{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T21:06:26Z","timestamp":1787259986346,"version":"build-2736575974"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,3,1]],"date-time":"2020-03-01T00:00:00Z","timestamp":1583020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R21HD071332"],"award-info":[{"award-number":["R21HD071332"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008980","name":"Medical College of Wisconsin","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008980","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Research Service Award","award":["T32 HP10030"],"award-info":[{"award-number":["T32 HP10030"]}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["8UL1TR000055"],"award-info":[{"award-number":["8UL1TR000055"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,27]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>STUDY QUESTION<\/jats:title><jats:p>What are couples\u2019 decisional conflicts around family-building approaches before and after seeking a specialty consultation for infertility?<\/jats:p><\/jats:sec><jats:sec><jats:title>SUMMARY ANSWER<\/jats:title><jats:p>Decisional conflict is high among couples before an initial specialty consultation for infertility; on average, women resolved decisional conflict more quickly than men.<\/jats:p><\/jats:sec><jats:sec><jats:title>WHAT IS KNOWN ALREADY<\/jats:title><jats:p>Couples have multiple options for addressing infertility, and decisional conflict may arise due to lack of information, uncertainty about options and potential risks or challenges to personal values.<\/jats:p><\/jats:sec><jats:sec><jats:title>STUDY DESIGN, SIZE, DURATION<\/jats:title><jats:p>We conducted a total of 385 interviews and 405 surveys for this longitudinal, mixed-methods cohort study of 34 opposite-sex couples who sought a new reproductive specialty consultation (n\u00a0=\u200968), who enrolled before the initial consultation and were followed over 12\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>PARTICIPANTS\/MATERIALS, SETTING, METHODS<\/jats:title><jats:p>The in-depth, semi-structured interviews included questions about information gathering, deliberation and decision-making, and self-administered surveys included the Decisional Conflict Scale (DCS), at six time points over 12\u00a0months. A DCS total score of 25 is associated with implementing a decision, and higher scores indicate more decisional conflict. A systematic content analysis of interview transcripts identified major themes. Paired t tests identified differences in DCS between women and men within couples. Linear mixed models predicted changes in DCS over time, adjusting for sociodemographic and fertility-related factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>MAIN RESULTS AND THE ROLE OF CHANCE<\/jats:title><jats:p>The major qualitative themes were communication with partners, feeling supported and\/or pressured in decision (s), changing decisions over time and ability to execute a desired decision. Average DCS scores were highest before the initial consultation. Within couples, men had significantly higher decisional conflict than women pre-consultation (48.9 versus 40.2, P\u00a0=\u20090.037) and at 2\u00a0months (28.9 versus 22.1, P\u00a0=\u20090.015), but differences at other time points were not significant. In adjusted models, predicted DCS scores declined over time, with women, on average, reaching the DCS threshold for implementing a decision at 2\u00a0months while for men it was not until 4\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>LIMITATIONS, REASONS FOR CAUTION<\/jats:title><jats:p>This is a convenience sample from a single center, and generalizability may be limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>WIDER IMPLICATIONS OF THE FINDINGS<\/jats:title><jats:p>Understanding how couples discuss and make decisions regarding family-building could improve the delivery of patient-centered infertility care. Our findings are the first to prospectively explore decisional conflict at multiple time points in both men and women; the observed gender differences underlie the importance of supporting both partners in clinical decision-making for infertility.<\/jats:p><\/jats:sec><jats:sec><jats:title>STUDY FUNDING\/COMPETING INTEREST(S)<\/jats:title><jats:p>This work was supported by the National Institute of Child Health and Human Development under Grant [R21HD071332], the Research and Education Program Fund, of the Advancing a Healthier Wisconsin endowment at Medical College of Wisconsin, the National Research Service Award under Grant [T32 HP10030] and the use of REDCap for data collection from the National Center for Advancing Translational Sciences, National Institutes of Health under Grant through [8UL1TR000055]. The authors have no competing interests.<\/jats:p><\/jats:sec>","DOI":"10.1093\/humrep\/dez292","type":"journal-article","created":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T20:10:58Z","timestamp":1576267858000},"page":"573-582","source":"Crossref","is-referenced-by-count":12,"title":["Decisional conflict among couples seeking specialty treatment for infertility in the USA: a longitudinal exploratory study"],"prefix":"10.1093","volume":"35","author":[{"given":"R","family":"Anguzu","sequence":"first","affiliation":[{"name":"Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Cusatis","sequence":"first","affiliation":[{"name":"Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Fergestrom","sequence":"first","affiliation":[{"name":"Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Cooper","sequence":"first","affiliation":[{"name":"Social Science Research Institute, Duke University, Durham, NC 27708, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K D","family":"Schoyer","sequence":"first","affiliation":[{"name":"Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology and Infertility, Medical College of Wisconsin, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J B","family":"Davis","sequence":"first","affiliation":[{"name":"Cayman Fertility Centre, Barbados Fertility Centre Group, Grand Cayman, KY1, 1005, Cayman Islands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Sandlow","sequence":"first","affiliation":[{"name":"Department of Urology, Medical College of Wisconsin, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K E","family":"Flynn","sequence":"first","affiliation":[{"name":"Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,3,10]]},"reference":[{"key":"2020033016151679100_ref1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.4103\/jhrs.JHRS_63_17","article-title":"Acceptance of donor eggs, donor sperms, or donor embryos in Indian infertile couples","volume":"11","author":"Banerjee","year":"2018","journal-title":"J Hum Reprod Sci"},{"key":"2020033016151679100_ref2","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1007\/s00520-017-4006-z","article-title":"Fertility information needs and concerns post-treatment contribute to lowered quality of life among young adult female cancer survivors","volume":"26","author":"Benedict","year":"2018","journal-title":"Support Care Cancer"},{"key":"2020033016151679100_ref3","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.1002\/cncr.29917","article-title":"Young adult female cancer survivors\u2019 unmet information needs and reproductive concerns contribute to decisional conflict regarding posttreatment fertility preservation","volume":"122","author":"Benedict","year":"2016","journal-title":"Cancer"},{"key":"2020033016151679100_ref4","doi-asserted-by":"crossref","DOI":"10.1093\/humrep\/dem046","article-title":"International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care","author":"Boivin","year":"2007","journal-title":"Hum Reprod"},{"key":"2020033016151679100_ref5","doi-asserted-by":"crossref","first-page":"3127","DOI":"10.1093\/humrep\/dep340","article-title":"When and why do subfertile couples discontinue their fertility care? 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