title: Joint modeling of success and treatment discontinuation in in vitro fertilization programs: a retrospective cohort study.
abstract: BACKGROUND
  As discontinuation in in vitro fertilization (IVF) programs has been associated with a poor prognosis, one hypothesis is that some couple-specific predictive factors in IVF may be shared with opposite effect by both success (i.e. live birth) and treatment discontinuation processes. Our objective was to perform a joint analysis of these two processes to examine the hypothesis of a link between the two processes.
  
  
  METHODS
  Analyses were conducted on a retrospective cohort of 3,002 women who began IVF between 1998 and 2002 in two French IVF centers: a Parisian center and a center in a medium-sized city in central France. A shared random effects model based on a joint modelization of IVF treatment success and discontinuation was used to study the link between the two processes.
  
  
  RESULTS
  Success and discontinuation processes were significantly linked in the medium-sized city center, whereas they were not linked in the Parisian center. The center influenced risk of treatment discontinuation but not chance of success. The well-known inverse-J relation between the woman's age and chance of success was observed, as expected. Risk of discontinuation globally increased as the woman's age increased.
  
  
  CONCLUSIONS
  The link between success and discontinuation processes could depend on the fertility center. In particular, the woman's decision to pursue or to discontinue IVF in a particular center could depend on the presence of other IVF centers in the surrounding area.
authors.affiliation: Ined, 133 boulevard Davout, F-75020, Paris, France. penelope.troude@inserm.fr
authors.forename: Pénélope
authors.initials: P
authors.lastname: Troude
authors.forename: Sophie
authors.initials: S
authors.lastname: Ancelet
authors.forename: Juliette
authors.initials: J
authors.lastname: Guibert
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pouly
authors.forename: Jean
authors.initials: J
authors.lastname: Bouyer
authors.forename: Elise
authors.initials: E
authors.lastname: de La Rochebrochard
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001499:Bayes Theorem; D015331:Cohort Studies; D004624:Embryo Transfer / Q000706:statistics & numerical data*; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data*; D005602:France / Q000453:epidemiology; D006801:Humans; D050498:Live Birth / Q000453:epidemiology*; D008423:Maternal Age; D015233:Models, Statistical; D009010:Monte Carlo Method; D012189:Retrospective Studies; D016896:Treatment Outcome; D028761:Withholding Treatment / Q000706:statistics & numerical data*; D055815:Young Adult