Abstract
STUDY QUESTION
What is the relationship between decisional conflict, decisional regret and psychological well-being in women following unsuccessful IVF cycles?
SUMMARY ANSWER
The mediating effect of decisional regret on the relationship between decisional conflict and fertility-related quality of life (FRQOL) has been found to be moderated by the availability (versus absence) of frozen embryos after an unsuccessful IVF cycle.
WHAT IS KNOWN ALREADY
Infertility treatment is marked by its open-ended nature. Stresses in treatment decision-making could be aggravated by a culture which honours families through procreation. While studies have investigated treatment-related decision-making among infertile women, little is known about the mental health consequences of decisional conflict and decisional regret following an unsuccessful IVF cycle.
STUDY DESIGN, SIZE, DURATION
A study was conducted over a 3-month period with infertile women who had recently experienced a failed IVF cycle (T0). Decisional conflict when they decided on terminating or continuing treatment (T1) and decisional regret 3 months later (T2) were measured. Participants reported their levels of depression, anxiety and FRQOL at three time points. A total of 151 participants completed all time points (attrition rate: 39%). The average age of participants was 37.2 years, and they had had 1.1 cycles (range: 0-8) on average at the time of study intake. The duration of the study was 2 years.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Participants were infertile women who were not pregnant following an IVF cycle recruited from a university-affiliated assisted reproduction centre. Following the notification of a negative pregnancy result, patients were invited to complete measures of FRQOL, depression and anxiety across three time points and decisional conflict and decisional regret at T1 and T2 respectively.
MAIN RESULTS AND THE ROLE OF CHANCE
Decisional regret partially mediated the effect of decisional conflict on overall and treatment-specific FRQOL (P < 0.05). The mediation by decisional regret was present only among participants who had no remaining frozen embryos after their unsuccessful IVF cycle (P < 0.05).
LIMITATIONS, REASON FOR CAUTION
Self-selection bias at recruitment remains a concern.
WIDER IMPLICATIONS OF THE FINDINGS
Our results show for the first time how mental health implications of decisional conflict may vary among patients with different clinical characteristics (i.e. availability of frozen embryos), despite their common experience of an unsuccessful IVF cycle. Healthcare professionals should be aware of the psychological ramifications of treatment decision-making difficulties, as well as individual differences in adjustment to unsuccessful treatment.
STUDY FUNDING/COMPETING INTERESTS
The study was funded by the Hong Kong University Grant Council-General Research Fund (HKU740613) and the authors have no conflicts of interest.
TRIAL REGISTRATION NUMBER
HKU Clinical Trials Registry (Trial registration number: HKUCTR-1680).
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