A longitudinal study investigating the role of decisional conflicts and regret and short-term psychological adjustment after IVF treatment failure.
What is the relationship between decisional conflict, decisional regret and psychological well-being in women following unsuccessful IVF cycles?



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.



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.



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 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 T1and T2respectively.



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).



Self-selection bias at recruitment remains a concern.



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.



The study was funded by the Hong Kong University Grant Council-General Research Fund (HKU740613) and the authors have no conflicts of interest.



HKU Clinical Trials Registry (Trial registration number: HKUCTR-1680).
Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China chancelia@hku.hk.
Celia Hoi Yan
CH
Chan
Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China.
Hi Po Bobo
HP
Lau
Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China.
Michelle Yi Jun
MY
Tam
Department of Obstetrics and Gynecology, The University of Hong Kong, Pokfulam, Hong Kong, China.
Ernest Hung Yu
EH
Ng
D000328:Adult; D003220:Conflict, Psychological; D003657:Decision Making; D000066498:Emotional Adjustment; D004644:Emotions; D005260:Female; D005307:Fertilization in Vitro / Q000523:psychology*; D006801:Humans; D007247:Infertility, Female / Q000523:psychology / Q000628:therapy*; D008137:Longitudinal Studies; D017211:Treatment Failure
IVF; assisted reproductive technology; decisional conflicts; decisional regret; psychological well-being; quality of life; treatment decision-making; treatment failure