When and why do subfertile couples discontinue their fertility care? A longitudinal cohort study in a secondary care subfertility population

Abstract

About half of the couples stopped before any fertility treatment was started and one-third stopped after at least one IVF cycle. The main reasons for withdrawal were emotional distress and poor prognosis. This insight may help to improve quality of patient care by making care more responsive to the needs and expectations of subfertile couples.

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

“…In addition to clinically depressed women, women with depressive symptomatology should be referred to a mental health professional to prevent not only discontinuation but also other consequences of psychosocial adjustment after ART, including lower self-esteem, low maternal self-efficacy [66], and postpartum depression [67]. Preventing discontinuation in fertility treatment may not only increase success rates [5][6][7][8] and improve the efficacy and cost effectiveness of MAR treatment but also decrease the eventual psychological effects of discontinuation after unsuccessful treatment [61].…”

“…The exclusion criteria were as follows: (a) a participant had not completed the questionnaires or left >50% of the items of a given measure unanswered (n = 35), (b) the couple had children together (n = 16), and (c) a previously diagnosed sexually transmitted disease or unfavorable genetic diagnosis (n = 5). Criteria b) and c) were adopted to prevent bias considering previous evidence of an association with discontinuation [5,20]. Because a parental project starts with a decision shared by both members of the couple [25], we hypothesize that couples having previous children in common have a higher likelihood of discontinuing.…”

“…According to these studies, a psychological burden is the most commonly cited reason by patients for discontinuation [3,5,10,[12][13][14]. Psychological variables have also been found to predict discontinuation [9,15], and associations between discontinuation and marital and personal problems [13,16,17], perceived poor diagnosis [5,13], female age [15,18,19], and parity [20] have also been reported. Although these studies have helped elucidate the discontinuation phenomenon, gaps in the literature remain (for a review, see Gameiro et al [21]).…”

“…Discontinuation of fertility treatment diminishes the probability of successful pregnancy, whereas compliance with treatment increases the probability of treatment success [5][6][7][8]. The WHO defines compliance or adherence as Bthe extent to which a person's behaviour-taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider [ 8], (p. 3).…”

“…The high prevalence of discontinuation, an estimated 30% of couples [3,5], is thus surprising. Discontinuation rates nevertheless vary across studies (e.g., 5.6% [9], 70% [10]) because of the use of different conceptualizations of discontinuation.…”