Advances in assisted reproductive technologies (ARTs) have improved the chances that couples with fertility problem can have children, but may also involve significant emotional, physical and financial consequences in both the short and long term. Despite the increasing use of ARTs, little is known about how couples make decisions about ART, the factors that are most critical in influencing these decisions, or the natural history of decision-making over the course of treatment. Knowledge gained from research on reproductive decision-making, which has focused primarily on traditional (i.e., non-assisted) proception, has not been applied to help answer questions regarding assisted proception. The proposed 5-year study will be the first prospective, longitudinal investigation of ART decision making and will: 1) examine the natural of couples' ART-related beliefs and their decisions to initiate, continue and stop ART treatment; 2) examine the degree to which essential elements of informed decision making characterize ART-related decision; 3) examine the utility of a theoretical model for describing, explaining and predicting decisions to initiate, continue, and stop ART treatment; 4) determine the role of fertility motivations and desires in ART decision-making; and 5) describe the nature and magnitude of influence that husbands play in couple's ART decision-making. In-depth interviews with 620 couples will be conducted prior to their use of ART, after receiving results from a first ART cycle, and at 6,12, and 18 month follow-ups to assess patients' perceptions of decision options, risks and benefits; fertility motivations and desires; beliefs about social norms; control beliefs; and fertility- related intentions. Reproductive outcomes, ART attempts, and the use of other reproductive options, including adoption, will be tracked for all study participants throughout the study period. In addition to expanding our knowledge of both assisted and unassisted reproductive behavior, the research will identify critical factors that influence ART decisions, allowing use t make specific recommendations about areas in which clinician intervention may be most promising and patient populations for whom such interventions are especially warranted. Results regarding patients' capacity for making informed decisions will have particular relevance to policy issues related to informed consent.
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