The impact of younger age on treatment discontinuation in insured IVF patients

Abstract

Purpose This retrospective cohort study aimed to determine whether age influences treatment discontinuation among insured patients undergoing in vitro fertilization (IVF). We hypothesized that the youngest patients would be the least likely to discontinue treatment. Methods All women age 18-42 who underwent their first fresh, non-donor IVF cycle from 2002 to 2013 were followed until a live birth was achieved, until they discontinued treatment at our center (not presenting for treatment for a one-year period), or until they completed six fresh or frozen embryo transfer cycles, whichever occurred first. Results Of 11,361 women included, 4336 (38.2 %) discontinued treatment at our center before achieving a live birth or undergoing six IVF cycles. Discontinuation differed by age for cycles 2-4 (all P ≤ 0.004), with the proportion among women age 40-42 averaging 6-7 % higher than the other groups; discontinuation per cycle was similar among women <30 compared to women age 30-<35 and 35-<40. This continued in cycles 5 and 6, and in the sixth, 35.2, 32.0, 32.3, and 40.2 % of women among the four age groups discontinued treatment, respectively (P = 0.17). In cycles 2-5, women in the oldest two age groups with secondary infertility consistently discontinued treatment more frequently than those with primary infertility. Conclusions We found that women in the oldest age group were more likely to discontinue IVF treatment than younger women. Surprisingly, we found that the youngest women discontinued treatment in a similar fashion to women age 30-<40.

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

“…However, if treatment termination were due solely to poor prognosis, then young women would be the least likely to stop treatment, which is not the case. We previously found that although women aged 40–42 years were the most likely to stop treatment, women <30 years old were as likely to stop treatment as those aged 30 to <40 years, indicating that factors other than prognosis affect decision making (19). However, women aged <30 and 40–42 years were the least likely to report stress as the reason why they terminated treatment.…”

Factors associated with early in vitro fertilization treatment discontinuation

“…Although previous studies have examined factors associated with treatment discontinuation, most only included patients with IVF insurance coverage. (3)(4)(5)(6)(7)(8)(9)(10)(11)(16)(17)(18)(19)(20)(21)(22)(23)(24) Therefore, a significant gap in our understanding of IVF treatment discontinuation persists given that the majority of Americans do not have IVF insurance coverage (25) and have limited access to fertility treatment. (26) The primary aim of this study was to investigate the association between IVF insurance coverage and treatment discontinuation over one year following any first IVF cycle that did not result in a live birth.…”

Methodological approaches to analyzing IVF data with multiple cycles

“…In particular, couples who discontinue treatment after a failed cycle may have different exposure characteristics than couples who undergo a subsequent cycle. For example, advanced maternal age and poor prognosis has been associated with an increased rate of treatment discontinuation (Dodge et al, 2017). Alternatively, many couples discontinue treatment because they have conceived spontaneously (Domar et al, 2018).…”