Duthie Elizabeth A, Cooper Alexandra, Davis Joseph B, Sandlow Jay, Schoyer Katherine D, Strawn Estil, Flynn Kathryn E
Center for Patient Care and Outcomes Research, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
Social Science Research Institute, Duke University, Box 90989, Durham, NC, 27708, USA.
Reprod Health. 2017 Apr 5;14(1):52. doi: 10.1186/s12978-017-0311-8.
Infertility 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.
Participants 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).
Maintaining 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).
Clinicians 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.
不孕不育治疗决策要求人们在多个优先事项之间进行权衡。在夫妻双方中，伴侣之间也必须就优先事项进行协商。在本研究中，我们评估了夫妻在首次咨询生殖专家之前建立家庭的优先事项。
参与者为即将首次咨询生殖专家的夫妻（N = 59对夫妻（59名女性；59名男性））。在咨询之前，夫妻双方分别完成了“建立家庭优先事项工具”，该工具要求他们对与建立家庭相关的10个因素从最不重要到最重要进行排序。我们描述了最高（前三项）和最低（后三项）优先事项、夫妻之间优先事项的一致性，并测试夫妻中男女在优先排序上的差异（Wilcoxon符号秩检验）。
大多数男性和女性都将与伴侣保持亲密且令人满意的关系列为高度优先事项，并且在25%的夫妻中，双方都将这一因素列为建立家庭最重要的优先事项。大多数男性和女性也将以一种不让他人明显看出不孕不育的方式建立家庭列为低优先事项，并且在27%的夫妻中，双方都将这一因素列为建立家庭最不重要的优先事项。夫妻之间也存在差异，即男性或女性将某个特定目标的优先级排在高于其伴侣的位置。更多女性将两个因素的优先级排在高于其伴侣的位置：1）我无论如何都要成为父母（p = 0.015）和2）我在未来一两年内要生孩子（p < 0.001），而更多男性将4个因素的优先级排在高于其伴侣的位置：1）我们的孩子拥有[女性]的基因（p = 0.025），2）我们的孩子拥有[男性]的基因（p < 0.001），3）我与伴侣保持亲密关系（p = 0.034），以及4）我避免治疗的副作用（p < 0.001）。
支持患者评估可用的建立家庭途径的临床医生应意识到：（1）患者在成为父母的过程中或之外会权衡多个优先事项；（2）患者及其伴侣在实现为人父母的优先排序上可能不一致。对于处于恋爱关系中的不孕不育患者，临床医生应鼓励双方积极参与，并坦诚讨论每个伴侣建立家庭时的优先事项。
