Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, PO Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands.
Hum Reprod. 2009 Dec;24(12):3127-35. doi: 10.1093/humrep/dep340. Epub 2009 Sep 26.
A substantial number of subfertile couples discontinues fertility care before achieving pregnancy. Most studies on dropouts are related to IVF. The aim here is to examine dropout rates at all stages of fertility care.
We analysed a consecutive cohort of 1391 couples, referred to our secondary care hospital between January 2002 and December 2006. Discontinuation rates were studied at six stages. Stage I: immediately after first visit, Stage II: during diagnostic workup, Stage III: after finishing diagnostic workup but before treatment, Stage IV: during or after non-IVF treatment, Stage V: during IVF, Stage VI: after at least 3 cycles of IVF. Reasons to discontinue and spontaneous pregnancy rates after discontinuation were secondary outcomes.
In our cohort 319 couples dropped out of fertility care, 76.8%, [95% confidence interval (CI): 72.2-81.4] on their own initiative and 23.2% (95% CI: 18.6-27.8) on doctor's advice. Percentage (95% CI) of couples discontinuing per stage were: Stage I 6.0% (3.4-8.6), Stage II 3.4% (1.5-5.5), Stage III 35.7% (30.5-41.0), Stage IV 23.5% (18.9-28.2), Stage V 17.9% (13.7-22.1) and Stage VI 13.5% (9.7-17.2). Main reasons for dropout (%, 95% CI) were 'emotional distress' (22.3%, 17.7-26.8), 'poor prognosis' (18.8%, 14.5-23.1) and 'reject treatment' (17.2%, 13.1-21.4). The spontaneous ongoing pregnancy rate after discontinuation was 10% (6.7-13.3).
About half of the couples stopped before any fertility treatment was started and one-third stopped after at least one IVF cycle. The main reasons for withdrawal were emotional distress and poor prognosis. This insight may help to improve quality of patient care by making care more responsive to the needs and expectations of subfertile couples.
大量的不孕夫妇在怀孕前就停止了生育治疗。大多数关于脱落率的研究都与 IVF 有关。本研究旨在检查生育治疗各个阶段的脱落率。
我们分析了 2002 年 1 月至 2006 年 12 月期间我院二级保健医院就诊的 1391 对连续夫妇。研究了六个阶段的终止率。第 I 阶段：首次就诊后立即，第 II 阶段：诊断工作期间，第 III 阶段：完成诊断工作后但在治疗前，第 IV 阶段：非 IVF 治疗期间或之后，第 V 阶段：IVF 期间，第 VI 阶段：至少 3 个 IVF 周期后。自行停药的原因和停药后的自发妊娠率是次要结局。
在我们的队列中，319 对夫妇退出了生育治疗，76.8%（95%可信区间[CI]：72.2-81.4）是自行退出的，23.2%（95%CI：18.6-27.8）是医生建议的。每个阶段停止治疗的夫妇比例（%，95%CI）为：第 I 阶段 6.0%（3.4-8.6），第 II 阶段 3.4%（1.5-5.5），第 III 阶段 35.7%（30.5-41.0），第 IV 阶段 23.5%（18.9-28.2），第 V 阶段 17.9%（13.7-22.1）和第 VI 阶段 13.5%（9.7-17.2）。退出的主要原因（%，95%CI）是“情绪困扰”（22.3%，17.7-26.8），“预后不良”（18.8%，14.5-23.1）和“拒绝治疗”（17.2%，13.1-21.4）。停药后持续妊娠的自发率为 10%（6.7-13.3）。
大约一半的夫妇在开始任何生育治疗之前就停止了治疗，三分之一的夫妇在至少一个 IVF 周期后停止了治疗。退出的主要原因是情绪困扰和预后不良。这种了解可能有助于通过使护理更能满足不孕夫妇的需求和期望来提高患者护理质量。
