Impact of treatment decisions and significance of cultural beliefs in predicting quality of life of Chinese infertile women

Abstract

STUDY QUESTION: What is the impact of treatment decision-making on Chinese infertile women and what factors can predict their quality of life (QOL) 3 months after the decision? SUMMARY ANSWER: QOL in mind-body, social and tolerability improved but relational, environment and mental-health worsened. Believing “infertility as violation of filial piety” was identified as major predictor. WHAT IS KNOWN ALREADY: When engaging in treatment decision making, there has been a paradigm shift to look at a patient’s decision not only based on its subsequently treatment outcome or disease prognosis, but also how the decision impacts on his/her quality life. In the case of infertility, the decision of continuing or discontinuing treatment is often embedded in a midst of socio-cultural considerations such as childbearing desire and cultural attitudes towards fertility, especially in societies who regard maternity as a central milestone in adult development and childlessness will cause major disruption in women’s lives by inferring with the established and desired life course. STUDY DESIGN, SIZE, DURATION: A longitudinal questionnaire study was conducted with 151 Chinese infertile women. Data was collected on their quality of life (FertiQOL and HADS), childbearing desires, attitudes towards infertility, and demographic details at three time-points: notification of treatment failure (T0), immediately after treatment decision making (T1) and 3 months after (T2). The study spanned 2 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were recruited from a fertility clinic at a university affiliated public hospital. Out of465 patients approached by the research assistant, 246 agreed to participation, and 151 completed all questionnaire (attrition rate 39%). On average, their age is 37.2 years (SD 3.27), received subfertility diagnosis for 3.8 years and had experience 1.1 IVF treatment cycle prior to the current failure. They mostly received tertiary education, non-religious, and were full-time employed. MAIN RESULTS AND THE ROLE OF CHANCE: Between baseline (T0) and immediately after treatment decision making (T1), no significant changes were found in the women’s quality of life domains and mental well-being, except a decrease in anxiety scores [t(150) = 6.57, p <0.001]. Three months after the treatment decision (T2), significant improvement was found for the Mind-body [t(150) = 3.17, p < 0.01], Social [t(150) = 10.8, p < 0.001], and Tolerability [t(150) = 5.34, p < 0.001] domain. However, the scores for the Relational [t(150) = −15.53, p < 0.001] and Environment [t(150) = −4.64, p < 0.001] domain, as well as the anxiety [t(150) = 13.96, p < 0.001] and depression [t(150) = 24.15, p < 0.001] scores were worsened. Regression analysis revealed the participant’s identification towards the cultural saying that “infertility is biggest violation to filial piety” is an effective predictor of her anxiety level (β = 0.21, p < 0.01) as well as her quality of life in the emotional (β = −0.22, p < 0.05), mind-body (β = −0.18, p < 0.05), and tolerability domain (β = −0.20, p < 0.05) 3 months after treatment decision making. LIMITATIONS, REASONS FOR CAUTION: Data was collected from a single fertility clinic, so may not be representative of all IVF patients across clinics. Although there was no significant difference in age, education, and religious background between those who completed the study and those who dropped out, self-selection bias is a concern. WIDER IMPLICATIONS OF THE FINDINGS: This study showed impact of infertility treatment decisions on women’s quality of life and psychological adjustments. By identifying cultural beliefs as predictor of post-decision QOL, psychosocial support may consider exploration of such beliefs with the infertile couple prior to treatment, and allow re-visiting of these conversations throughout the treatment course.