Medication Adherence Among Women Undergoing Infertility Treatment: A Systematic Review

Infertility is a significant health problem for women, which is estimated to affect 80 million people worldwide (1,2). In the United States, approximately 16% of the women of childbearing age are affected by infertility (3). In addition, many women undergo infertility treatment and are highly motived to become pregnant (4). Infertility treatment incorporates a variety of modalities to help women achieve pregnancy from minimally invasive to highly invasive procedures, along with fertility medication. According to American Society of Reproductive Medicine (5), treatment regimens can incorporate oral and/or injection medication for controlled ovarian hyper stimulation (COH) in combination with or without intrauterine insemination (IUI), as well as assisted reproductive technology (ART) procedures such as vitro fertilization (IVF). Women who tend to undergo any sort of infertility treatment are advised by healthcare providers to engage in self-managed lifestyle behaviors (e.g., healthy diet, adequate physical activity, smoking and marijuana cessation, and alcohol restrictions) and follow the prescribed protocols for fertility drugs in order to increase the chances of treatment success (6-10). However, adhering to lifestyle changes recommended by the health providers are found to be problematic (9,11-14). In fact, negative lifestyle behaviors contributed to lower pregnancy rates for women undergoing IVF (15-20). This raises concerns regarding the extent to which women adhere to fertility medications while receiving the treatment. Adherence to the prescribed medication is important for achieving the targeted health outcomes (21). Medication non-adherence is recognized as a prevalent global problem among the general population with adherence rates 50% on average, worldwide (22). Further, the medication-taking behavior of women receiving infertility treatment has not been adequately assessed. This is probably due to the belief that medication adherence is optimal in this patient population, particularly with high stakes procedures like IVF. In general, infertility treatment resulted in successful pregnancies for many women although most often after the repeated treatments. Although a woman’s likelihood of pregnancy with infertility treatment decreases as she ages (35 years and older), younger women (under 35 years) undergoing assisted reproductive technology (ART) in the United States average 38% of pregnancy rates (U.S.) for each treatment cycle (23,24). Infertility treatment Abstract Objectives: The present study aimed to investigate medication adherence awareness among women undergoing infertility treatment. Materials and Methods: Several databases were searched including PubMed, Embase, CINAHL, PsycINFO, as well as ProQuest dissertations in order to collect the required data. In addition, based on the purpose of the study, English-language prospective, retrospective, observational, cross-sectional, quasi-experimental, and randomized controlled trial studies were selected which focused on medication adherence as a primary or secondary outcome in women with a diagnosis of infertility. Finally, critical appraisal for the quality of the study was assessed using Downs and Black Quality Checklist (1998) and STROBE guidelines. Results: Three studies conducted during 1993-2011 were analyzed. Further, sample sizes varied from 30 to 626 subjects with average rates of oral medication adherence ranging from 26% to 81% when used as the first-line therapy. More frequent daily dosing was associated with lower adherence rates. Based on the results, adherence was significantly lower when women were concerned about the side effects of medication adherence or reported 3 or more side effects rather than one or 2 cases. Furthermore, women with a body mass index of <23 kg/m2 or those who viewed medical treatment as convenient had higher adherence rates. It is noteworthy that none of the studies evaluated medication adherence during controlled ovarian hyperstimulation (COH) cycles, along with intrauterine insemination (IUI) or in vitro fertilization (IVF). Conclusions: In general, rates of oral medication adherence are found suboptimal when used alone as first-line therapy. Accordingly, further studies regarding medication-taking behaviors are warranted in future research trials involving injection medications and COH cycles associated with IUI and IVF cycles in order to strengthen the clinical practice.