Gameiro S, Leone D, Mertes H
School of Psychology, Cardiff University, Cardiff, UK.
Unit of Clinical Psychology, San Paolo University Hospital, Milan, Italy.
Hum Reprod. 2024 Aug 1;39(8):1591-1598. doi: 10.1093/humrep/deae128.
In medically assisted reproduction (MAR) success has mostly been measured in terms of achieving (healthy) livebirths. We argue this focus is too narrow and that success should be measured in terms of alleviating patient suffering caused by an unfulfilled child wish. The major implication is that clinics must better tailored care to effectively support patients who do not have child(ren) with treatment. First, we argue that clinics have a duty of care towards patients for whom MAR does not result in children because this is a common treatment outcome, because treatment is burdensome and creates new losses for patients, and because the field has the necessary expertise to provide support and it is part of patient-centred care. Then, we examine concerns about the adequacy of addressing the possibility that treatment may end without children, namely, that this may hinder patients' hope and put them off doing treatment, and that it may be perceived as a sign of clinical incompetence, as well as concerns about the required skill set. We end with a set of research-informed recommendations to promote healthy adjustment to ending fertility treatment without children. These focus on the need to reconceptualize 'success' and 'failure' in MAR, to promote open discussion about the possibility of treatment not resulting in children and encourage patients to develop 'plan(s) B', to support patients who end treatment without children, and to create the organizational structures needed to support clinics and healthcare professionals in this endeavour.
在医学辅助生殖（MAR）中，成功大多是以实现（健康的）活产来衡量的。我们认为这种关注点过于狭隘，成功应以减轻因未实现生育愿望而给患者带来的痛苦来衡量。主要的影响是，诊所必须更好地量身定制护理，以有效支持那些接受治疗但未育有子女的患者。首先，我们认为诊所对那些接受医学辅助生殖但未育有子女的患者负有照护责任，因为这是一种常见的治疗结果，因为治疗是繁重的且会给患者带来新的损失，还因为该领域具备提供支持所需的专业知识，且这是患者中心护理的一部分。然后，我们审视了对于处理治疗可能无果而终这一可能性是否充分的担忧，即这可能会阻碍患者的希望并使他们放弃治疗，还可能被视为临床能力不足的表现，以及对所需技能组合的担忧。我们最后提出了一系列基于研究的建议，以促进对未育有子女而结束生育治疗的健康调适。这些建议着重于重新界定医学辅助生殖中的“成功”与“失败”，促进对治疗可能无法育有子女这一可能性进行开放的讨论，并鼓励患者制定“备用计划”，支持那些未育有子女而结束治疗的患者，以及创建所需的组织结构，以支持诊所和医疗保健专业人员开展此项工作。
