This cross-sectional study investigated the degree of regret over the timing of the childbearing decision and reasons for delaying the decision among Japanese women and men seeking fertility treatment. We also explored the association between regret over the timing and reasons for the delay.
Women and men who had feelings of regret over the delay in childbearing decision were 57.3% and 49.5% respectively. The most common reasons for the delay in childbearing decision for both women and men were establishing their relationship and having financial security. These findings are similar to the reasons reported in a study of women seeking fertility treatment in Australia . A stable relationship has been identified as the most important factor for childbearing [16, 17]. Although the participants in the present study were all married at the time of the study, it had taken a long time for them to find a stable partner or to get married. Financial security was the second most important reason in the Australian study, as well as the second most important reason that men and women had in common in the present study. Financial stability is certainly essential for parenting children. However, women and men must also understand the cost of fertility treatment [16, 18], because they potentially may spend more money for fertility treatment by delaying the childbearing decision, and it may cause more financial hardship .
Except for establishing the marital relationship as a reason for the delay in childbearing decision, all other reasons were endorsed by less than 20% of the participants. Our results suggest that perhaps some of the participants may have delayed the childbearing decision for reasons that were not covered in our survey, or it may be that there was no apparent reason for the delay. The Centers for Disease Control and Prevention  encourage women and men to have a reproductive life plan. Making a reproductive life plan gives women and men an opportunity to explore their values and preferences about whether or when to have children .
One reason for regretting the timing of the childbearing decision was lack of fertility knowledge, which was found in both women and men. Many studies have reported that fertility knowledge is necessary to prevent women and men from delaying the childbearing decision [22, 23]. School-based sex education in Japan has traditionally focused on contraception and sexually transmitted diseases . Such a traditional model of sex education might lead to overestimating the chances of conception [12, 24], and uninformed decision making about the timing of childbearing. It is important to have knowledge not only to avoid pregnancy but also to achieve healthy conception. “Preconception care” has the aim of having women and men think about their future with regard to pregnancy, be conscious of caring for their health, and live a healthy life . In the United States, several states have developed tools to facilitate a reproductive life plan and promote preconception health, and some tools are also developed for middle school and high school students . We, therefore, need to provide information of a reproductive life plan in school-based sex education in Japan.
The present study found an association between health problems and regret over the timing of the childbearing decision only in men. In women, it was the second most important reason for the delay in childbearing decision but not related to feelings of regret. Men typically do not consider how their health may be associated with the physiological difficulties of having a child ; however, men who attended fertility counseling reported that they had tried to change their lifestyle behaviors after becoming aware of their fertility problem . Preconception care, which is health care before pregnancy, can ameliorate disease, improve the risk status, and prevent poor pregnancy outcomes [27, 28]. The Centers for Disease Control and Prevention  states that preconception health is important for both women and men; there are behaviors they can do for their own health, such as preventing sexually transmitted infections, quit smoking, and maintaining a healthy weight. Educating people on preconception health may allow them to make informed reproductive choices and decisions .
The timing of the childbearing decision is an individual one, so it does not mean that the decision to delay childbearing is wrong or necessarily will result in feelings of regret. However, it is important for early reproductive-aged women and men to have the opportunity to think about parenting and to decide what is best for them with accurate and sufficient fertility knowledge. Health professionals such as gynecologists and nurses/midwives should promote fertility knowledge including preconception health, and encourage informed decision making about the timing of childbearing.
There are two important limitations to this study that should be noted. First, the sample comprised only women and men who were seeking fertility treatment. Therefore, regret over the timing of the childbearing decision and reasons for delaying the decision may not be representative of women and men not seeking such treatment or those who were unsuccessful after attempting fertility treatment. Second, our retrospective design may result in recall bias, because the accuracy of the participants’ memories may be influenced by subsequent events and experiences, thereby posing a potential threat to the internal validity of the study.