Table 3 Qualitative Themes and Example Quotes

Burdensome process of adding a child to family was “worth it”

Participants acknowledge the physical, mental, and emotional difficulties involved in the process of adding a child to one’s family while also expressing appreciation and sentiments that “it was all worth it.”

“It was no question with my husband and I that we wanted to add to our family, it was just a matter of how to, either through treatment or adoption. It was SO (like I can’t even tell you how much) exhausting mentally, emotionally and financially. But after 6 years, 5 cycles of IVF, we have our twin girls and another on the way, and it was worth it. Every single procedure, test, vial of blood, appointment, phone call, every dollar, was worth it.” Woman, age 35

“I feel very grateful that my husband and I were able to adopt our son. We tried 6 rounds of IUI treatments and we were left with great disappointment every time it didn’t work. Adopting was the best decision we could have made; it helped us have our family, helped the birth mother, and it helped our son find his forever home.” Woman, age 38

“It was a hard process in the beginning with our fertility struggles and the emotional roller coaster but I do not regret for one second that we went through that to get our children.” Woman, age 31

“I think it turned out in the end; it was a tough battle but worth it.” Male partner, age 41

“All the effort it took was worth it. Our 2 children are the greatest accomplishment of our lives.” Male partner, age 30

“We are extremely happy to have added our son to our family through adoption. The process itself was horrendous and emotionally exhausting, but it all worked out.” Woman, age 35

“We have two beautiful children and they were worth the process for sure. Adoption would not have been any less expensive.” Woman, age 45

Gratitude for parenthood

Participants express thankfulness for the way they added a child to their family, whether that was through treatment, fostering, adoption, or other paths

“I love the path we've taken to become parents thru fostering. It's extremely fulfilling, and I couldn't imagine not doing something like this.” Male partner, age 40

“We have tried and continue to get ourselves healthy and able to have more children. It has been amazing to know that we have two miracle children, despite our health and fertility struggles.” Male partner, age 31

“Great. We had two kids from the same donor sperm via IUI.” Woman, age 33

“Both adoption and IVF brought children to our family, and so I am extremely grateful for the decisions we made.” Woman, age 33

Dissatisfaction or regret about a past decision or process related to trying to add a child to their family

Participants reflecting on the path they attempted to add a child to their family and expressing discontent in the path

“Should have tried earlier.” Woman, age 45

“I wish I didn’t have to do clomid.” Woman, age 33 and Woman, age 37

Dissatisfaction or regret regarding the expenses to add a child to one’s family

Disappointment or unhappiness expressed related to the financial cost of adding a child to one’s family

“I wish we were able to afford to do more to add children to our family.” Woman, age 40

“I wish I had the financial means to do more to add to our family.” Woman, age 41

“I love my kids, could have done without the financial burden.” Male Partner, 43

“It's absurd how expensive IVF is. Absolutely insane! And I feel at least a portion should be covered by insurance or there should be a specific insurance plan available strictly for infertility. You shouldn't have to go broke to have a family.” Woman, age 40

“I wish we would have done one round of egg retrieval but if it wouldn’t have worked (like the first time) I think we would be worse off financially and emotionally, so I’m ok with it.” Woman, age 40

“We end[ed] up almost spending the same as IVF but [it] took us forever to have a child through inseminations [IUI].” Woman, age 31

Dissatisfaction or regret related to medical care

Disappointment or unhappiness expressed related to participants interaction with the medical system

“Your staff misled us on the viability of our options.” Male Partner, age 55

“I should have trusted my gut that something ELSE was wrong with me. Each time I had a negative side effect (i.e., dizziness, thirst, vision issues, lethargy), I was told by the attending nurse that these were side effects of the treatments I was receiving. I was never allowed to talk to the doctor directly. If only I had reached out to a qualified primary care medical provider, I would have learned of my diabetes earlier and possibly had the opportunity to continue growing my family.” Woman, age 49

“There were times during my treatment when I felt like I was being treated according to a 'one size fits all' plan… Ultimately, I wish I had advocated harder for myself from the get-go. I still would have chosen IUIs, but I would have increased and/or added certain medications to the mix… when fertility treatments are not covered by insurance, there are significant financial repercussions from failed cycles. Messing around with no/low intervention cycles can financially break a patient before they have the opportunity to 'move up' to an intervention that works.” Woman, age 40

Distress or regret because of health

Worry or concern related to participants or participants partner’s health as a result of infertility treatment

“My wife found a lump on her breast when our son was only 4 months old. It turned out to be breast cancer. Knowing what she went through, possibly because of the clomid, if I knew then what I know now, I’d ask her not to take it. But that could mean our son potentially would not have been born. I don’t know.” Man, age 38

“I don’t want to go through the fertility meds and hormones again. I have had multiple friends who have had fertility treatments and later developed breast or ovarian cancer and I am afraid to do anything like this again because of my friends.” Woman, age 33

Distress or regret about not adding a child to their family

Worry or concern related to unsuccessful paths to parenthood

“My husband and I went through a few procedures to conceive. None of the procedures or medication helped. I felt very discouraged and sad that we did not get pregnant.” Woman, age 41

Resignation

Abdication for the outcome of pursuing infertility treatment

“It was just how it had to be.” Woman, age 52

“We tried, it didn't work. Was a little sad, but we have moved on to enjoy life as God has it planned for us.” Woman, age 49

Satisfaction even though they did not add a child to their family

Happiness related to not adding a child to one’s family

“I felt it was a good decision at the time and yes, I [would] totally do it again, I just wish it would have worked. But at this stage in my life now I'm somewhat happy it didn't” Male partner, age 41

“My partner and I broke up, hugely [due] to [trying to have] a baby, and it just made other issues worse that were not even related to that. In a way I'm glad we separated before having a child. I would not want to be a single mother!!” Woman, age 42