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

Survey evidence from a large patient sample found psychologic burden to be the most common reason why insured patients discontinued IVF treatment before achieving a live birth.

Volume 109, Issue 6, Pages 1121–1126


Alice D. Domar, Ph.D., Kristin Rooney, B.A., Michele R. Hacker, Sc.D., Denny Sakkas, Ph.D., Laura E. Dodge, Sc.D.



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


Cross-sectional study.


Private academically affiliated infertility center.


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.



Main Outcome Measure(s)

Reasons for treatment termination.


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%).


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.

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