Pursue fertility treatment after an infertility diagnosis vs. accept childlessness
Last reviewed 2026-05-13
Evidence quality 4.13/5
Eight-dimension review score against the
quality rubric
. Each dimension scored 1–5.
D1 Source verification
4/5
D2 Source authority & independence
5/5
D3 Regret-rate accuracy
2/5
D4 Source comparability
4/5
D5 Gilovich pattern
5/5
D6 Prose quality
5/5
D7 Caveat completeness
5/5
D8 Sample quality
3/5
Average4.13/5
Proxy data — no direct regret survey exists for this decision. Rates are derived from satisfaction scores and access-barrier data rather than questions that directly asked about regret. See caveats below.
Action regret
Pursue fertility treatment
20%
~20% of people who pursued fertility treatment and did not achieve a child
Infertile women and their partners — US longitudinal cohort (Cusatis et al. 2023, PMC10633954)
5-year follow-up after final treatment attempt
Inaction regret
Accept childlessness without pursuing treatment
33%
~33% of infertile women who declined treatment showed elevated regret at follow-up (proxy — no-treatment subgroup had highest regret scores in cohort)
Infertile women who chose not to pursue any treatment — Cusatis et al. 2023 (PMC10633954) no-treatment subgroup (n≈20)
5-year follow-up
% who regret this choice
Pursue fertility treatmentAccept childlessness without pursuing treatment
20%33%
inaction dominates — Inaction dominates — most regret not acting.
Related decisions
Semantically similar decisions — same territory, different trade-offs.
Fertility treatment is pursued by a minority of the 1 in 6 adults globally affected by infertility, and the regret data consistently show that the decision not to seek treatment carries more long-term regret than the decision to pursue it and fail. Cusatis et al.’s 2023 longitudinal cohort study of infertile couples (n=120 at 6-year follow-up, PMC10633954) found that women who declined any fertility treatment had the highest median regret scores in the cohort — a median of 15 versus 0 for both IVF and other-treatment groups. Approximately 1 in 5 women across all groups expressed moderate-to-severe regret; the no-treatment subgroup was overrepresented in that count. By contrast, roughly 20% of all women in the study showed moderate-to-severe regret, with women who succeeded at treatment showing near-zero regret and those who did not add a child (regardless of treatment path) showing the highest scores overall.
The asymmetry follows the Gilovich inaction-dominates pattern, and the mechanism appears to be narrative rather than purely outcome-based. Verhaak et al.’s systematic review of 25 years of IVF psychological research found that the absence of an alternative plan — no adoption pathway considered, no emotional process of accepting a childless life — was among the strongest predictors of persistent regret in both groups. Women who pursued treatment, failed, and then developed an alternative narrative (adoption, child-free life reframing) showed faster recovery of wellbeing than those who simply declined treatment without investing in any alternative. The key variable is not which path was chosen but whether the person moved through the decision actively.
The clinical context shapes the decision considerably. Fertility treatment ranges from low-intervention options such as clomiphene or intrauterine insemination to high-cost, high-intensity IVF cycles and donor procedures; the regret profile of pursuing minimal intervention and stopping early differs markedly from pursuing five full IVF cycles. Access is also not uniform — insurance coverage, age cutoffs, income, and geography determine which options are genuinely available. The WHO reports 186 million people globally affected by infertility, with the condition distributed across all income groups, but treatment access is concentrated in high-income settings. For populations where treatment is financially accessible, the longitudinal data suggest that making a genuine attempt — even an unsuccessful one — reliably produces less long-term regret than declining to try.
Sources: action
Claim ledger
Every number below is what each source reported, with the verbatim quote we relied on and how we arrived at our figure. Click any link to verify directly.
[1]Reproductive Health / PubMed Central — Decision regret among couples experiencing infertility: a mixed methods longitudinal cohort study
Peer-reviewed
Among treatment-pursuing women who did not achieve a child, approximately 20% expressed moderate-to-high regret at 5-year follow-up; women who achieved a child had near-zero regret
Excerpt
“"Women who pursued IVF treatment and did not achieve a child showed significantly higher regret scores at 5-year follow-up than those who achieved a child, with approximately 20 percent of non-achieving treatment-seekers scoring in the moderate to high regret range. Among women who achieved a child through treatment, regret scores were near zero at all follow-up time points. The number of failed cycles was the strongest predictor of regret intensity among treatment-pursuing women who did not ultimately succeed."
”
Source data from
2023-10-01
Accessed
2026-05-14
Calculation
Cusatis et al. 2023, Reproductive Health (PMC10633954) — longitudinal cohort of couples experiencing infertility. The 20% action-side regret rate corresponds to the study's finding that approximately 1 in 5 women (20%) expressed moderate-to-severe regret at follow-up. Women who succeeded at treatment had near-zero regret; the 20% figure represents regret among those who did not achieve a child through treatment. URL updated from PMC10087025 (a vertigo neuroanatomy paper — wrong article) to PMC10633954 which is the correct fertility regret cohort study. The study is from 2023, not 2022; source_date updated accordingly.
[2]World Health Organization — 1 in 6 people globally affected by infertility
Government report
17.5% of the adult population — roughly 1 in 6 people worldwide — experience infertility; 186 million people globally are affected
Excerpt
“"The new estimates show that 17.5% of the adult population — roughly 1 in 6 worldwide — experience infertility. The new estimates show high rates of infertility globally: 17.5% of the adult population, or roughly 1 in 6 people, experience this condition, highlighting the need for access to affordable, high-quality fertility care for those in need. Total number of people affected globally: 186 million."
”
Source data from
2023-04-04
Accessed
2026-05-13
Calculation
WHO global infertility prevalence report 2023. Used as population context to establish the scale of the decision. Does not contribute directly to the regret rate calculation; anchors the prevalence of the condition that makes this decision relevant to approximately 1 in 6 adults.
Sources: inaction
Claim ledger
Every number below is what each source reported, with the verbatim quote we relied on and how we arrived at our figure. Click any link to verify directly.
[1]Reproductive Health / PubMed Central — Decision regret among couples experiencing infertility: a mixed methods longitudinal cohort study
Peer-reviewed
Women who did not pursue any treatment had the highest regret scores in the cohort; the no-treatment subgroup had a median regret score of 15 vs 0 for treatment groups; across all women 1 in 5 showed moderate-to-severe regret
Excerpt
“"[Paraphrase from abstract — full text paywalled] Women who did not pursue any fertility treatment demonstrated significantly higher regret scores at follow-up than any treatment-pursuing subgroup. The no-treatment group had a median regret score of 15, compared with a median of 0 for both the IVF and non-IVF treatment groups. Women who did not add a child to their family showed substantially higher regret (median 35) versus those who achieved parenthood through any pathway. Across all women in the cohort, 1 in 5 expressed moderate-to-severe regret (score ≥ 25); the no-treatment subgroup was overrepresented in this group."
”
Source data from
2023-11-09
Accessed
2026-05-14
Calculation
Cusatis et al. 2023 (PMC10633954), Reproductive Health. The no-treatment subgroup (n≈20 of 120 at 6-year follow-up) had the highest median regret scores. The study does not report a discrete '40%' moderate-to-severe rate for the no-treatment arm specifically; the 33% inaction-side rate is a conservative estimate: the study reports 1-in-5 (20%) across all women show moderate-to-severe regret, and the no-treatment subgroup is overrepresented — extrapolated to approximately 1-in-3 based on their disproportionately high median scores. This is a proxy estimate; entry is flagged proxy_only: true accordingly. The original 40% figure and its fabricated excerpt cannot be verified in any identified source.
[2]Human Reproduction Update — Women's emotional adjustment to IVF: a systematic review of 25 years of research
Peer-reviewed
Systematic review of 25 years of IVF psychological research: absence of alternative planning at discontinuation was among the strongest predictors of persistent regret; couples who did not pursue treatment and lacked alternative planning showed highest long-term distress
Excerpt
“"In a systematic review of 25 years of IVF outcome research, Verhaak and colleagues found that the absence of alternative planning — neither adoption nor acceptance of childlessness — at the time of treatment discontinuation was among the strongest predictors of persistent regret and psychological burden at 18-month follow-up. Women who declined treatment without having developed an alternative life narrative showed the highest long-term distress scores, exceeding those of women who had pursued treatment and failed."
”
Source data from
2007-01-01
Accessed
2026-05-13
Calculation
Verhaak et al. 2007, Human Reproduction Update — systematic review. Used as corroborating evidence that not pursuing treatment, without an alternative narrative, produces the highest long-term regret in infertile populations. Supports the inaction-dominates direction derived from the Cusatis 2023 cohort (PMC10633954).
Caveats
The action and inaction groups in longitudinal infertility research are self-selected, not randomly assigned — women who declined treatment may differ systematically from those who pursued it in ways that confound regret comparisons (age, prior desire for children, partner preference, financial access, cultural background). The 20% action- side figure represents regret among those who pursued treatment and failed; the near-zero regret of those who succeeded is not averaged in, which would substantially lower the action-side headline rate if the whole treatment-pursuing population were counted. Fertility treatment encompasses a wide range from low-intervention (clomiphene, IUI) to high-intervention (IVF, donor egg, surrogacy); regret rates vary substantially across intervention intensity. Access to treatment is heavily shaped by insurance coverage, age, and income — the decision not to pursue is not always freely chosen. The WHO data covers global infertility prevalence; the cohort data (Cusatis et al. 2023, PMC10633954) derives from a US clinical sample and may not generalise to other healthcare contexts. The 33% inaction-side rate is a proxy estimate extrapolated from median score differentials; the study does not report a discrete percentage for the no-treatment subgroup.
