"I'm never doing this again": Patients’ lived experiences of discontinuing homologous reproduction and considering third-party reproduction

Objectives: During the Medically Assisted Reproduction (MAR) pathway, the treatment termination is a critical phase. This study aims to explore the lived experiences of patients discontinuing homologous reproduction by a) examining how they perceive the clinician relationship in the decision‑making process, and b) exploring the factors that motivate patients to pursue third‑party reproduction or permanently forgo the treatment. Methods: This qualitative study employed Interpretative Phenomenological Analysis. Through convenience and purposive sampling, the study engaged patients who 1) have completed at least one cycle of homologous reproduction without live birth; 2) are currently awaiting third-party reproduction treatment or have permanently discontinued treatment within the past 36 months; (3) are Italian-speaking adults. Participants completed an online questionnaire to gather sociodemographic and clinical data and were involved in semi-structured interviews. Results: The sample included 21 participants. Of the 13 interviews conducted, five interviews were conducted with the woman alone, and eight were conducted with both partners present. The analysis yielded five overarching themes: 1) The MAR pathway: from diagnosis to the end of homologous treatment; 2) the clinician-patient relationship throughout the MAR journey and at treatment conclusion; 3) the dyadic decision-making process and couple communication; 4) the decision to transition to third-party reproduction; 5) the decision to permanently discontinue treatment. Conclusions: The findings highlight the communicative and relational dimensions of care as critical determinants of patients' experiences and decisions. Patients provide specific indications for improving the planning of MAR pathway, establishing goals and potential alternatives in advance. Healthcare professionals should share timely, evidence-based information and actively engage patients. Practical implications: The integration of these practices into routine MAR care has the potential to improve not only patients' satisfaction and their psychological wellbeing, but also the quality of care and appropriateness of decisions.