In the present study, 40.3% of women and 21.9% of men answered “strongly agree” when asked about feeling regret over the delay in childbearing decision. Notably, regret arises from the contrast between a negative outcome, owing to a wrong decision and an alternative, better outcome, which may have happened if a different decision had been made [26, 27]. In a previous study, women who sought fertility treatment regretted their decision to delay childbearing, and instead, felt they should have chosen to conceive a child . Similarly, our participants regretted the fact that, at the time of this study, they could have already had children if they had not chosen to delay childbearing in their past.
Our results suggest that regret over the delay in childbearing decision is negatively associated with life satisfaction in women. Thus, given that 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 exactly is considered an appropriate behavior/situation regarding childbearing, and how to achieve it. In previous qualitative interviews, participants’ regret over a delay in finding the right partner or over 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 concerning the process of human fertility could have enabled them to attempt conception earlier in life, thereby reducing feelings of regret.
In the present study, previous live birth was a positive factor that influenced life satisfaction in women. In a Japanese survey of men and women aged between 18 to 49 of age, researchers found that, regardless of marital status (i.e. married or unmarried), the most common reason participants had children was “Having children makes life pleasing and plentiful” . Additionally, in a study in Portugal with childless women and men between 18 to 45 years of age who were randomly recruited, 99.5% of participants desired children in the future and 61.7% reported that having children would positively contribute to life satisfaction . Nevertheless, a different study conducted 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 is no wide consensus regarding this topic, our study suggests that achieving parenthood may have a positive impact on life satisfaction for Japanese women and men seeking fertility treatment.
Additionally, we found that, for women, experience with ART was negatively related to life satisfaction, which is somewhat consistent with previous studies. For example, in previous studies, ART patients had significantly more depressive symptoms than infertile women not undergoing fertility treatments, and the level of depression was negatively correlated with life satisfaction . In the present study, 83.1% of the women who used ART were over 35 years of age, similar to Japanese statistics in 2017, where the 35-year-old production rate per ART cycle indicated was less than 20% . Ultimately, fertility treatment cannot always overcome age-related infertility and many women are experiencing psychological burdens while being treated.
Unlike women, there was no relationship observed between life satisfaction and regret over the delay in childbearing decision in men. Previous studies have reported that men recognize infertility as ‘a disconcerting event but not a tragedy’ that is considered solved or accepted, whereas women see it ‘as a devastating experience’ that affects their identity . Moreover, infertile women may be more at risk of psychological distress than their partners .
This study has two clinical implications. First, to reduce feelings of regret related to their past decisions concerning childbearing, health professionals should care for patients; indeed, psychosocial counseling is recommended as an essential component of fertility treatment [35, 36], mainly because fertility treatments place psychological and physical burdens on the patient. Our results suggest that reducing the feelings of regret through counseling may have a positive impact on life satisfaction. All patients have their own personal history and characteristics, so health professionals should respect what the patients have achieved prior to planning a pregnancy and try to reduce patients’ negative affect, including feelings of regret. As fertility treatment carries no guarantee of achieving parenthood, and around 30% of the patients do not achieve it [37, 38], reducing the feeling of regret during the treatment process is also important to help patients live satisfying lives, even if they end the treatment without achieving parenthood.
Second, health professionals should encourage women and men to start thinking about their parenthood, and its timing, from an earlier age. An international survey noted that the delay in childbearing decision was due to a lack of fertility knowledge – such as lack of understanding regarding age-related infertility – and risk factors that affect fertility . Although reproductive-aged Japanese individuals learn about contraception during school, they mostly learn about fertility through the mass media, followed by the internet . Therefore, it is necessary to explore new ways of spreading information as widely as possible, such as creating websites and smartphone applications that incorporate the opinions of reproductive-aged women and men [40, 41]. In addition, health professionals also assess the usability of existing online information and instruct reproductive-aged women and men how to use it effectively . Overall, it is important for health professionals to explore effective methods without being bound by traditional ones .
In a previous study, when people made the best-informed decision possible, they could justify their decisions, even when the outcome was not one for which they had hoped . Hence, to help people to live a satisfying life without major regrets later, it may be necessary to provide women and men with a better informed and satisfying reproductive life plan.
Finally, we considered that the regret owing to the delay in childbearing decision was not only a problem stemming from within the individual, but was also a social one. Faced with this prospect, we see a need to overcome important challenges. Specifically, to prevent regrets related to delayed childbearing decision possibly resulting in involuntary childlessness, health professionals should try avoiding extending medical solutions (such as ART), and the social environment should provide reproductive-aged women and men with the opportunity to start a family earlier in life without needing to sacrifice their careers, academic goals, and life expectations in order to do so [8, 13]. Therefore, to limit the increasing prevalence of infertility within Japanese society., there is a need to extend public awareness regarding the impact of delaying childbearing decision. A reproductive life plan is effective for extending this awareness, because it provides an opportunity for reproductive-aged women and men to reflect on their interest and hopes of becoming parents and on preconception care. Just as many countries use internet to increase fertility awareness , using online tools and a reproductive life plan can also be helpful for Japanese reproductive-aged women and men.
This study has some limitations. First, there is an issues of causality. That is, we targeted women and men seeking fertility treatment, and given that their psychological burden of participating was considered quite heavy, we utilized a cross-sectional design. However, a cross-sectional study cannot assess causality, so it represents only the relationship between lower life satisfaction and regret over delaying childbearing decision among women seeking fertility treatments. In addition, we used psychological indicators as independent and dependent variables that were unstable in their measurement. To clarify the potentially causation between life satisfaction and regret, longitudinal research with multiple indicators must be conducted, without burdening the participants. Second, this study was limited to Japanese women and men who were seeking fertility treatment, so our findings cannot be generalized to the other populations. However, we collected data from nine facilities, including seven private clinics and two units from general hospitals used for infertility treatments. Consequently, 83.1% of the women who used ART in the present study were over 35 of age and the rate was similar to Japanese ART statistics in 2017 (77.0%) . Therefore, we believe that our results can be generalized to infertility patients in Japan. Third, although the overall valid response rate was low (35.3%), it was similar to a previous study of life satisfaction among infertile participants (i.e., 41%) . Although the response rate to be low in this type of study, due to psychological burdens placed on the participant, we should further expand this research in an effort to increase the response rate. Finally, we did not investigate those who did not wish to participate, thus, in the future, researchers should characterize participants who refuse to participate, as their burden of infertility may be so great that they refuse to participate.