Decision Making in Infertile Couples

Headed by Susan G. Millstein, PhD.

Advances in assisted reproductive technologies (ARTs) have improved the chances that couples with fertility problems can have children, but may also involve significant emotional, physical and financial consequences in both the short and long term. Despite the increasing use of these technologies, little is known about how couples make decisions about their use, the factors that are most critical in influencing these decisions, or the natural history of decision-making over the course of treatment.

The current study is a prospective, longitudinal investigation of ART decision making in couples presenting to infertility clinics. The study was designed to:
1) examine the natural history of couples’ ART-related beliefs and their decisions to initiate, continue and stop ART treatment;
2) examine the degree to which essential elements of informed decision making characterize ART-related decisions;
3) examine the utility of a theoretical model for describing, explaining and predicting decisions to initiate, continue, and stop ART treatment;
4) determine the role of fertility motivations and desires in ART decision-making; and
5) describe the nature and magnitude of influence that husbands play in couple’s ART decision-making.

In-depth interviews with over 400 couples were conducted prior to their use of ART, and at 4, 8, and 18 month follow-ups to assess patients’ perceptions of decision options, risks and benefits; fertility motivations and desires; beliefs about social norms; control beliefs; and fertility-related intentions. Reproductive outcomes, ART attempts, and the use of other reproductive options, including adoption, were tracked for all study participants throughout the study period.

In addition to expanding our knowledge of both assisted and unassisted reproductive behavior, the research will identify critical factors that influence ART decisions, allowing us to make specific recommendations about areas in which clinician intervention may be most promising and patient populations for whom such interventions are especially warranted. Results regarding patients’ capacity for making informed decisions will have particular relevance to policy issues related to informed consent.