University of Coimbra, Coimbra, Portugal.
Hum Reprod Update. 2012 Nov-Dec;18(6):652-69. doi: 10.1093/humupd/dms031. Epub 2012 Aug 6.
BACKGROUND Chances of achieving parenthood are high for couples who undergo fertility treatment. However, many choose to discontinue before conceiving. A systematic review was conducted to investigate patients' stated reasons for and predictors of discontinuation at five fertility treatment stages. METHODS Six databases were systematically searched. Search-terms referred to fertility treatment and discontinuation. Studies reporting on patients' stated reasons for or predictors of treatment discontinuation were included. A list of all reasons for discontinuation presented in each study was made, different categories of reasons were defined and the percentage of selections of each category was calculated. For each predictor, it was noted how many studies investigated it and how many found a positive and/or negative association with discontinuation. RESULTS The review included 22 studies that sampled 21 453 patients from eight countries. The most selected reasons for discontinuation were: postponement of treatment (39.18%, postponement of treatment or unknown 19.17%), physical and psychological burden (19.07%, psychological burden 14%, physical burden 6.32%), relational and personal problems (16.67%, personal reasons 9.27%, relational problems 8.83%), treatment rejection (13.23%) and organizational (11.68%) and clinic (7.71%) problems. Some reasons were common across stages (e.g. psychological burden). Others were stage-specific (e.g. treatment rejection during workup). None of the predictors reported were consistently associated with discontinuation. CONCLUSIONS Much longitudinal and theory led research is required to explain discontinuation. Meanwhile, treatment burden should be addressed by better care organization and support for patients. Patients should be well informed, have the opportunity to discuss values and worries about treatment and receive advice to decide about continuing treatment.
接受生育治疗的夫妇实现生育的机会很高。然而，许多人在怀孕前选择停止治疗。本系统评价旨在调查五个生育治疗阶段中患者停止治疗的原因和预测因素。
系统检索了六个数据库。检索词涉及生育治疗和停止治疗。纳入报告患者停止治疗原因或预测因素的研究。列出每个研究中报告的所有停止治疗原因，定义不同类别的原因，并计算每个类别的选择百分比。对于每个预测因素，记录有多少研究调查了它，以及有多少研究发现它与停止治疗存在正相关和/或负相关。
本综述纳入了 22 项研究，这些研究从 8 个国家招募了 21453 名患者。最常被选择的停止治疗原因是：推迟治疗（39.18%，推迟治疗或未知原因 19.17%）、身体和心理负担（19.07%，心理负担 14%，身体负担 6.32%）、关系和个人问题（16.67%，个人原因 9.27%，关系问题 8.83%）、治疗拒绝（13.23%）和组织（11.68%）和诊所（7.71%）问题。一些原因在各个阶段都很常见（如心理负担），而另一些原因则是特定于某个阶段的（如在检查阶段的治疗拒绝）。没有一个报告的预测因素与停止治疗始终相关。
需要进行更多的纵向和基于理论的研究来解释停止治疗的原因。同时，应通过更好的治疗组织和对患者的支持来减轻治疗负担。应充分告知患者，让他们有机会讨论对治疗的价值观和担忧，并提供建议以决定是否继续治疗。
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