Predictors of not pursuing infertility treatment after an infertility diagnosis: Examination of a prospective U.S. cohort

Department of Urology, University of California San Francisco, San Francisco, California 94143-0738, USA.
Fertility and sterility (Impact Factor: 4.59). 11/2010; 94(6):2369-71. DOI: 10.1016/j.fertnstert.2010.03.068
Source: PubMed


We studied a prospective cohort of 434 couples in Northern California and found that 13% did not pursue any form of infertility treatment after their initial consultation. Although age, education, and financial concerns remain important for patients in choosing whether to pursue infertility treatment, depressive symptoms may also be a barrier to achieving reproductive goals.

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Available from: Patricia P Katz, May 28, 2014
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    • "In this study, distress, in terms of anxiety and depression , was not related to discontinuation, in contrast to what was reported in other studies (Smeenk et al., 2004; Eisenberg et al., 2010). An explanation for this discrepancy is that our study succeeded in obtaining information from a relatively large, clearly defi ned cohort, which omitted those who went to other clinics and those advised to stop treatment because of poor prognosis; indeed, the advice to stop treatment could reveal signifi cant negative emotions. "
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    ABSTRACT: In this study, we investigated the relationship between psychosocial factors assessed pre-treatment and the discontinuation of in vitro fertilisation (IVF) treatment after one year. A cohort study was performed in a Dutch fertility clinic and included 667 couples. Demographic characteristics, scores for psychosocial factors, discontinuation rates, reasons for discontinuation and outcome data of the treatment were measured. Discontinuation due to personal reasons was differentiated from discontinuation because of changing a clinic or physicians' advice. The results showed that 37.5% of the couples became pregnant, while 40 (6%) discontinued IVF treatment because of personal reasons. A sample size of 288 women remained for analysis. A longer duration of infertility, less perceived social support in women and higher scores on acceptance of infertility in both men and women were significantly correlated with discontinuation. Multivariate analysis, using these variables including the age of the women, showed that these factors could explain 29% of the discontinuation. These results point to a differentiation between couples who choose positively choose to discontinue treatment and those discontinuing from a more negative perspective. Opportunities to tailor interventions to this second group of couples need to be investigated.
    Human Fertility 01/2015; 18(2):1-7. DOI:10.3109/14647273.2014.995240 · 0.91 Impact Factor
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    • "Callan et al., 1988). It is known that discontinuation can occur at any treatment stage, from as early as diagnostic workup (Eisenberg et al., 2010) to any stage during assisted reproductive technologies (ART; Olivious et al., 2004) and that treatment success rates are negatively affected by it (Land et al., 1997; Witsenburg et al., 2005). Why couples discontinue treatment is not entirely clear. "
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    ABSTRACT: BACKGROUND Chances of achieving parenthood are high for couples who undergo fertility treatment. However, many choose to discontinue before conceiving. A systematic review was conducted to investigate patients' stated reasons for and predictors of discontinuation at five fertility treatment stages. METHODS Six databases were systematically searched. Search-terms referred to fertility treatment and discontinuation. Studies reporting on patients' stated reasons for or predictors of treatment discontinuation were included. A list of all reasons for discontinuation presented in each study was made, different categories of reasons were defined and the percentage of selections of each category was calculated. For each predictor, it was noted how many studies investigated it and how many found a positive and/or negative association with discontinuation. RESULTS The review included 22 studies that sampled 21 453 patients from eight countries. The most selected reasons for discontinuation were: postponement of treatment (39.18%, postponement of treatment or unknown 19.17%), physical and psychological burden (19.07%, psychological burden 14%, physical burden 6.32%), relational and personal problems (16.67%, personal reasons 9.27%, relational problems 8.83%), treatment rejection (13.23%) and organizational (11.68%) and clinic (7.71%) problems. Some reasons were common across stages (e.g. psychological burden). Others were stage-specific (e.g. treatment rejection during workup). None of the predictors reported were consistently associated with discontinuation. CONCLUSIONS Much longitudinal and theory led research is required to explain discontinuation. Meanwhile, treatment burden should be addressed by better care organization and support for patients. Patients should be well informed, have the opportunity to discuss values and worries about treatment and receive advice to decide about continuing treatment.
    Human Reproduction Update 08/2012; 18(6):652-69. DOI:10.1093/humupd/dms031 · 10.17 Impact Factor
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    • "Access to the DA did not impact on uptake of fertility-preserving interventions. Uptake of fertility interventions is not only dependent on information, but also on personal circumstances (such as having a male partner), availability and cost of interventions, previous fertility as well as religious and personal beliefs (Lee et al, 2006; Dutney, 2007; Jukkala, 2009; Ata and Seli, 2010; Eisenberg et al, 2010; Hershberger and Pierce, 2010). In addition, uptake of interventions is likely to be influenced by clinician recommendations (Young, 1996a, 1996b; Cyrus-David and Strom, 2001; Bober et al, 2004; Taylor and Taguchi, 2005; McGregor et al, 2007). "
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    ABSTRACT: Fertility is a priority for many young women with breast cancer. Women need to be informed about interventions to retain fertility before chemotherapy so as to make good quality decisions. This study aimed to prospectively evaluate the efficacy of a fertility-related decision aid (DA). A total of 120 newly diagnosed early-stage breast cancer patients from 19 Australian oncology clinics, aged 18-40 years and desired future fertility, were assessed on decisional conflict, knowledge, decision regret, and satisfaction about fertility-related treatment decisions. These were measured at baseline, 1 and 12 months, and were examined using linear mixed effects models. Compared with usual care, women who received the DA had reduced decisional conflict (β=-1.51; 95%CI: -2.54 to 0.48; P=0.004) and improved knowledge (β=0.09; 95%CI: 0.01-0.16; P=0.02), after adjusting for education, desire for children and baseline uncertainty. The DA was associated with reduced decisional regret at 1 year (β=-3.73; 95%CI: -7.12 to -0.35; P=0.031), after adjusting for education. Women who received the DA were more satisfied with the information received on the impact of cancer treatment on fertility (P<0.001), fertility options (P=0.005), and rated it more helpful (P=0.002), than those who received standard care. These findings support widespread use of this DA shortly after diagnosis (before chemotherapy) among younger breast cancer patients who have not completed their families.
    British Journal of Cancer 03/2012; 106(6):1053-61. DOI:10.1038/bjc.2012.61 · 4.84 Impact Factor
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