Ambivalence in treatment decision-making among women undergoing IVF treatment: a qualitative study

Abstract

Background: In Hong Kong, in vitro fertilisation (IVF) is considered as a common infertility treatment for couples with reproductive problems. Researches have shown that women usually experienced high level of anxiety and depression during treatment due to the demanding nature of medical procedure. Besides the unpredictable treatment outcomes, women always experience ambivalence in deciding whether to continue or terminate treatment. The purpose of this study was to explore the psychosocial factors affecting treatment decision-making among women who have failed their first IVF treatment cycle. Methods: This was a qualitative focus group study. A convenient sample of 16 female patients who failed to get pregnancy in the first IVF cycle was recruited from the Centre of Assisted Reproduction and Embryology, The University of Hong Kong – Queen Mary Hospital. They were assigned into three focus groups. Each group session lasted for three hours. Semi-structured interviews were conducted by one infertility counsellor and one medical social worker. Content of interview was transcribed and analysed by NVivo programme. Thematic analysis was used to interpret the main themes in the focus groups. Results: General speaking, participants expressed that they experienced high ambivalence in deciding treatment option and timeframe after completion of first cycle. Findings of the study showed that factors affecting treatment decision-making during the course of IVF included: 1) Healthcare communication such as extensiveness of knowledge regarding the physical and psychosocial implications of the treatment to be acquired; 2) Self-capacity such as physical and emotional capacity to bear the burden arising from treatment process and outcome; 3) Relational resources such as spousal support throughout the process and treatment outcome 4) General decision making pattern of oneself in balancing autonomy and dependency. Conclusions/Implications: Treatment ambivalent has been one of the major emotional experience among women throughout infertility treatment, which might lead to emotional and relational issue such as anxiety and depression as well as conflicts or mistrust in doctor-patient and/or spousal relationships. The present study shed light on healthcare service delivery in addressing the decisional ambivalence during infertility treatment.