The Determinants of Treatment Persistence after Unsuccessful Infertility Treatment: A Qualitative Study

• Background and Purpose
  Infertility is a life crisis, and assisted reproductive technologies such as in-vitro fertilization (IVF) are perceived as the final hope for achieving parenthood by infertile couples. Therefore, patients inevitably face difficulty in making decisions after unsuccessful treatment. Decisional conflict increase after treatment failures and is associated with a higher level of depression and anxiety. Understanding the factors related to decisional conflict benefits identifying the needs and providing practical support for infertile individuals and couples. Previous studies have put much effort into the determinants of treatment termination, neglecting those who persist with continuing treatment. With great childbearing importance attached to fertility, IVF patients are likely to indulge in treatment cycles even after recurrent treatment failures. Persistence with treatment might cause adverse outcomes regarding the physical, psychosocial, and financial burden of IVF treatment. This study aims to investigate the factors contributing to the treatment persistence among infertile women who experienced unsuccessful IVF treatment.
• Methods
  A qualitative method was conducted with fourth Chinese women in 2022. Eligible female participants who failed to achieve clinical pregnancy after at least one IVF cycle were recruited by convenience sampling method. Participants who were undertaking IVF treatment in reproductive centers were recruited through posters or practitioners ‘referrals. Enrolled participants were about 30 years of age, and experienced two failed IVF cycles on average. Upon completing informed consent, participants were invited to attend a one-hour in-depth interview with social workers. Thematic analysis was used to interpret the data.
• Results
  Four categories were identified with the determinants of treatment persistence: (1) Perceptions of decision: no well-marked termination of treatment, the high expectation for successful rate, great importance attached to childbearing, predisposition towards options were exclusive and ambiguous. (2) Perceptions of others: optimism due to others' success story, perceived limited support from parents-in-law, perceived high expectation and low participation from husband. (3) Resources to make Decision: personal active but partner’s passive role in decision-making, uncertainty and unconfident towards outcome, limited information and instrumental support from clinics and health professionals, lack of support on emotional, financial and relational issues, low motivation and avoidance for considering other options.
• Conclusions and Implications
  The critical factors of treatment persistence arising from the study were the optimism towards treatment success, intergenerational pressure, partner’s passive participation, stigmatization towards other family-building alternatives, and limited support from family, clinics, and government. To promote better adjustment and decision-making following unsuccessful treatment, policymakers should push for healthcare coverage of assisted reproduction. Medical social workers should extend their services after treatment and facilitate informed decision-making by affording decisional support or implication counseling. A decisional support intervention could be designed for further study, and an RCT study should be implemented to boost evidence-based practice.