Burden of care is the primary reason why insured women terminate in vitro fertilization treatment

Fertil Steril. 2018 Jun;109(6):1121-1126. doi: 10.1016/j.fertnstert.2018.02.130.


Objective: To study the reason(s) why insured patients discontinue in vitro fertilization (IVF) before achieving a live birth.

Design: Cross-sectional study.

Setting: Private academically affiliated infertility center.

Patient(s): A total of 893 insured women who had completed one IVF cycle but did not return for treatment for at least 1 year and who had not achieved a live birth were identified; 312 eligible women completed the survey.

Intervention(s): None.

Main outcome measure(s): Reasons for treatment termination.

Result(s): Two-thirds of the participants (65.2%) did not seek care elsewhere and discontinued treatment. When asked why they discontinued treatment, these women indicated that further treatment was too stressful (40.2%), they could not afford out-of-pocket costs (25.1%), they had lost insurance coverage (24.6%), or they had conceived spontaneously (24.1%). Among those citing stress as a reason for discontinuing treatment (n = 80), the top sources of stress included already having given IVF their best chance (65.0%), feeling too stressed to continue (47.5%), and infertility taking too much of a toll on their relationship (36.3%). When participants were asked what could have made their experience better, the most common suggestions were evening/weekend office hours (47.4%) and easy access to a mental health professional (39.4%). Of the 34.8% of women who sought care elsewhere, the most common reason given was wanting a second opinion (55.7%).

Conclusion(s): Psychologic burden was the most common reason why insured patients reported discontinuing IVF treatment. Stress reduction strategies are desired by patients and could affect the decision to terminate treatment.

Keywords: IVF; infertility; psychologic burden; treatment termination.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude to Health*
  • Cost of Illness
  • Cross-Sectional Studies
  • Female
  • Fertilization in Vitro* / economics
  • Fertilization in Vitro* / psychology
  • Fertilization in Vitro* / statistics & numerical data
  • Humans
  • Infertility / economics
  • Infertility / epidemiology
  • Infertility / psychology
  • Infertility / therapy*
  • Insurance, Health* / economics
  • Insurance, Health* / statistics & numerical data
  • Live Birth / economics
  • Live Birth / epidemiology
  • Patient Participation / economics
  • Patient Participation / psychology
  • Patient Participation / statistics & numerical data
  • Pregnancy
  • Pregnancy Outcome / economics
  • Pregnancy Outcome / epidemiology
  • Pregnancy Rate
  • Treatment Refusal* / psychology
  • Treatment Refusal* / statistics & numerical data
  • Withholding Treatment* / economics
  • Withholding Treatment* / statistics & numerical data
  • Young Adult