Medical factors associated with early IVF discontinuation.
Even when IVF is reimbursed by the social insurance system, as in France, high discontinuation rates have been reported and some patients drop out as soon as the first failed IVF cycle. This study aims to investigate medical factors associated with treatment discontinuation in an IVF centre after the first unsuccessful cycle. The study included 5135 couples recruited in eight French IVF centres and who had had an unsuccessful first IVF cycle in these centres in 2000-2002 (i.e. no live birth). Of these couples with a first failed IVF, 1337 did not have a second IVF in the centre (26%, 'early discontinuation group') and 3798 continued treatment with a second IVF in the centre. The characteristics of couples who discontinued IVF treatment were compared with those who continued using logistic regressions. Older women, women with duration of infertility >5years, with female factor or unexplained infertility, with 0 or 1 oocyte retrieved and no embryo transfer during the first IVF were more likely to discontinue treatment early. Risk of early discontinuation was associated with medical factors that are also well known to be associated with impaired chance of successful IVF. Even when IVF is reimbursed by the social insurance system, as in France, high discontinuation rates have been reported and some patients drop out as soon as the first failed IVF cycle. This study aims to investigate medical factors associated with treatment discontinuation in an IVF centre after the first unsuccessful cycle. The study included 5135 couples recruited in eight French IVF centres who had had an unsuccessful first IVF cycle in these centres in 2000-2002 (i.e. who remained childless after a first cycle). Of these couples with a first failed IVF, 1337 did not have a second IVF in the centre and 3798 continued treatment with a second IVF in the centre. The characteristics of couples who discontinued IVF treatment were compared with those who continued. After a first failed IVF cycle, more than one-quarter (26%) of couples discontinued IVF treatment. Older women, women with duration of infertility >5years, with female factor or unexplained infertility, with 0 or 1 oocyte retrieved and with no embryo transfer during the first IVF were more likely to discontinue treatment early. The risk of early discontinuation was associated with medical factors that are also well known to be associated with impaired chance of success during IVF treatment. A next step would be to examine whether the early discontinuation results from a decision of the couple themselves, from medical, psychological and/or social staff counselling or from some combination of all of these factors.
Ined, 133 bd Davout, F-75020 Paris, France; Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, 82 rue du Général Leclerc, F-94276 Le Kremlin-Bicêtre, France; AP-HP, Hôpital Lariboisière, 2 rue Ambroise Paré, F-75475 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, Service de Santé Publique et Economie de la Santé, F-75475 Paris, France. Electronic address: penelope.troude@inserm.fr.
Pénélope
P
Troude
Laboratoire de Procréation Médicalement Assistée, Institut Mutualiste de Montsouris, 2 boulevard Jourdan, F-75014 Paris, France.
Juliette
J
Guibert
Ined, 133 bd Davout, F-75020 Paris, France; Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, 82 rue du Général Leclerc, F-94276 Le Kremlin-Bicêtre, France; Univ Paris-Sud, UMRS 1018, 82 rue du Général Leclerc, F-94276 Le Kremlin-Bicêtre, France.
Jean
J
Bouyer
Ined, 133 bd Davout, F-75020 Paris, France; Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, 82 rue du Général Leclerc, F-94276 Le Kremlin-Bicêtre, France; Univ Paris-Sud, UMRS 1018, 82 rue du Général Leclerc, F-94276 Le Kremlin-Bicêtre, France.
Elise
E
de La Rochebrochard
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007246:Infertility / Q000523:psychology / Q000628:therapy*; D016015:Logistic Models; D010352:Patient Dropouts / Q000523:psychology; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome
IVF; cohort study; dropout; infertility; medical factors; treatment discontinuation