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

• Published in: Fertility and sterility Vol. 109; no. 6; pp. 1121 - 1126
• Main Authors: Domar, Alice D., Rooney, Kristin, Hacker, Michele R., Sakkas, Denny, Dodge, Laura E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2018
• Subjects: Adult; Attitude to Health; Cost of Illness; Cross-Sectional Studies; Female; Fertilization in Vitro - economics; Fertilization in Vitro - psychology; Fertilization in Vitro - statistics & numerical data; Humans; infertility; Infertility - economics; Infertility - epidemiology; Infertility - psychology; Infertility - therapy; Insurance, Health - economics; Insurance, Health - statistics & numerical data; IVF; Live Birth - economics; Live Birth - epidemiology; Patient Participation - economics; Patient Participation - psychology; Patient Participation - statistics & numerical data; Pregnancy; Pregnancy Outcome - economics; Pregnancy Outcome - epidemiology; Pregnancy Rate; psychologic burden; Treatment Refusal - psychology; Treatment Refusal - statistics & numerical data; treatment termination; Withholding Treatment - economics; Withholding Treatment - statistics & numerical data; Young Adult; IVF; psychologic burden; infertility; treatment termination
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/j.fertnstert.2018.02.130

To study the reason(s) why insured patients discontinue in vitro fertilization (IVF) before achieving a live birth. Cross-sectional study. Private academically affiliated infertility center. A total of 893 insured women who had completed one IVF cycle but did not return for treatment for at least 1 year and who had not achieved a live birth were identified; 312 eligible women completed the survey. None. Reasons for treatment termination. Two-thirds of the participants (65.2%) did not seek care elsewhere and discontinued treatment. When asked why they discontinued treatment, these women indicated that further treatment was too stressful (40.2%), they could not afford out-of-pocket costs (25.1%), they had lost insurance coverage (24.6%), or they had conceived spontaneously (24.1%). Among those citing stress as a reason for discontinuing treatment (n = 80), the top sources of stress included already having given IVF their best chance (65.0%), feeling too stressed to continue (47.5%), and infertility taking too much of a toll on their relationship (36.3%). When participants were asked what could have made their experience better, the most common suggestions were evening/weekend office hours (47.4%) and easy access to a mental health professional (39.4%). Of the 34.8% of women who sought care elsewhere, the most common reason given was wanting a second opinion (55.7%). Psychologic burden was the most common reason why insured patients reported discontinuing IVF treatment. Stress reduction strategies are desired by patients and could affect the decision to terminate treatment.