Family-Building Priorities Differ Between Pregnancy Candidates and Partners Seeking Fertility Counseling

Women and their partners who seek fertility care often express different priorities for family building, according to findings from a new study. Priorities for couples also shift over time, suggesting important implications for patient education and counseling.

Elizabeth A. Duthie, PhD, of the Medical College of Wisconsin in Milwaukee, WI, presented results from the longitudinal prospective cohort study at the Scientific Congress & Expo of the American Society for Reproductive Medicine, held October 15 to 19, 2016, in Salt Lake City, UT. Alexandra L. Cooper, PhD, associate director of education, research, and evaluation at the Social Science Research Institute at Duke, was a coinvestigator of the study.

The study enrolled 85 patients with infertility and 62 supportive partners, representing 57 couples who were seeking care from reproductive endocrinology and infertility (REI) specialists. Within 1 week prior to their first REI consultation, all study participants were asked to rank their top 3 priorities for family building from a list of 10 potential priorities in the Family-Building Priorities Ranking Tool. At 12 months, participants who were not yet pregnant or parenting were asked to rerank their top 3 priorities from the same list of 10.

Results showed significant differences in family-building priorities for pregnancy candidates and their partners at both time points (Table). Areas of significant discordance involved having a child in the next year or so, becoming a parent one way or another, whether the child has the supporting partner’s genes, and avoiding the side effects of treatment.

Table. Ranking of Top 3 Priorities at Baseline and 12 Months

Priority Baseline 12 Monthsa
Pregnancy Candidates (n = 82), %

Supporting Partners
(n = 61), %

Pregnancy Candidates (n = 39), % Supporting Partners
(n = 24), %
That I maintain a close and satisfying relationship with my partner 62 79 74 58
That I have a child in the next year or two 55 23 39 25
That I become a parent one way or another 52 38 59 33
That I/my partner get(s) to be the person who is pregnant with and gives birth to my child 42 36 23 38
Cost 24 16 13 21
That my child has my genes 22 30 31 33
That my child has my partner’s genes 20 39 26 50
That I get to parent my child from birth 20 16 13 21
That I avoid side effects from medical treatments 2 20 10 13
That I can build my family in a way that doesn’t make it obvious to others that we had trouble 1 0 5 0

aIncludes only respondents who were not pregnant or parenting at 12 months.
Bold text indicates significant differences between pregnancy candidates and supporting partners.

Areas of consensus within couples also emerged. The most commonly shared priority among couples involved maintaining a close and satisfying relationship with one’s partner, which appeared among the top 3 priorities for 50% to 53% of couples at both time points. Couples also tended to agree on the least relevant factor for family building. At both time points, 5% or fewer of pregnancy candidates and none of the supportive partners prioritized the ability to maintain privacy about their methods for family building. These findings suggest that stigma around multiple births (which may suggest use of in vitro fertilization) or inter-racial adoption is minimal for couples seeking REI consultations. 

Priorities for family building also evolved over time. Among pregnancy candidates, more than one-half of those who prioritized being pregnant and giving birth at baseline no longer included this among their top 3 priorities at 12 months. Furthermore, REI specialists should recognize that becoming a parent may not be a high priority for some patients, even those who seek fertility counseling. At both time points, fewer than 40% of supportive partners prioritized “that I become a parent one way or another.”

Overall, approximately 75% of couples shared 1 or 2 of their top 3 priorities at both time points, indicating some common ground. However, priorities often substantially differed. More than 1 in 6 couples (16%-21%) had no overlap in their top 3 priorities at either time point. Few couples (4%-7%) shared all top 3 priorities at both time points.

“Family building is frequently a partnered activity, and the clinical discussions and treatment decisions that shape it should involve both prospective parents,” Duthie said.

Source: Duthie EA, Cooper A, Davis JB, et al. Infertility & family-building priorities. Presented at: American Society for Reproductive Medicine 2016 Scientific Congress & Expo; October 15-19, 2016; Salt Lake City, UT. Abstract O-9.