Burden of care is the primary reason why insured women terminate in vitro fertilization treatment

Abstract

Objective: To study the reason(s) why insured patients discontinue in vitro fertilization (IVF) before achieving a live birth. Design: Cross-sectional study. Setting: Private academically affiliated infertility center. Patient(s): A total of 893 insured women who had completed one IVF cycle but did not return for treatment for at least 1 year and who had not achieved a live birth were identified; 312 eligible women completed the survey. Intervention(s): None. Main Outcome Measure(s): Reasons for treatment termination. Result(s): Two-thirds of the participants (65.2%) did not seek care elsewhere and discontinued treatment. When asked why they discontinued treatment, these women indicated that further treatment was too stressful (40.2%), they could not afford out-of-pocket costs (25.1%), they had lost insurance coverage (24.6%), or they had conceived spontaneously (24.1%). Among those citing stress as a reason for discontinuing treatment (n = 80), the top sources of stress included already having given IVF their best chance (65.0%), feeling too stressed to continue (47.5%), and infertility taking too much of a toll on their relationship (36.3%). When participants were asked what could have made their experience better, the most common suggestions were evening/weekend office hours (47.4%) and easy access to a mental health professional (39.4%). Of the 34.8% of women who sought care elsewhere, the most common reason given was wanting a second opinion (55.7%). Conclusion(s): Psychologic burden was the most common reason why insured patients reported discontinuing IVF treatment. Stress reduction strategies are desired by patients and could affect the decision to terminate treatment. (Fertil Steril® 2018;109:1121–6. ©2018 by American Society for Reproductive Medicine.)

Point of Influence: What is the Role of Acupuncture inIn VitroFertilization Outcomes?

“…27 In the 2 systematic reviews, 18,19 an analysis on acupuncture's impact on relevant psychosocial outcomes was absent, yet, IVF patients are significantly burdened by infertilityrelated stress, 28,29 and insured IVF patients have cited stress as the primary reason they discontinued treatment despite not conceiving. 4 Because acupuncture is widely known to modulate stress, it could be an important way to support patients during their treatment. There is a gap in knowledge of the magnitude of acupuncture's effects for reducing the emotional burden of IVF treatment.…”

“…3 There is no guarantee of success, and patients endure invasive physical interventions, psychosocial burdens, and risks of financial strain while completing these treatments. 4 To help improve their odds of delivering a child, couples may turn to complementary and integrative health approaches to supplement their fertility treatments. [5][6][7] Surveys have estimates that 8%-47% of couples add acupuncture to their IVF cycles.…”

Antioxidative enzyme-related gene expression levels in cumulus cells during in vitro fertilization: A comparison between normal and poor ovarian responders

“…Although multiple POR etiologies are proposed such as ovarian aging, premature ovarian insu ciency, ovarian tumor or other ovarian pathologies including endometrioma [3], some infertile women who present with normal baseline characteristics and receive standard doses of gonadotropin still encounter a problem of poor ovarian response without any identi able causes. The speci c etiology together with precise infertility treatment in POR patients, until now, has not been established which leads to recurrent IVF failure and has detrimental effects on physical or psychological patient life qualities [4].…”

Patient perceptions and understanding of treatment instructions for ovarian stimulation during infertility treatment

“…Assisted reproductive technology (ART) treatments are expensive (Cassettari et al, 2016;Chambers et al, 2013) and are associated with a considerable physical and psychological burden for patients (Boivin et al, 2012;Domar et al, 2012;Gameiro et al, 2012;Rich and Domar, 2016). The psychological burden of infertility treatment is commonly associated with stress caused by relationship strain, and with anxiety and depression resulting from unsuccessful treatment (Domar et al, 2010(Domar et al, , 2018. Treatment administration adds to the psychological burden for female patients and has an impact on their everyday activities (Boivin et al, 2012;Huisman et al, 2009;Mamata et al, 2015).…”

“…Moreover, the physical burden from injection pain or the occurrence of adverse events, such as breast tenderness or pain at oocyte retrieval, can be considerable (Van den Broeck et al, 2009). In addition to cost, these emotional and physical treatment burdens lead to a significant proportion of couples discontinuing fertility treatment before achieving a pregnancy (Domar et al, 2018;Gameiro et al, 2012;Olivius et al, 2004;Rajkhowa et al, 2006;Van den Broeck et al, 2009). In a large cohort of 1391 couples in the Netherlands, approximately half dropped out before receiving any fertility treatment, and one-third of patients withdrew after one cycle of in-vitro fertilization (IVF) (Brandes et al, 2009).…”