Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment

S Gameiro, J Boivin, L Peronace, C M Verhaak, S Gameiro, J Boivin, L Peronace, C M Verhaak

Abstract

BACKGROUND Chances of achieving parenthood are high for couples who undergo fertility treatment. However, many choose to discontinue before conceiving. A systematic review was conducted to investigate patients' stated reasons for and predictors of discontinuation at five fertility treatment stages. METHODS Six databases were systematically searched. Search-terms referred to fertility treatment and discontinuation. Studies reporting on patients' stated reasons for or predictors of treatment discontinuation were included. A list of all reasons for discontinuation presented in each study was made, different categories of reasons were defined and the percentage of selections of each category was calculated. For each predictor, it was noted how many studies investigated it and how many found a positive and/or negative association with discontinuation. RESULTS The review included 22 studies that sampled 21 453 patients from eight countries. The most selected reasons for discontinuation were: postponement of treatment (39.18%, postponement of treatment or unknown 19.17%), physical and psychological burden (19.07%, psychological burden 14%, physical burden 6.32%), relational and personal problems (16.67%, personal reasons 9.27%, relational problems 8.83%), treatment rejection (13.23%) and organizational (11.68%) and clinic (7.71%) problems. Some reasons were common across stages (e.g. psychological burden). Others were stage-specific (e.g. treatment rejection during workup). None of the predictors reported were consistently associated with discontinuation. CONCLUSIONS Much longitudinal and theory led research is required to explain discontinuation. Meanwhile, treatment burden should be addressed by better care organization and support for patients. Patients should be well informed, have the opportunity to discuss values and worries about treatment and receive advice to decide about continuing treatment.

Figures

Figure 1
Figure 1
Decision flowchart for identified studies.
Figure 2
Figure 2
Percentage (%) of the three most selected categories of reasons for discontinuation overall and according to each treatment stage. INITIATE = during diagnosis, before initiation of treatment; FIRST = during first-order treatments like insemination or ovulation induction; ART-START = on the waiting list to start assisted reproductive techniques; ART-FAILED = after the first failed ART cycle; ART-TYPICAL = before completion of the typical ART regimen. Relational = relational problems; Rejection tr = rejection of treatment; Personal, personal reasons; Logistics = logistics/practical reasons; Postponement tr = postponement of treatment; Psych = psychological burden of treatment; Censoring = doctor censoring; Financial = financial issues; Postponement tr/unknown = postponement of treatment or unknown.

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