Feasibility and acceptability of psychosocial care for unsuccessful fertility treatment

Introduction: Many people undergo fertility treatment to have biological children, but
around four in ten patients complete all treatment cycles without having the children
they desire. This triggers intense grief from which patients report taking on average
2 years to recover. Fertility guidelines and regulators stress the need to support
patients through this process, but there is a scarcity of evaluated interventions to this
end and evidence about when and how to offer care is lacking. This study explored
patients' and healthcare professionals' (HCPs) experiences of and views about
provision of psychosocial care (to patients facing unsuccessful fertility treatment, i.e.,
care provided by a mental health professional to address the emotional, cognitive,
behavioural, relational and social needs that patients have at this stage of treatment).
Methods: Five qualitative online focus groups were conducted with Portuguese
participants: three with patients waiting to initiate or undergoing their last cycle of in
vitro fertilization/intracytoplasmic sperm injection or having completed it within the
last 2 months without achieving a pregnancy and two with HCPs working at fertility
clinics. Focus groups were recorded and transcribed verbatim, and data were
analysed with Framework Analysis.
Results: Thirteen patients and nine HCPs participated. Analysis resulted in 1293
codes, systematically organized into 13 categories, 4 themes and 1 metatheme. The
latter showed high consensus about the need for psychosocial care for unsuccessful
treatment, but perceived challenges in its implementation. Themes reflected (1)
consensual demand for psychosocial care at all stages of treatment but particularly
at the end, (2) high perceived acceptability of integrating preventive care initiated
during treatment with early psychosocial care only for those patients who
experience unsuccessful treatment, (3) perceived challenges of implementing psychosocial care for unsuccessful treatment at clinics and (4) suggestions to
promote its acceptability and feasibility.
Conclusion: Patients and HCPs perceive that clinics should improve care provision
across the whole treatment pathway and in particular for unsuccessful fertility
treatment. Suggestions were made to inform future research focusing on the
development and evaluation of psychosocial interventions to this end.
Patient or Public Contribution: Patients and HCPs participated in the focus groups.
Two HCPs also revised the manuscript.
The authors are also grateful to the European Social
Fund and Portuguese Foundation for Science and Technology, I.P.
(FCT; Fundação para a Ciência e a Tecnologia) for supporting the
present study, through the Portuguese State Budget. Mariana
Sousa‐Leite has a doctoral fellowship (SFRH/BD/144429/2019),
Raquel Costa has a postdoctoral fellowship (SFRH/BPD/117597/
2016), and the EPI Unit, ITR and CIPsi (PSI/01662) are also funded by
FTC, in the scope of the projects UIDB/04750/2020, LA/P/0064/
2020 and UIDB/PSI/01662/2020, respectively.