Unraveling fertility treatment decisions : working with women dealing with unsuccessful in-vitro fertilization

Abstract

Background: The failure of fertility treatment is potentially unavoidable and can induce psychological distress among women experiencing infertility. Patients face the dilemma of whether to continue or stop treatment after unsuccessful in-vitro fertilization (IVF) treatment, which presents a challenging and ongoing decision-making process. The integration of psychological intervention offered by mental health practitioners into standard fertility care is a global trend. The importance of customized psychosocial intervention is emphasized in order to support individuals in decision-making and psychosocial adjustment following unsuccessful fertility treatment.

Objectives: The research aimed to explore the decision-making experience of women with failed IVF treatment and to investigate the effectiveness of a tailored psychosocial intervention for women following unsuccessful IVF treatment.

Methods: The research adopted mixed research methods. A qualitative study was conducted to understand the decision-making process and decisional needs of women following failed IVF treatment. In-depth interviews were undertaken with 20 Chinese women who experienced at least one IVF treatment cycle resulting in no clinical pregnancy. After the qualitative study, a randomized controlled trial was undertaken to assess the efficacy of a single-session meaning-oriented implications counseling approach (MICA) in reducing decisional conflict and improving the mental health of women experiencing unsuccessful IVF treatment. Eighty women who had undergone at least one failed IVF treatment cycle were randomly assigned to either an intervention or waiting list control group. The intervention comprised one individual session, lasting approximately 60 minutes.

Results: The qualitative study captured three decision-making patterns among women who have experienced unsuccessful IVF treatment: (1) Information-driven decision-making, driven by multiple sources of information; (2) Outcome-centric decision-making based on expectations and outcomes related to treatment; (3) Emotional-centric decision-making based on the emotional balance between gain and loss. The specific decisional and psychological needs related to clinical practices also informed the intervention design. The quantitative results indicated that the intervention increased IVF patients’ informed decision-making and enhanced the meaning-making process. Between-group effect analysis showed a significant time x group interaction in informed decision scores (F = 5.18, p < 0.05, η2 = 0.06) and meaning-making (F = 11.28, p < 0.001, η2 = 0.13). There were also marginally significant decreases in anxiety symptoms (F=3.19, p=0.08).

Discussion: Women experiencing unsuccessful IVF treatment endured decision-making and psychosocial adjustment challenges following unsuccessful IVF treatment. Study participants articulated their urgent need for both decision and psychosocial support. Meaning-oriented implications counseling can be a promising method for improving informed decision-making, meaning-making, and mental health among women with unmet parenthood goals.

Significance: This study offers evidence-based practical resources for healthcare practitioners who support women navigating the complex decision-making process in multi-cycle fertility treatment. This study provided identification of decision-making process to better understand the decision-making features and needs of Chinese women during multiple treatment cycles. It also enriches the psychosocial provision pathway within routine fertility care by improving care following unsuccessful fertility treatment through an intervention tool that is both effective and easily accessible.