Psychological Stress: Reasons for Termination of In-vitro Fertilization
by. Dr. Lin Zhou, OMD, l.Ac., FABORM.
Infertility remains a clinical and social problem affecting many people in the world. The most common causes of infertility are sperm abnormalities, ovulation dysfunction, endometriosis, reduced ovarian reserves and tubal pathology; plus, there are unexplained reasons of infertility owing to combined male and female factors. In-vitro fertilization (IVF) offers a new hope for conception for such couples when other infertility treatments are not successful.
Couples that have elevated levels of fertility are highly motivated to consult IVF clinics as chances are high to achieve conception. However, the regimens applied for IVF are diverse, expensive, time-consuming, complex and sometimes stressful. Many couples cannot endure the strains of this treatment modality and discontinue IVF therapy. Since the treatment is most likely to be at the early stage, when the probability of achieving pregnancy is at its minimal, discontinuation should therefore be put into consideration as an adverse treatment result could definitely have an effect on the success of the program.
According to research, high rates of drop-out are frequently encountered in IVF treatment. The drop-out rates reported by couples undergoing IVF treatment shows a large variation. The highest percentage of participants who underwent unsuccessful treatment did not seek out care elsewhere, thereby discontinuing treatment. When asked why they discontinued treatment, these women indicated that further treatment was too stressful, they could not afford the out-of-pocket costs, and they had lost insurance coverage, or had conceived spontaneously. Among those citing stress as a reason for discontinuing treatment, the top sources of stress included already having given IVF their best chance, feeling too stressed to continue, and infertility taking too much of a toll on their relationship*.
Many health professionals in the infertility field think that patients discontinue treatment because of an inability to pay and/or a poor prognosis. Although most research on uninsured patients supports the hypothesis that finances play a large role in the decision to discontinue treatment, studies have shown that recommendation given by the medical practitioner is not the major reason for treatment termination. In fact, in each of those studies of insured patients, it was reported that the negative psychological stress during the treatment was the primary reason for terminating treatment**. Various studies have been carried out to verify these findings with different patients and recurrent results showing that psychological stress is the major reason why patients tend to terminate treatment via IVF.
Since it is now well known that stress play a vital role in treatment termination, we cannot undermine the factors that contribute to influence their decision and, perhaps most importantly, what patients think might have allowed them to continue treatment.
*Olivius, C., Friden, B., Borg, G., & Bergh, C. (2004). Why do couples discontinue in vitro fertilization treatment? a cohort study. Fertility and Sterility, 81(2), 258-261. doi:10.1016/j.fertnstert.2003.06.029
**M. Rajkhowa, A. Mcconnell, G.E. Thomas; Reasons for discontinuation of IVF treatment: a questionnaire study, Human Reproduction, Volume 21, Issue 2, 1 February 2006, Pages 358–363, https://doi.org/10.1093/humrep/dei355
** Burden of care is the primary reason why insured women terminate in vitro fertilization treatment. Fertility and Sterility Feb 19, 2018. Volume 109, Issue 6, Pages 1121–1126.