Let’s talk about cost, baby! Perceived financial burden, quality of life, sexual well-being in couples seeking medically assisted reproduction

By Lucy Coady and David Allsop

This blog is a summary of our published article: Allsop, D. B., Péloquin, K., Saxey, M. T., Rossi, M. A., & Rosen, N. O. (2023). Perceived financial burden is indirectly linked to sexual well-being via quality of life among couples seeking medically assisted reproduction. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1063268

Medically assisted reproduction is a difficult treatment process for couples both financially and sexually. Yet, these two domains have not been examined together among couples seeking treatment, leaving couples and practitioners without guidance on how to address these domains together.

In line with Couples and Finance Theory, we tested the hypothesis that perceived financial burden and couple income would predict quality of life during medically assisted reproduction, which would then predict four domains of sexual well-being (i.e., sexual satisfaction, desire, distress, and frequency). We also examined if the results differed by treatment status-that is, between partners who were receiving treatment and those who were not. 

What did we do?

We surveyed 120 couples who had undergone medically assisted reproduction (MAR). Of the couples in the study, most were around 33 years old, White, in mixed-gender relationships, working full-time, and making between $100,000 and $140,000 a year in combined household income.

The surveys asked couples about: (1) how MAR burdens them financially, (2) their income, and (3) their quality of life during MAR. The couples were also asked about their sexual satisfaction, sexual desire, sexual distress, and sexual frequency. We then used the survey responses to test how finances affect quality of life during MAR and sexual well-being.

What did we expect?

Our hypotheses were based on Couples and Finance theory, which talks about how finances and relationships are connected by characteristics like life satisfaction [1]. We predicted that higher perceived financial burden of MAR and income would relate to poorer quality of life, which would then relate to poorer sexual well-being. In addition, they were interested in whether the links between financial variables, quality of life, and sexual well-being were different for the partner directly receiving fertility treatment compared to the partner not receiving treatment.



What did we find?

We found that the perceived financial burden of MAR was associated with lower quality of life, which was in turn associated with lower sexual satisfaction and desire, and higher sexual distress. We also found that when one member of the couple reported a larger financial burden, this had a negative effect on the quality of life and the sexual well-being for both members of a couple. While we found perceived financial burden played a role in quality of life and sexual well-being, we did not find evidence that a couple’s household income did the same. Additionally, we did not find evidence that the findings changed based on whether one partner in the relationship was undergoing treatment or not.  

What does this mean?

The results indicate that financial burdens from MAR play a negative role in couples’ quality of life during treatment, and in turn, a negative role in sexual well-being. This shows us that, yes, MAR is financially straining, but more importantly, that this strain is associated with poorer life quality and a poorer sexual relationship with one’s partner. Along with the toll on quality of life and sexual relationships, MAR involves the stress of a hefty emotional investment as well. Treatments can be expensive (upwards of $39,000 [2]) with no guarantee of achieving pregnancy or live birth of a child; our data indicates that the emotional burden of this investment takes a toll on couples when it comes to their quality of life and their sexual relationships.

Keeping these results in mind, it’s important for clinicians to address with clients how this perceived financial burden may affect their lives and their sexual well-being. When clinicians are talking about finances with couples, it’s important to ask both members of a couple if finances may be affecting their own and their partner’s lives and sexual relationships. If both clinicians and couples can become more aware of these links between the financial burden of MAR, quality of life, and sexual well-being, couples may be better equipped to deal with the stressors and financial strain of MAR, and have better relationships during treatment. 


[1]  Archuleta, & Burr, E. A. (2014). Systemic Financial Therapy. In B. Klontz, S. Britt, & K. Archuleta (Eds.), Financial Therapy (pp. 217–234). Springer International Publishing. https://doi.org/10.1007/978-3-319-08269-1_13

[2]  Wu, Odisho, A. Y., Washington, S. L., Katz, P. P., & Smith, J. F. (2014). Out-of-Pocket Fertility Patient Expense: Data from a Multicenter Prospective Infertility Cohort. The Journal of Urology, 191(2), 427–432. https://doi.org/10.1016/j.juro.2013.08.083