01. OVERVIEW
PERSONAL TAKEAWAYS + REFLECTION:
02. INTRODUCTION
We are currently pursuing publication for our research! Stay tuned for updates!
BACKGROUND:
Traditionally, infertility has been defined as the failure to become pregnant after one year of regular, unprotected sexual intercourse. As my team discussed this definition, we began to have conversations about which groups were excluded. Social infertility occurs when social or relational factors, such as being single or in a same-sex relationship, limit one's ability to build a family.
We wondered, how might we increase access to inclusive family building services for those experiencing social infertility?
Graphics by Sahana Prabhu.
We know research into the topic of social infertility is more timely than ever— the American Society of Reproductive Medicine (ASRM) released an expanded definition of infertility in October 2023 to include those navigating social infertility. However, research on this population is extremely limited and these groups continue to be excluded from most other clinical definitions of infertility and consequently, access to fertility services.
03. RESEARCH
We kicked off our research phase with a team alignment meeting to establish schedules, communication preferences, work styles, hopes and concerns, and team norms. To ground our approach, we then identified our existing assumptions and prior knowledge about the research topic.
RESEARCH GOAL:
Understand social infertility and the unique experiences and barriers that impact individuals navigating the family building journey.
Setting our research goal: who is affected, what are the known challenges, when does this occur, and in what context does this problem show up?
RESEARCH TOPICS:
RESEARCH QUESTIONS:
We formulated our research questions around the following framework: context, systems, individuals, and analogies. Thinking through our questions in this framework helped us ensure we were examining our topic from multiple perspectives and considering varying levels of impact.
METHODOLOGIES:
We conducted secondary (desk) research and a series of eight, semi-structured interviews with people who were either (1) individuals experiencing social infertility undergoing care at different stages or (2) medical providers involved in the treatment of populations experiencing social infertility (i.e. reproductive endocrinologists, reproductive psychiatrists).
Participant overview.
04. SYNTHESIS + INSIGHTS
As we analyzed the literature and our interview data, we began to see patterns emerge.
For example: (1) many definitions of family don't specify genetics, (2) LGBTQ+ medical education is often seen as optional (therefore many fertility providers aren't educated on social infertility), (3) individuals experiencing social infertility have to do extensive research on their own, and (4) insurance traditionally doesn't recognize or cover social infertility.
From here, we grouped our patterns to create analyses, rooted in questions such as, “why is this happening?” and “why does this matter?”.
Early stages of synthesis. Sorting observations (yellow) into patterns (purple).
A small cross-cut of our synthesis process.
INSIGHTS:
This led us to our insights— comprehensive conclusions that reframe the problem and are leverage points for design.
Our insight framework.
BACKGROUND
Those navigating social and physiological infertility share a fundamental goal— the desire to build a family. Regardless of the diverse roots of their infertility, those navigating infertility share commonalities and unity in their journey.
Those navigating social and physiological infertility share a fundamental goal— the desire to build a family. Regardless of the diverse roots of their infertility, those navigating infertility share commonalities and unity in their journey.
META ISSUE
However, the larger issue is that society moves faster than medicine. Medicine is rooted in evidence, and change relies on a high burden of proof.
However, the larger issue is that society moves faster than medicine. Medicine is rooted in evidence, and change relies on a high burden of proof.
REQUIRES
Because medicine is constantly playing catch-up to society, those navigating the social infertility care landscape have to be more intentional when building families while also often bearing the burden of proving they are physiologically infertile to gain access to care.
Because medicine is constantly playing catch-up to society, those navigating the social infertility care landscape have to be more intentional when building families while also often bearing the burden of proving they are physiologically infertile to gain access to care.
BRIDGING THE GAPS
Barriers patients and their families have to overcome include: stigma with terminology, fitting the clinical definition of infertility to gain insurance coverage, lack of provider education, and patients often viewing providers as barriers to care.
Barriers patients and their families have to overcome include: stigma with terminology, fitting the clinical definition of infertility to gain insurance coverage, lack of provider education, and patients often viewing providers as barriers to care.
RESULTS
Family building for those experiencing social infertility involves more intentionality— including researching methods and method availability, and challenging existing familial norms. Given the barriers these populations endure, they are more willing to build a non-nuclear family structure and very well-equipped to raise a family.
Family building for those experiencing social infertility involves more intentionality— including researching methods and method availability, and challenging existing familial norms. Given the barriers these populations endure, they are more willing to build a non-nuclear family structure and very well-equipped to raise a family.
05. DEFINITION + IDEATION
ECOSYSTEM & JOURNEY MAPPING:
We created an ecosystem map to understand where each of our insights fit within the greater family building landscape and to help us determine the best leverage point(s) for a service intervention.
Ecosystem map with insights.
To visualize the process our end users go through while navigating the fertility care landscape, we also created a journey map. This helped us identify several key touch points we wanted to impact with our service solution:
(1) contemplation
(2) seeking fertility care
(3) navigating care options
(4) receiving care
(5) navigating 'failure' and/or reevaluating care options.
(2) seeking fertility care
(3) navigating care options
(4) receiving care
(5) navigating 'failure' and/or reevaluating care options.
DESIGN PRINCIPLES: This service will be successful if it can...
INSIGHT PRIORITIZATION & IDEATION:
To help us focus on the most impactful intervention(s) that might arise from our research, we prioritized our insights using an outcome-driven approach. We asked ourselves: if we address [this insight] will we achieve [this outcome/design principle]?
From this, we decided to focus on the following three insights for our service:
(1) Society proceeds faster than medicine
(2) Providers as barriers to care
(3) Terminology gap.
(1) Society proceeds faster than medicine
(2) Providers as barriers to care
(3) Terminology gap.
Outcome-driven insight prioritization.
Rapid-fire ideation!
Additionally, we mapped our concepts on a matrix according to impact and feasibility and decided to pursue a patient-facing solution that addressed our problem from a systemic perspective.
We wondered how we could create a support network for patients throughout the entire family building journey and discussed the concept of a social infertility-specialized doula. For the purposes of our semester-long assignment, chose to focus more in-depth on how this service would strengthen and increase access to resources and guidance prior to accessing clinical fertility services.
Impact and feasibility matrix.
06. SERVICE DESIGN SOLUTION
Embr is a doula organization that supports people on their fertility and family building journey. By pairing clients with a fertility doula, Embr aims to alleviate the burden of navigating a landscape that historically has not been built for those with nontraditional families.
Early stages of Embr brainstorming. Sketched on Miro.
To further work through our proposed concept, we created a high-level service blueprint.
Service blueprint created on Miro.
Additionally, we created a sample user journey for our couple, K & O, to show what the process might look like for someone wishing to access this service. Below is a simplified snapshot of their journey, from contemplation to navigating care.
07. PROTOTYPING
We focused on prototyping the initial touchpoints of a client's family-building journey— exploring options such as fostering, adoption, and IVF—while also introducing them to Embr as an organization. Our goal was to gain deeper insight into how this proposed intervention might shape the user experience.
We invited our original interviewees to give us feedback on the following three experiences:
CONTEMPLATION: Recognizing that many people discover brands and services through social media, we chose to prototype awareness of Embr with a TikTok video, exploring how engaging, social-first content could effectively introduce the organization and its offerings to a wider audience.
Prototypers watched a TikTok influencer share her experience with social infertility and Embr.
REACHING OUT: To ensure a personalized experience with our website and match our users with the appropriate service line, we wireframed a questionnaire and asked users to run through it.
A hand-drawn wireframe of the Embr questionnaire prospective clients would complete before accessing services.
INITIAL MEET WITH DOULA: We tested an in-person run through of an initial meeting with an Embr doula. Based on feedback from our research, we knew a pain point in the family building journey was having to constantly self-advocate and repeat one's story, so we aimed to design an experience where the client felt heard, supported, and empowered from the start.
Our prototype focused on fostering a collaborative dynamic, beginning with a meeting where the client and doula could think through and set up 'ground rules' for their professional relationship.
Prototyping a 30 minute doula intake appointment for a new client.
A shared, evolving document outlining ground rules involving communication, boundaries, conflict resolution strategies, and feedback.
PROTOTYPE FEEDBACK:
We received insightful feedback from our prototypers.
Contemplation: We learned the TikTok ad addresses emotional support and is attention grabbing, however our users were looking for more information on cost breakdown and would have liked the ad to have addressed biases on fostering and adoption. It brought up questions around whether doulas would be required to have lived experience and if there is a list of providers who are educated in social infertility.
Reaching out: Questionnaire was easy to use and questions felt intentional— users had the chance to identify their own support system and their own goals for their time with Embr. Our prototypers suggested to explain what purpose the responses will be used for, particularly given Texas policy and privacy concerns. They wondered whether certain questions could/should be made optional.
Initial meeting: Structuring of new client intake and 'ground rules' document allowed clients to take control over what they wanted out of the relationship as well as equipping them with knowledge/questions to take to their fertility provider(s). We also heard that it would be more beneficial to wait to go over 'ground rules' until after the first visit to ensure the doula was a good fit for the client. The overarching question: where does this service end?
08. REFLECTIONS + NEXT STEPS
While this was originally a semester-long graduate project, we have received IRB approval to continue research and share our findings. We are currently drafting a manuscript for journal submission in May 2025.
Our interviews were conducted in September 2023, immediately preceding the ASRM’s update to the clinical infertility definition in October. We celebrate this win and simultaneously acknowledge that because clinical recognition and inclusion for people experiencing social infertility is still emerging, there may still be gaps in 1) access to fertility care services and 2) recognition and understanding of these individuals’ experiences in larger fertility and reproductive care systems. Further research is needed to understand experiences in the context of this stage.
INTERPROFESSIONAL HEALTH SHOWCASE 2024:
We were accepted to present our poster, Using Human-Centered Design to Address Care Gaps in the Social Infertility Landscape, at the Interprofessional Health Showcase hosted by the University of Texas Center for Health Interprofessional Practice and Education on April 19, 2024.
Presenting at UT Austin's 2024 Interprofessional Health Showcase.
Design in Health Team. From left to right: Laura Long, Courtney Duong, Sahana Prabhu, Karen Jimenez, Alice Liu
