Factors associated with early in vitro fertilization treatment discontinuation

Bedrick, Bronwyn S.; Anderson, Kelsey; Broughton, Darcy E.; Hamilton, Barton H.; Jungheim, Emily S.

doi:10.1016/j.fertnstert.2019.03.007

Cited by 53 publications

(42 citation statements)

References 40 publications

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“…It has been stated that insurance coverage of ART is associated with higher utilization and improvements in practice [9,18,19]. However, this also raises the question of whether this disparity in participation represented a difference in economic access to ART [20][21][22] and/or whether other unidentified social and/or culture factors associated with race underlined such a difference [23,24]. Despite these observations of disparity in access, cycle LBRs (outcomes) were not significantly different between black and white women based upon the presence or absence of state insurance mandates.…”

Section: Discussionmentioning

confidence: 99%

Status of racial disparities between black and white women undergoing assisted reproductive technology in the US

Seifer

Şimşek

Wantman³

et al. 2020

Reprod Biol Endocrinol

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Background Numerous studies have demonstrated substantial differences in assisted reproductive technology outcomes between black non-Hispanic and white non-Hispanic women. We sought to determine if disparities in assisted reproductive technology outcomes between cycles from black non-Hispanic and white non-Hispanic women have changed and to identify factors that may have influenced change and determine racial differences in cumulative live birth rates. Methods This is a retrospective cohort study of the SARTCORS database outcomes for 2014–2016 compared with those previously reported in 2004–2006 and 1999/2000. Patient demographics, etiology of infertility, and cycle outcomes were compared between black non-hispanic and white non-hispanic patients. Categorical values were compared using Chi-squared testing. Continuous variables were compared using t-test. Multiple logistic regression was used to assess confounders. Results We analyzed 122,721 autologous, fresh, non-donor embryo cycles from 2014 to 2016 of which 13,717 cycles from black and 109,004 cycles from white women. The proportion of cycles from black women increased from 6.5 to 8.4%. Cycles from black women were almost 3 times more likely to have tubal and/or uterine factor and body mass index ≥30 kg/m2. Multivariate logistic regression demonstrated that black women had a lower live birth rate (OR 0.71;P < 0.001) and a lower cumulative live birth rate for their initial cycle (OR 0.64; P < 0.001) independent of age, parity, body mass index, etiology of infertility, ovarian reserve, cycle cancellation, past spontaneous abortions, use of intra-cytoplasmic sperm injection or number of embryos transferred. A lower proportion of cycles in black women were represented among non-mandated states (P < 0.001) and cycles in black women were associated with higher clinical live birth rates in mandated states (P = 0.006). Conclusions Disparities in assisted reproductive technology outcomes in the US have persisted for black women over the last 15 years. Limited access to state mandated insurance may be contributory. Race has continued to be an independent prognostic factor for live birth and cumulative live birth rate from assisted reproductive technology in the US.

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Section: Discussionmentioning

confidence: 99%

Status of racial disparities between black and white women undergoing assisted reproductive technology in the US

Seifer

Şimşek

Wantman³

et al. 2020

Reprod Biol Endocrinol

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“…Correspondingly, many previous studies have examined and identified several factors that lead people to discontinue infertility treatment. Several identified predictors of discontinuation are related to patients, clinics, and their relationships, including the patients’ physical and psychological burdens, their limited financial resources, inadequate organization of care, poor communication skills of staff, and negative interactions between the patients and staff 9‐14 . Additionally, other studies have found that female age, duration of subfertility, other maternal conditions, and stressful life events were key factors in determining the success of the infertility treatment 15‐18 …”

Section: Introductionmentioning

confidence: 99%

Chances of pregnancy after dropping out from infertility treatments: Evidence from a social survey in Japan

Hirakawa

Usui

Mitsuyama

et al. 2021

Reprod Medicine & Biology

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Purpose We examined a patient's chances of pregnancy after dropping out from infertility treatments, an issue that has been largely understudied. Method Drawing from a nationwide Internet survey in Japan with 1930 respondents, we used data from 199 individuals (109 women and 90 men) who had undergone an infertility treatment. We estimated linear probability models to investigate the extent to which the probability of pregnancy was affected by dropping out after controlling for a couple's attributes. Results Among the 199 respondents who had experienced an infertility treatment, 91 (45.7% of the entire sample) became pregnant during the treatment, and 108 (54.3%) dropped out. Among these 108 dropouts, 66 (33.2%) eventually became pregnant. After controlling for a couple's attributes, treatment discontinuation reduced the probability of pregnancy by 31.6% (standard error: 5.0%). A relatively limited reduction in the chances of pregnancy was also observed after a patient dropped out of any of the three treatment stages (timed intercourse, intrauterine insemination, and in vitro fertilization). Conclusions The results suggest that dropping out from infertility treatments does not preclude any chance of a future pregnancy. More follow‐up attention should be provided to dropout patients.

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“…The dropout of fertility treatments refers to the further treatment despite the favorable progress and the ability to pay for treatment that can occur at any stage of the treatment [8]. The prevalence of discontinuation varies from 5.6% to 70% in different studies [9][10][11][12][13][14][15]. In Iran, the rate of discontinuation of treatment was 56.5% in one study [16] and 28.3% in another study [17].…”

Section: Introductionmentioning

confidence: 99%

Dropout of infertility treatments and related factors among infertile couples

et al. 2020

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Background Dropout of infertility treatments is a global issue and many factors play role in this phenomenon. It is one of the most challenges in life of infertile couples. The purpose of this study was to determine dropout rate and related factors/reasons in the world and in Iran. Methods We will conduct a mixed method study with sequential exploratory design (systematic review, qualitative and quantitative phase). In the first stage a systematic review on dropout rate of infertility treatments and related factors will be done. In second stage (quantitative–qualitative study), a retrospective cohort study will be conducted on infertile couples to determine dropout rate of infertility treatments. The follow-up period to assess the discontinuation of treatment in patients, who have discontinued the treatment, will be considered 6 months after the treatment cessation. Data would be analyzed by descriptive statistics. We want to determine proportion and percentage of discontinuation rate among different groups with different causes of infertility. Then, we also will use Chi-square test to compare discontinuation rates among these groups. In qualitative section of second stage, semi-structured interviews would be performed with infertile female who had the history of infertility treatments failure. In this stage, participants will be selected using purposeful sampling method with maximum variation in terms of age, education, occupation, type of infertility, type of treatments, number of unsuccessful treatment and infertility duration. Data would be analyzed using conventional content analysis. Discussion Determining dropout rate and its related factors/reasons would be helpful for future studies to plan suitable interventions for supporting infertile couples. It also helps politicians to have a better understanding of infertility and its consequences on infertile couple’s life. Plain English Summary In today’s world, infertility is a common phenomenon due to postponement of childbearing following the older age of marriage, tendency to reach higher educational level, economical problems and etc. Infertility brings many challenges and stresses to the individuals by itself and it is very hard to cope with. The problem gets worse, when it is associated with failure in treatments. Many of infertile couples cannot tolerate this failure and may decide to discontinue treatments before achieving pregnancy for ending many stressors which are associated with treatments. As we know, childbearing and having at least one child has important position in some societies such as Iranian culture; so ending the treatment before achieving optimal result may have some adverse consequences in the families such as divorce, remarriage, family conflicts, et. Absolutely many factors play role in dropout of infertility treatments, and many studies around the world have suggested many factors/reasons in dropout of infertility treatments, but there are still many gaps about this subject, especially among Iranian society. This study would be conducted in three consecutive stages, in the first stage; we will do a complete review of existing studies of the world to find out related factors/reasons of dropout in detail. In second stage, dropout rate of infertile couples (380 couples) after at least one unsuccessful cycle of treatment would be achieved by assessing medical records and telephone interview. Data of the first and second stage will help us to have better vision about the issue of dropout and would be used to construct a semi structured interview for the last stage. And finally in the third stage, reasons of dropout would be asked by an in depth interview from infertile couples. We hope the information from this study will help politicians better understand and plan for dropout of treatment.

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Factors associated with early in vitro fertilization treatment discontinuation

Cited by 53 publications

References 40 publications

Status of racial disparities between black and white women undergoing assisted reproductive technology in the US

Status of racial disparities between black and white women undergoing assisted reproductive technology in the US

Chances of pregnancy after dropping out from infertility treatments: Evidence from a social survey in Japan

Dropout of infertility treatments and related factors among infertile couples

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