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 (19%) across all groups expressed moderate-to-severe regret, cohort-wide; the no-treatment subgroup was overrepresented in that count. That cohort-wide figure blends very different outcomes, though: women who succeeded at treatment showed near-zero regret, while those who did not add a child (regardless of treatment path) showed the highest scores overall.
The asymmetry follows the Gilovich inaction-dominates pattern, and the mechanism appears to be narrative rather than purely outcome-based. Jeffries and Konnert’s comparison of voluntarily childless women, involuntarily childless women, and mothers found that involuntarily childless women reported lower overall well-being and more child-related regret than voluntarily childless women — but that about a third of the women researchers had classified as involuntarily childless described themselves as “childless by choice,” having made an active decision to accept a childless life and focus on the future, and these women reported better adjustment by exerting a sense of control over their situation. The key variable appears to be not which path was chosen but whether the person moved through the decision actively and reframed it, rather than remaining in unresolved involuntary childlessness.
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, but the regret data do not track that intensity gradient the way it might seem: Cusatis et al. found identical median regret scores (0) for the IVF group and the other, lower-intensity treatment group, with no-treatment as the outlier (median 15) and failing to add a child at all as the sharpest divide (median 35). Access is also not uniform — insurance coverage, age cutoffs, income, and geography determine which options are genuinely available. The WHO estimates roughly 1 in 6 people worldwide (17.5% of the adult population) are affected by infertility, with comparable lifetime prevalence across high-, middle-, and low-income countries, 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.