SHARED DECISION MAKING WITH MULTIPLE STAKEHOLDERS: IN VITRO FERTILIZATION AND EMBRYO TRANSFER

Purpose: Infertile couples pursuing parenthood through in vitro fertilization (IVF) often produce multiple fertilized embryos and must decide how many embryos to transfer.

 Methods: As part of a longitudinal cohort study on infertility decision making, both members of 37 couples separately completed interviews ≤6 times over 12 months. We content-analyzed text segments pertaining to embryo transfer to identify: (1) how many embryos couples transferred per treatment; (2) factors contributing to that decision; and (3) changes over time. During the study period, 4 couples pursued IVF, attempting a total of 9 embryo transfers with 15 total embryos transferred.

Results: Participants identified several factors influencing their decision: provider advice; desiring/avoiding a multiple gestation; trying to increase the chances of success by transferring >1 embryo; and the desire to have remaining embryos that could be cryopreserved for future use. One participant consistently wanted to transfer a single embryo. The rest reported uncertainty, especially at the first attempt, when three of the four couples transferred a different number of embryos than they had planned (more than planned for two couples and fewer than planned for one). Patients attributed this change to seeing a different provider at the transfer than they had seen previously. One woman made the decision alone because her partner could not attend the visit. 

Conclusions: Couples recognized the importance of deciding how many embryos to transfer and carefully considered the decision with their partners and providers. However, most ended up making a different decision from what they had originally intended. Couples indicated general understanding of a medical-team model (wherein the provider with whom the couple consults may not conduct the transfer) and the benefits of this approach, but clearly did not appreciate the implications of this model for making decisions about how many embryos to transfer.  In this context, where decisions made affect multiple individuals (both parents and any resulting children), couples may benefit from a direct discussion with their provider early in the process including that 1) new information is often available at the time of embryo transfer and thus medical recommendations may change; 2) different providers hold different perspectives and may offer different advice; and thus, 3) both partners should be present at the transfer itself to make a final decision together.