Psychosocial and demographic correlates of the discontinuation ofin vitrofertilization

Abstract

In this study, we investigated the relationship between psychosocial factors assessed pre-treatment and the discontinuation of in vitro fertilisation (IVF) treatment after one year. A cohort study was performed in a Dutch fertility clinic and included 667 couples. Demographic characteristics, scores for psychosocial factors, discontinuation rates, reasons for discontinuation and outcome data of the treatment were measured. Discontinuation due to personal reasons was differentiated from discontinuation because of changing a clinic or physicians' advice. The results showed that 37.5% of the couples became pregnant, while 40 (6%) discontinued IVF treatment because of personal reasons. A sample size of 288 women remained for analysis. A longer duration of infertility, less perceived social support in women and higher scores on acceptance of infertility in both men and women were significantly correlated with discontinuation. Multivariate analysis, using these variables including the age of the women, showed that these factors could explain 29% of the discontinuation. These results point to a differentiation between couples who choose positively choose to discontinue treatment and those discontinuing from a more negative perspective. Opportunities to tailor interventions to this second group of couples need to be investigated.

Couples’ discontinuation of fertility treatments: a longitudinal study on demographic, biomedical, and psychosocial risk factors

“…One of them has identified female depression as an important predictor of discontinuation [15]. Another found that female depression is not a predictor of discontinuation [24]. However, this latter study has a reduced number of discontinuers comparing with continuers, which can create a bias in the predicting power of the analysis.…”

“…First, using the couple as the unit of analysis enables the research to account for the non-independence of the data and mutual influence of each member of couples [40]. Second, this study adds to our understanding of how fertility centers and medical staff can be more sensitive to aspects that can undermine fertility care continuity, suggesting that couples should be screened for psychopathology at the beginning of treatment [15,24]. Couples with an older or clinically depressed female partner should be specifically targeted for counseling concerning the importance of compliance within MAR treatments.…”

“…Furthermore, patients' responses may be sensitive to recall bias when studies are not prospective. Third, most studies have focused on the individual, particularly females [3,12,23] ( [16,24] for exceptions), yet the decision to discontinue treatment is likely made by both members of the couple, as are previous reproductive choices such as the decision to stop contraception or pursue treatment [25,26]. Fourth, researchers have generally used either demographic and biomedical variables [17,20,27] or psychosocial variables [3,12] as independent variables.…”

“…Fourth, researchers have generally used either demographic and biomedical variables [17,20,27] or psychosocial variables [3,12] as independent variables. Recently, a study has investigated demographic, medical, and psychosocial predictors [24]. However, the analysis of psychosocial variables was made separately for women and men.…”

“…However, the analysis of psychosocial variables was made separately for women and men. Moreover, studies indicating that psychological adjustment influences couples' decision to discontinue treatment use generalized measures, such as anxiety and depression [9,15,16] (exception for [24]), that do not capture the specific distress associated with the infertility experience or treatments [28]. Infertility-specific variables, such as active-avoidance coping, are known to be associated with higher infertility distress [29][30][31], and they may thus be expected to influence the decision to discontinue fertility treatment.…”