Decision regret after failed autologous in vitro fertilization in women ≥42 years of age

Abstract

Objective: To quantify the level of decision regret in women ≥42 years of age after autologous in vitro fertilization (IVF) and identify factors associated with moderate-to-severe regret.

Design: Cross-sectional survey.

Setting: Academic center.

Patient(s): Ninety-four women ≥42 years of age who underwent autologous IVF between 2012 and 2018.

Intervention(s): None.

Main outcome measure(s): Decision regret score, with >25 as threshold for moderate-to-severe regret.

Result(s): The overall response rate was 22%. Respondents had a median age of 43 years at the time of IVF. The median and mean decision regret scores were 10 and 17.1 (range, 0-75), respectively. Seventy-three percent (n = 69) had absent-to-mild regret (score, 0-25), and 27% (n = 25) had moderate-to-severe regret (score, >25) after IVF. Having no live births was associated with increased regret (odds ratio [OR], 22 [95% confidence interval {CI}, 2.82-171.82]). Among those who were unsuccessful, 40% (n = 24) had moderate-to-severe regret. Predictors for moderate-to-severe regret in this group included the lack of insurance coverage (OR, 0.33 [95% CI, 0.12-0.99]). Conversely, the perceived adequacy of information/counseling (OR, 0.44 [95% CI, 0.2-0.77]) and the perceived adequacy of emotional support (OR, 0.29 [95% CI, 0.15-0.55]) were protective factors inversely correlated with regret.

Conclusion(s): Autologous IVF carries a low success rate and a considerable risk of decision regret in women ≥42 years of age. In those who were unsuccessful, the perceived adequacy of information and that of emotional support were protective factors against increased regret. Although concluding from a small, selected pool, our results strongly suggest that ample counseling and psychological support should be particularly emphasized within this patient population.

Keywords: Decision regret; IVF; advanced reproductive age; emotional support.