Priorities for family building among patients and partners seeking treatment for infertility

Abstract

BackgroundInfertility treatment decisions require people to balance multiple priorities. Within couples, partners must also negotiate priorities with one another. In this study, we assessed the family-building priorities of couples prior to their first consultations with a reproductive specialist.MethodsParticipants were couples who had upcoming first consultations with a reproductive specialist (N = 59 couples (59 women; 59 men)). Prior to the consultation, couples separately completed the Family-Building Priorities Tool, which tasked them with ranking from least to most important 10 factors associated with family building. We describe the highest (top three) and lowest (bottom three) priorities, the alignment of priorities within couples, and test for differences in prioritization between men and women within couples (Wilcoxon signed rank test).ResultsMaintaining a close and satisfying relationship with one’s partner was ranked as a high priority by majorities of men and women, and in 25% of couples, both partners ranked this factor as their most important priority for family building. Majorities of men and women also ranked building a family in a way that does not make infertility obvious to others as a low priority, and in 27% of couples, both partners ranked this factor as the least important priority for family building. There were also differences within couples that involved either men or women ranking a particular goal more highly than their partners. More women ranked two factors higher than did their partners: 1) that I become a parent one way or another (p = 0.015) and 2) that I have a child in the next year or two (p < 0.001), whereas more men ranked 4 factors higher than their partners: 1) that our child has [woman’s] genes (p = 0.025), 2) that our child has [man’s] genes (p < 0.001), 3) that I maintain a close relationship with my partner (p = 0.034), and 4) that I avoid side effects from treatment (p < 0.001).ConclusionsClinicians who support patients in assessing available family-building paths should be aware that: (1) patients balance multiple priorities as a part of, or beside, becoming a parent; and (2) patients and their partners may not be aligned in their prioritization of achieving parenthood. For infertility patients who are in relationships, clinicians should encourage the active participation of both partners as well as frank discussions about each partner’s priorities for building their family.

A conceptual framework for patient-centered fertility treatment

“…As part of this conversation, clinicians should aim to understand patients’ priorities for treatment. One approach to doing so while also helping patients to clarify their own positions in relation to the dimensions is to work through the Family-Building Priorities Tool with new patients [ 9 ]. Adoption of this tool will show clinicians how patients prioritize factors associated with different treatments, giving them a sense of what patients value most as they approach treatment decisions.…”

“…When couples are seeking treatment, patient-centered fertility care should balance the preferences, needs, and values of both members of the couple. While couples seeking medical treatment for infertility ostensibly do so because they strongly desire to have a child, this goal is balanced by other priorities [ 8 ], particularly maintaining a close relationship with a partner [ 9 ].…”

Effectiveness of an Educational Program in Enhancing Infertile Women’s Psychological Health

“…In this context, a study in the United States revealed that the highest priority of the majority of infertile couples were the maintenance of a stable and satisfying marital relationships. [36] Additionally, the high scores of the avoidant aspect of the ECR-R scale could be a reflection of the present study woman's attitude towards the society, which always blames the infertile woman for this condition. In agreement with this, a study in Sweden revealed that many of the infertile women, particularly those with secondary infertility were avoidant in the discussion of fertilityrelated issues in their social encounters, but to a less extent with their spouses.…”

Integration of partners of young women with cancer in oncofertility evidence‐based informational resources

“…37 Among noncancer populations, research has advocated that for infertility patients, clinicians should encourage the active participation of both partners in fertility discussions and decisions. 38 This practice is substantiated by the European Society of Human Reproduction and Embryology (ESHRE) guidelines, developed for fertility information provision for patients in the general community on psychosocial care in infertility treatment, which recommends the active involvement of partners in fertility decision making. 39 In parallel, NICE (National Institute for Health and Care Excellence) guidelines for fertility problems recommends that couples who experience problems in conceiving should be seen together because both partners are affected by decisions surrounding investigation and treatment.…”