O-081 Navigating the crossroads: unraveling predictors for treatment discontinuation in couples pursuing assisted reproduction: findings from a 2-year prospective study
Authors: Péloquin K 
Published: July 2024

Abstract

Study question
What are the medical, individual, relationship, and clinic-related factors associated with fertility treatment discontinuation ?

Summary answer
Insurance status and medication use by the partner emerged as primary predictors for treatment discontinuation, while emotional burden and cost were the leading reasons cited.

What is known already
Despite advancements in assisted reproduction, the arduous nature of fertility treatments prompts 20 to 30% of couples to discontinue before pregnancy, even with a favorable prognosis and financial means. Whereas the World Health Organization deems treatment compliance critical for effectiveness, fundamental knowledge on fertility treatment compliance is lacking. Existing retrospective studies attribute discontinuation to the physical and psychological burdens of treatment and relationship strain. However, understanding the precise nature of psychological and relational issues influencing this decision remains limited. Additionally, previous research has overlooked patient and clinic factors related to discontinuation, hindering professionals in supporting couples through this process.

Study design, size, duration
A 2-year prospective study with a correlational design. The sample included 310 couples (35 same-gender/sex couples) pursuing assisted reproduction in Canada or the United States. Data were collected between December 2019 and November 2023.

Participants/materials, setting, methods
Couples seeking assisted reproductive services within six months of their initial visit to a fertility clinic were recruited through social media and affiliated fertility clinics. Both partners completed online questionnaires evaluating sociodemographics, medical and treatment history, psychological and relationship functioning, and their perception of patient-centered care at baseline. Follow-up assessments occurred at 6, 12, 18, and 24 months. Treatment status (ongoing, terminated due to pregnancy) and reasons for discontinuation were also recorded at each follow-up.

Main results and the role of chance
To identify the primary predictors of treatment discontinuation, we conducted survival analyses using sociodemographic variables (age, relationship duration, income, insurance coverage), medical and treatment history (infertility duration, medication side effects), psychological (depression, anxiety symptoms, quality of life, distress tolerance, attachment style), relationship (satisfaction, dyadic coping, commitment), and patient-centered care (communication, involvement in decisions, information accessibility) data at baseline for both partners (person to be carrying the pregnancy and their partner). Variables were initially tested separately (p &lt; .05), and significant predictors were included in a multivariate model. In individual analyses, couples whereby the partner did not have insurance or was using anxiety/mood medication were more likely to discontinue at some point during the study. Couples in which the person to be carrying the pregnancy reported higher attachment avoidance, lower relationship commitment, or less dyadic coping were also more likely to discontinue during the study. In the comprehensive model, only the partner’s insurance and medication use predicted discontinuation. The most frequently cited reasons for discontinuation were the emotional burden of treatment (43.6%) and cost (43.7%), followed by physical discomfort (31.4%), loss of hope regarding treatment (33.3%), reasons related to services in clinics (28.6%), and personal circumstances impeding treatment (27.5%).

Limitations, reasons for caution
Given the correlational study design, causation cannot be inferred between identified predictors and treatment discontinuation. The 2-year study duration also limits capturing later discontinuations. Predictors were assessed at baseline only, potentially differing across treatment stages. Finally, 2SLGBTQ+ couples experiencing social infertility are underrepresented in the sample.

Wider implications of the findings
These findings underscore the importance of addressing insurance accessibility and psychological factors in fertility treatment support. Elevated emotional burden and cost as prominent discontinuation reasons highlight the need for comprehensive, affordable care and emotional support in fertility clinics to improve overall patient experience and outcomes.

Trial registration number
n/a