resources

Assess clients’ reproductive goals; counsel on proactively supporting fertility and achieving healthy pregnancy, as appropriate.

Client-Centered Reproductive Goals and Counseling Flow Chart

Preconception Counseling Checklist

Support for Achieving a Healthy Pregnancy eLearning

Assess and address clients’ factors related to fertility, including providing STI screening and treatment to prevent tubal infertility.

Sexually Transmitted Infections Treatment Guidelines, 2021

Chlamydia Screening Toolkit

Provide information to clients on supporting fertility and fertility preservation, when relevant.

Understanding Endocrine Disruptors and Fertility Video

Hypertension and Fertility Videos

Insulin Resistance and Prediabetes: Why NOW is the Time to Intervene Job Aid

Provide counseling and education on fertility and fertility awareness-based methods (FABMs) to achieve pregnancy.

Fertility Awareness-Based Methods: Fertility Indicator Concepts and Counseling Points Job Aid

Fertility Awareness-Based Methods of Contraception: An Overview for Family Planning Providers eLearning

By understanding each client’s unique circumstances and family building goals, family planning staff can provide appropriate clinical services, non-clinical resources, and referrals to support clients experiencing infertility or clients who are interested in fertility preservation options.

Action Steps
Supportive Resources

Determine each client’s need for infertility services. 

Determining Your Client’s Need for Services and Discussing Reproductive Goals eLearning

Clinical Pathway for Family Planning Services Chart

Conduct a medical history, reproductive history, review of systems, physical examination, and laboratory testing, as indicated, and provide counseling and referrals based on information from the clinical evaluation.

Family Planning and Related Preventive Health Services Checklists for Women and Men

Basic Clinical Evaluation of Infertility for Male Clients: A Checklist for Providers

Basic Clinical Evaluation of Infertility for Female Clients: A Checklist for Providers

Provide inclusive infertility services supportive to all, including LGBTQ+ clients.

The Need for Accepting and Affirming Care in Title X Settings Video Series

Support LGBTQ+ Clients with Affirming Language Job Aid

Implement a trauma-informed, client-centered approach—guided by the principles of trauma-informed care—when providing infertility services and support.

Counsel clients on additional infertility evaluation, as needed, and on considerations for accessing and utilizing treatment options.

Provide clients with clinical and non-clinical referrals and resources that may go beyond your site’s scope of services. In addition to linking clients to specialist care for medically-based infertility services, family planning agencies can provide clients with information, education, and resources on the social, emotional, financial, and other aspects of navigating infertility and treatment.

Action Steps
Supportive Resources

Strengthen your agency’s referral system. 

Establishing and Providing Effective Referrals for Clients: A Toolkit for Family Planning Providers

Compile information on local and regional resources and referrals for clients who have additional needs that go beyond your site’s scope of services, including support groups. 

Local Resource List

Refer clients experiencing infertility or infertility factors for additional assessment, treatment, counseling, and/or social, emotional, or spiritual support services, including LGBTQ+-specific services. 

Share resources on others’ fertility journeys and experiences to provide information, support, and community for clients experiencing infertility.

Participate in National Infertility Awareness Week events (e.g., social media campaigns, live events) to raise awareness about infertility.

Promoting Preconception Health Observances Through Social Media Job Aid

Messages and graphics to help you share this resource with your networks