Why do couples discontinue in vitro fertilization treatment? A cohort study

Objective: To investigate reasons for discontinuation of IVF treatment. Design: Prospective, cohort study. Setting: Center for reproductive medicine at a large university hospital. Patient(s): The 450 couples of a cohort of 974 couples who started IVF treatment between January 1996 and December 1997 and did not achieve childbirth. Intervention(s): The reasons for ceasing treatment were evaluated by scrutinizing the medical records for all couples (n = 288) who did not achieve live birth and who did not complete three stimulated IVF cycles. A questionnaire was sent to all patients for whom the reason for discontinuation was not obvious from the medical records (n = 211). Main Outcome Measure(s): Reasons for discontinuing IVF. Result(s): Of 450 couples not achieving live birth, 208 completed their subsidized cycles, whereas 242 discontinued IVF. In 192 (79%) of the 242 cases, the reasons for ceasing treatment could be identified from records or questionnaires. The reason for discontinuation was psychological burden in 26%, a poor prognosis in 25%, spontaneous pregnancy in 19%, physical burden in 6%, serious disease in 2%, and other reasons in 7%. Conclusion(s): An unexpectedly high percentage of couples who performed IVF discontinued the treatment before the three cycles that were offered to a majority of the couples. A majority of these discontinuations were due to psychological stress. This information is of importance when counseling patients during treatment. (C) 2004 by American Society for Reproductive Medicine.