Patients should be provided with adequate information
about their chances of pregnancy in the programme they are about to join before
they start In-Vitro Fertilization (IVF) treatment. The estimation of the
likelihood of pregnancy for couples is often based on the pregnancy rate per
cycle obtained in a programme. However, several methods can be used to express
pregnancy rates in IVF programmes. The deļ¬nition of clinical or ongoing
pregnancy can differ, and pregnancy rates can be calculated per started cycle,
per oocyte retrieval, or per embryo transfer. When informing patients about
success rates, a possible reduction in pregnancy rates in successive cycles
should be considered. For a randomly chosen patient each unsuccessful cycle
constitutes evidence in favour of lower fertility potential.
IVF pregnancy rates are compromised by the large
number of couples who drop-out of treatment before achieving pregnancy. Our aim
is to identify the role of the treatment strategy applied, and potential other
factors that influence the decision of couples to discontinue treatment.
Reducing drop-out rate is crucial to further improve the efficacy and
cost-effectiveness of IVF treatment. An important factor determining the risk
of drop-out is the burden of the treatment strategy. The application of a mild
treatment strategy and managing patient's expectations might reduce drop-out
rates.
Some answers will be fairly obvious; one of them
would be financial reasons because there are lots of patient who simply
couldn't afford to do a second or third IVF treatment cycle. Others may have
had a terrible experience because the doctor was rude or unkind. However, some
psychological differences between women who continue with IVF treatments as
compared to those who drop out. This would be a very interesting area of study
for psychologists and for IVF specialists because it would help us to identify
women who have the emotional resilience to understand that IVF treatment is a
process, which may take time rather than a single shot affair. It would also
help us to identify those women who had unrealistic expectations. It would help
us to counsel them so that they are better prepared for the possibility of
failure. This will stop them from going to pieces in case their first cycle
fails. This is an area which is ripe for study, which has been quite neglected
so far.
Failure of IVF treatment after a number of cycles can
be devastating for couples. Although mild IVF strategies reduce the
psychological burden of treatment, failure may cause feelings of regret that a
more aggressive approach, including the transfer of two embryos, was not
employed. Women who experienced treatment failure after standard IVF treatment
presented more symptoms of depression one week after treatment termination
compared with women who had undergone mild IVF. Failure of IVF treatment after
a mild treatment strategy may result in fewer short-term symptoms of depression
as compared to failure after a standard treatment strategy. These findings may
further encourage the application of mild IVF treatment strategies in clinical
practice.
Reducing drop-out rate is crucial to further improve
the efficacy and cost-effectiveness of IVF treatment. An important factor
determining the risk of drop-out is the burden of the treatment strategy. The
application of a mild treatment strategy and managing patient's expectations
might reduce drop-out rates.
