Patterns of progression and nonprogression through in vitro fertilization treatment

Purpose: Increasing numbers of couples are consulting for infertility and, after some years of investigation and treatment, will become enrolled in in vitro fertilization (IVF) programs. The media have focused on successful outcomes or difficulties in accessing services because of health authority funding guidelines. Couples are often assumed to be highly motivated because of their long prior involvement in treatment. However little is known about uptake of and continuation through IVF treatment programs. Methods: One hundred forty-four couples were followed through the process of IVF in a service that allows three cycles of treatment with a minimum gap of 3 months between treatment cycles. Patterns of engagement in and delay and withdrawal from treatment were examined. Results: One in five couples withdrew from the program before completion of the available number of treatment cycles. A further one in three significantly delayed their involvement in treatment cycles. Mean deviations of the time between attempts increased as the number of treatment cycles progressed. A proportion of couples did not complete a single treatment cycle. Conclusions: The dramatic proportions of patients withdrawing from or very significantly delaying subsequent involvement are indicative of the often unacknowledged difficulties associated with IVF treatment. implications for care are discussed.