Factors associated with early in vitro fertilization treatment discontinuation

Abstract

Objective: To investigate factors associated with early IVF treatment discontinuation.

Design: Retrospective cohort study.

Setting: Academic medical center.

Patient(s): Six hundred sixty-nine first-attempt IVF patients who did not have a live birth.

Intervention(s): None.

Main outcome measure(s): Treatment discontinuation and time to return for a second IVF cycle.

Result(s): Women without IVF insurance coverage were more likely to discontinue treatment than women with insurance coverage (adjusted odds ratio [aOR] = 3.12; 95% confidence interval [CI], 2.22-4.40). African-American women were more likely to discontinue treatment (aOR = 2.95; 95% CI, 1.54-5.66) and returned for treatment more slowly (adjusted hazard ratio [aHR] = 0.44; 95% CI, 0.28-0.71) than non-Hispanic white women, regardless of IVF insurance coverage or income. Women with a poor prognosis were more likely to discontinue treatment than women with a good prognosis. Older women with IVF insurance coverage or a good prognosis had a shorter time to return for a second IVF cycle than older women without IVF insurance coverage or with a poor prognosis. Estimated income, distance to clinic, fertility diagnosis, number of oocytes retrieved, and history of previous live birth were not associated with treatment discontinuation or time to return for a second IVF cycle after adjustment for covariates.

Conclusion(s): IVF insurance coverage, race, age, and future treatment prognosis are associated with IVF treatment discontinuation and time to return.

Keywords: IVF; IVF insurance; access to care; disparity; treatment termination.