title: The impact of younger age on treatment discontinuation in insured IVF patients.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave. KS 3, Boston, MA, 02215, USA.|Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Dodge
authors.affiliation: Boston IVF, 130 2nd Ave., Waltham, MA, 02451, USA.
authors.forename: Denny
authors.initials: D
authors.lastname: Sakkas
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave. KS 3, Boston, MA, 02215, USA.|Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Hacker
authors.affiliation: Boston IVF, 130 2nd Ave., Waltham, MA, 02451, USA.
authors.forename: Rachael
authors.initials: R
authors.lastname: Feuerstein
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave. KS 3, Boston, MA, 02215, USA. domar@domarcenter.com.|Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA. domar@domarcenter.com.|Boston IVF, 130 2nd Ave., Waltham, MA, 02451, USA. domar@domarcenter.com.
authors.forename: Alice D
authors.initials: AD
authors.lastname: Domar
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007246:Infertility / Q000473:pathology*; D050498:Live Birth; D011247:Pregnancy; D056826:Single Embryo Transfer / Q000379:methods*; D020554:Sperm Injections, Intracytoplasmic
keywords: In vitro fertilization; Infertility; Treatment discontinuation