Women who did not pursue a second in vitro fertilization cycle after a failed cycle were surveyed. The major reason for not pursuing a second cyclewas financial.KEY WORDS: finance; in vitro fertilization; psychologic stress. ~TRODUCTIONIn vitro fertilization (IVF) is still generally considered to be the last step for couples who are being treated for infertility. There have been many studies regarding the stress of infertility and specifically the stress of IVF. Collins et aL (1) examined the stress associated with infertility reported by couples who were enrolling in an IVF program. Sixty-three percent of the women and 38% of the men expected that IVF treatment would be extremely stressful. Mahlstedt et al. (2) analyzed responses from 94 IVF patients. They found that 82% of the patients did not view the decision to enter the IVF program to be a difficult one and that upon entry to the program 56% of patients indicated they would repeat the IVF treatment if the initial procedure was not successful. Interestingly after the first IVF cycle, only 37% of couples planned to repeat the treatment. Factors they found that influenced patients' plans not to repeat IVF included emotional strain, medical barriers, and disruption of activities. We also have been interested in the attitudes of couples who do not pursue a second IVF cycle after an initial cycle is not successful and have in this study examined such couples.i Department of Ob/Gyn, University Hospitals of Cleveland, 11100Euclid Avenue, Cleveland, Ohio 44106. MATERIALS AND METHODSQuestionnaires were sent to 54 couples who went through a single unsuccessful IVF cycle during the years 1990-1993 and who had not pursued a second cycle as of October 1995. Questionnaires were mailed to the last known address. If a response was not received in 3 weeks a telephone call was made in follow-up. Several of the questionnaires were returned undelivered, the couples having moved with no forwarding address available, DemographicsAt the time of the IVF procedure the women ranged in age from 29 to 40, with a mean age of 34.5 (SD, 3.5). Women were predominantly white (25 of 28). All women responding had at least a twelfth-grade education, with 17 to 28 being at least college graduates. Their spouses all had at least a twelfth-grade education as well, with 18 of 28 being at least college graduates. Nine of 28 women described their occupation as professional, and an equal number of men listed their occupation as professional. Length of infertility at the time of the IVF procedure ranged from 2 to 15 years, with a mean of 6.9 years (SD, 4.3 years). Twenty-four of the 28 women had no living children; the other 4 each had one. Five of the 28 women had had a voluntary termination in the past. MeasuresThe questionnaire included three sets of questions that attempted to determine the attitudes of couples who chose not to pursue a second cycle of IVE The 381

In vitro fertilization can be cost-effective if steps are taken to minimize high-order multiple (triplet or more) pregnancies.

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