Deconstructing self-fulfilling outcome measures in infertility treatment

The typical outcome measure in infertility treatment is the (cumulative) healthy live birth rate per patient or per cycle. This means that those who end the treatment trajectory with a healthy baby in their arms are considered to be successful and those who do not are considered to have failed. In this article, we argue that by adopting the healthy live birth standard as the outcome measure that defines a successful fertility treatment, it becomes an interpretative self-fulfilling prophecy: those who achieve the goal consider themselves successful and those who do not consider themselves failures. This is regardless of the fact that having children is only one out of many ways to alleviate the suffering related to infertility and that stopping fertility treatment can also be a positive decision to move on to other goals, rather than a form of giving up, dropping out, nonadherence, or failure. We suggest that those seeking fertility treatment would be served better by an alternative outcome measure, which can be equally self-fulfilling, according to which a successful treatment is one in which people leave the clinic released from the suffering that accompanied their status as infertile when they first entered the clinic. This new outcome measure still implies that walking out with a healthy baby is a positive outcome. What changes is that walking out without a baby can also be a positive outcome, rather than being marked exclusively as a failure.

Automated summary

This article discusses the issue of outcome evaluation in infertility treatment. Currently, the success of the treatment is measured based on whether a healthy baby is born, which may lead to an unfair division between success and failure. The authors suggest using a new outcome measure, in which the success of the treatment is evaluated based on whether the individuals have been released from the suffering associated with infertility. This new measure includes both the cases of successfully giving birth to a healthy baby and the cases of not giving birth but being free from infertility-related suffering.