From hope to hesitation: why couples fail to return for infertility treatment after the first consultation

Abstract

STUDY QUESTION What are the key factors that influence couples’ decision not to return for fertility treatment after their first consultation? SUMMARY ANSWER Advanced maternal age, lower ovarian reserve, and eligibility for heterologous fertilization are primary determinants of non-return among couples. WHAT IS KNOWN ALREADY Previous research highlights the psychological, financial, and demographic reasons behind high dropout rates in IVF, yet a comprehensive understanding of the factors driving non-return, particularly at the first consultation, is still lacking and warrants further study. STUDY DESIGN, SIZE, DURATION This single-center observational study, incorporating both retrospective and prospective components, analyzed couples consulting at Humanitas Research Hospital from 2012 to 2021. The retrospective review spanned 24 773 couples from 2012 to 2021, among whom 6174 did not return. The prospective cohort included 986 couples who failed to return out of a total of 3214 couples who had their first consultation in 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants included couples seeking their first fertility consultation at a specialized fertility center. Retrospective data were extracted from internal records to assess personal, demographic, and biological factors (anti-Mullerian hormone [AMH] and FSH levels) contributing to non-return, while non-returning patients in the prospective arm completed a telephone questionnaire in addition to data extraction from internal records. MAIN RESULTS AND THE ROLE OF CHANCE Between 2012 and 2021, 24.92% of couples did not return after the initial consultation, with older age and diminished ovarian reserve as significant predictors. Of 3214 couples in 2021, 986 (30.68%) did not return after their first consultation. All 986 patients were contacted, and the response rate was 85.1%. Non-returning women were significantly older (37.1 vs. 35.6 years) and exhibited lower AMH levels (1.87 vs. 2.83 ng/ml) and higher FSH levels (13.13 vs. 8.19 mIU/ml). Primary reasons for non-return included eligibility for gamete donation (34.09%), spontaneous pregnancy (29.20%), and transferring treatment to another center (18.71%). Other contributing factors were existing parenthood (11.43%), psychological distress (9.65%), and dissatisfaction with the doctor (7.39%). These findings highlight the multifaceted nature of treatment discontinuation and underscore the importance of comprehensive support to mitigate non-return risk. LIMITATIONS, REASONS FOR CAUTION This study is limited by its single-center design: generalizability may vary based on differences in patient demographics and healthcare settings across regions and countries. Additionally, the prospective analysis may be affected by selection bias, as those non-returning patients who could not be reached might have provided meaningfully different answers. WIDER IMPLICATIONS OF THE FINDINGS These findings align with current literature while providing new insights into non-return for fertility treatment. The study underscores the need for tailored support and counseling to address the challenges faced by the couples, potentially enhancing treatment adherence and outcomes. STUDY FUNDING/COMPETING INTEREST(S) This research received no specific funding. The authors report no conflicts of interest. TRIAL REGISTRATION NUMBER clinicaltrials.gov NCT06344585.