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Psychological burden drives insured patients
to discontinue in vitro fertilisation
DENNY SAKKAS
When insured patients discontinue in vitro fertilisation treatment, the reason they cite is
psychological burden.
D
enny Sakkas, PhD, of Boston IVF, Waltham,
Massachusetts, explained this outcome of the
cross-sectional survey reporting, “We sought
to find out why insured patients discontinue in vitro
fertilisation treatment before they achieve a live
birth.” Their centre is a private academically affiliated
in vitro fertilisation facility.
They sent a survey about treatment termination to
905 subjects whose final in vitro fertilisation cycle
was between 2010 and 2014, who did not achieve
a live birth, and who did not return to the centre for
at least 1 year. The women completed the survey
either online or by phone. Most Mas-
sachusetts residents are covered for
six in vitro fertilisation cycles.
Thirty-six percent of 324 recipients
(n = 324) completed the survey.
Eighty-three percent of them (n=268)
were fully or partially covered for in
vitro fertilisation and were included in
the analysis. Two thirds (66%) did not
look for in vitro fertilisation at another
centre but rather discontinued treat-
ment altogether
(Figure 1
).
The top three most reported sources
of stress included:
Having already given in vitro fertilis-
ation their best chance (64%)
Feeling too anxious or depressed
to continue (51%)
Infertility took too much of a toll on
their relationship (39%).
Twenty-three percent of respondents
said they conceived spontaneously.
Of the remaining 34% who looked
for care at another centre, the most
common reason (60%) was that they sought a
second opinion. When asked what features might
have improved their treatment experience, the most
common responses ranged from opening hours to
stress reduction strategies (
Figure 2)
.
Dr Sakkas concluded, “The most common reason
insured patients reported discontinuing in vitro fer-
tilisation treatment was psychological burden. They
expressed a wish for stress reduction strategies. Pro-
viding such services may affect women’s decisions
to stop treatment before they achieve a live birth.”
"
When asked what features might have
improved their treatment experience, the most
common responses ranged from opening
hours to stress reduction strategies.
Figure 1.
Reasons for discontinuing treatment
Could not afford
out-of-pocket costs
Pursuing adoption
Lost insurance coverage
41%
24%
24%
19%
11%
10%
3%
Additional treatment would
have been too stressful
Recommended they
stop treatment
Pursuing a childfree life
Proceeded to egg or
sperm donation
Figure 2.
Features that would improve the treatment
experience
46%
38%
36%
35%
34%
34%
33%
Evening or weekend
office hours
Easy, immediate access to
a mental health professional
More access
to the physician
More convenient location
Drop-in, evening
support groups
Literature on
how to deal with stress
Classes on stress reduction
ASSISTED REPRODUCTIVE TECHNOLOGY
ASRM 2016 •
Elsevier Conference Series
9