This cross-sectional study aimed to investigate infertility-related factors associated with life satisfaction among Japanese women and men seeking fertility treatment. Results supported our hypothesis, as it showed an association between life satisfaction and regret over the delay in childbearing decision. Additionally, experiencing a previous live birth positively associated with life satisfaction.
Among all participants, 32.3% answered “strongly agree” about their degree of regret over the delay in childbearing decision. People’s regret arises from the contrast between a negative outcome that happened owing to a wrong decision and an alternative better outcome which might have happened in case another decision had been made [18, 19]. A previous study reported that women seeking for fertility treatment regretted their decision against childbearing when they should have, instead, chosen to conceive a child . Similarly, participants in our study regretted the fact that, at the time of this study, they could already have had children if they had not chosen against childbearing in the past.
In the descriptive analysis of degree of regret, 45.1% of the low life satisfaction group responded “strongly agree,” while 26.9% of the high life satisfaction group responded “strongly agree.” Life satisfaction refers to the degree to which a person positively evaluates one’s life, and it represents how much the person likes the life she/he leads . Our results suggested that regret over the delay in childbearing decision was negatively associated with life satisfaction. Thus, since regret is dependent upon a comparison with an alternative behavior/situation that is thought to be appropriate, we believe it may be important to know what would be an appropriate behavior/situation regarding childbearing, and how to achieve it. Previous qualitative interviews reported that participants’ regret for delaying to find the right partner or putting their childbearing decision on hold to achieve a successful career owed to a lack of information about age-related infertility . This denotes that more knowledge and information on the process of human fertility could have made it possible for them to attempt conception earlier in life, then allowing the avoidance of such regret feelings.
Our results showed that previous live birth was a positive factor that influenced life satisfaction. In a Japanese survey applied to both men and women aged between 18 to 49 years, researchers found that, regardless of marital status (married or unmarried), the most common reason for participants to have children was “Having children makes life pleasing and plentiful” . Additionally, a research performed in Portugal with childless women and men (randomly recruited) aged between 18 to 45 years showed that, among the participants, 99.5% wanted to have children in the future and 61.7% reported that having children would positively contribute to life satisfaction . Nevertheless, another study showed that it cannot be said that parents are happier than nonparents, mainly because well-being is influenced by many variables that include characteristics from both parent and child . Although there seems to not be a wide consensus regarding the topic, our study still showed that achieving parenthood had a positive impact on life satisfaction for Japanese women and men seeking fertility treatment.
Several studies have found that reproductive-aged women and men deem important to complete their education, have financial security and a stable relationship before taking on the responsibility of parenthood [25–27]. Further, delaying childbearing decision to pursue personal aspirations confers benefits to the individual , even if the chance of having a child decreases with age. Thus, it may be important to focus on the fact that delaying childbearing decision - or even one’s infertility situation/condition - are not wrong or bad behaviors or decisions. However, it was a problem that an education starting in adolescence, which mainly focused on pregnancy prevention, caused misunderstanding “it's so easy to get pregnant” . Additionally, another study showed that participants believed that fertility treatment could overcome the effects of age that relate to infertility . We would like to denote that importance in this subject should be placed on informed decision-making about the timing of childbearing.
This study has two clinical implications. The first one is that, to reduce their feeling of regret related to their past decisions on childbearing, health professionals need to care for patients; psychosocial counseling has been recommended as an essential component of fertility treatment [29, 30], mainly because such treatment places psychological and physical burden on patients. Our results suggested that reducing the feeling of regret through counseling may have a positive impact on life satisfaction. Every patient has her or his personal history and characteristics, so health professionals need to respect what the patients had achieved before planning pregnancy and try to reduce their negative affective feelings such as their regret. Further, fertility treatment carries no guarantee of achieving parenthood, and around 30% of the patients do not achieve it [31, 32]. Therefore, reducing the feeling of regret during the treatment process is also important to allow them to keep on living satisfying lives even if they end the treatment without achieving parenthood.
The second one is that health professionals need to encourage women and men to start thinking about their parenthood, and its timing, from an earlier age. An international survey noted that people’s choice to delay their childbearing decision owes to a lack of fertility knowledge - such as lack of understanding regarding age-related infertility - and risk factors that affect fertility . Thus, reproductive education should place equal importance at both ends: it should allow for young women and men to grow up understanding not only how to prevent undesired pregnancy but also how to protect their fertility and achieve parenthood when they desire. A previous study showed that, when people make the best-informed possible decision, they are able to justify their decisions, even if the outcome is not the one that they hoped for . Hence, to allow for people to live a satisfying life without major regrets at its later stages, it may be necessary to provide women and men with a better informed and satisfying reproductive life plan.
Finally, we considered that the regret coming from one’s delay in childbearing decision is not only a problem that comes from within the individual but also a social one. Faced with this, we see a need to overcome important challenges: to prevent people’s regrets related to delayed childbearing decision and involuntary childlessness, health professionals should try to avoid extending medical solutions (such as assisted reproduction technology), and the social environment should provide reproductive-aged women and men with the opportunity to start a family earlier in life without the need to sacrifice their careers, academic goals and life expectations in order to do so [13, 35]. Therefore, there is a need to extend public awareness about the impact of the delay in childbearing decision to limit the increasing prevalence of infertility within the Japanese society.
This study has many limitations, but we deem that two should be noted. First, this study was a cross-sectional study, so we cannot infer the temporal associations between regret over the delay in childbearing decision and life satisfaction. Second, this study was limited to Japanese women and men who were seeking fertility treatment, so the findings cannot be generalized to the other populations. Further study with general population should be explored in the future.