O-081 Navigating the crossroads: unraveling predictors for treatment discontinuation in couples pursuing assisted reproduction: findings from a 2-year prospective study
Notice bibliographique
Résumé
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 < .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
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».