INFERTILITY-RELATED DECISION MAKING AND DECISIONAL CONFLICT

   Purpose: Infertility affects 15% of couples trying to conceive, and those who consider medical intervention must make complex decisions about reproductive options. We assessed decisional conflict about treatment options among couples that made an appointment with a reproductive specialist for infertility.

   Method: Both members of 37 couples completed surveys at 3 time points: prior to a first consultation with a reproductive specialist, one week after the consultation, and one week after receiving results from fertility-related testing. At each time, participants were prompted to identify the fertility treatment approach they most preferred at that time, and then to complete the Decisional Conflict Scale (DCS) considering that preferred approach. We analyzed differences by gender and changes across time in the DCS and its subscales. Scores above 37.5 are associated with delaying decisions; scores below 25 are associated with implementing decisions.

   Result: Before the first consult, both men and women had mean decisional conflict scores above 37.5 (48.53 and 39.24, respectively). Men’s scores were highest on the Informed subscale (measures feeling informed about decision alternatives, benefits, and risks), while women’s scores were highest on the Uncertainty subscale (measures uncertainty in choosing options). Decisional conflict declined post-consult (men to 32.68, p<0.001; women to 30.41, p<0.001) and again post-test-results (men to 28.13, p=0.085; women to 22.74, p=0.001). With one exception, men’s scores were higher than women’s on the total scale and all subscales at all time points. Differences between men and women were largest on the Informed subscale (pre-consult: men=60.30, women=46.15, p=0.013; post-consult: men=40.95, women=31.62, p=0.035; post-test-results: men=30.30, women=20.72, p=0.009).

   Conclusion: Prior to a first consultation with a reproductive specialist, both men and women experienced high levels of decisional conflict about which reproductive treatment options to pursue, with men reporting higher scores than women, on average. Decisional conflict tended to decline after couples met with the reproductive specialist and again after receiving test-results, but men’s scores did not reach the cutoff associated with implementing decisions. We will continue to track couples’ decisional conflict and decision making over the first year after meeting with a specialist.