Decision-making in IVF and adoption: negotiating circumstances over time

Conventional accounts of couples embarking on IVF foreground individual choice and static decision-making. Furthermore, research into different family-formation pathways for those who experience infertility is siloed into separate domains of IVF, adoption or remaining childless. This leaves an insufficient understanding of infertility in terms of the nature of decision-making, processes and inter-dependencies between couples and family networks in relation to meanings of establishing families. This PhD qualitative research tackles these shortcomings through a sample of 20 British heterosexual couples’ experiences of infertility and family-building based on retrospective accounts. The dataset includes men and women from a range of socio-economic circumstances and diverse families established through IVF and adoption.

Key findings based on the analyses of these accounts showed that decisions were not linear. Importantly, ongoing processes were informed by couples’ own experiences, family contexts and histories, which shaped their understanding and meanings of establishing families. Differences in decisions between adoption, IVF and donor conception families involved changes over the meanings of making families and varying disclosure practices to wider familial networks. My findings not only challenge existing literature but offer micro-level insights into decision-making patterns and practices of establishing families through infertility experiences.

Individual choice alone is not sufficient in explaining infertility decisions in IVF and adoption. Instead, decision-making contexts, circumstances in practice, reconfigured meanings of families and disclosure practices in family contexts should be understood as in/fertility journeys.

Overall, my findings build a case for advancing new knowledge in a range of areas around in/fertility journeys. My study especially contributes sociological insight into the ‘making’ and ‘doing’ of families through IVF or adoptive couples’ continual efforts in producing and shaping families ‘we live by’ both in material and interpretive terms. Implications of this research include developing more joined up health and social care practice and policy to support such decision-making.