High in vitro fertilization discontinuation rate in France

Abstract

The effectiveness of in vitro fertilization (IVF) treatment has been widely investigated over the last 30 years. Most research has assessed the results of this technique by considering birth rates after a single IVF cycle, but few studies have examined success rates over the entire IVF program, which may include several cycles [1,2]. These success rates may depend on the proportion of couples who leave the program before achieving pregnancy. In several countries, including the United Kingdom and the United States, the discontinuation rate is likely to be elevated because of the high cost of treatment [3,4]. On the contrary, in France the first 4 IVF cycles are fully reimbursed by the national health insurance system. This provides a unique opportunity to investigate discontinuation of IVF treatment in a context where cost is not a factor. Data from 3037 couples beginning treatment between 1998 and 2002 in 2 French IVF centers serving different populations were analyzed. The first center is in Paris (n=1584 couples), a city with numerous IVF centers, while the second is in Clermont-Ferrand (n=1453 couples), a medium-sized city with the only IVF facility available in this region of central France. Success and discontinuation rates are shown in Tables 1 and 2. After the first IVF cycle, 21%–22% of couples had a live birth, while 25% of couples from the Clermont center and 38% from the Paris center discontinued IVF treatment. Regarding cumulative probabilities, 46% of couples (Clermont) and 58% (Paris) discontinued IVF before the fourth cycle, whereas 33% (Paris) and 40% (Clermont) achieved a live birth during the first 4 cycles. These results show that in France, where couples may have 4 IVF cycles free of charge, the discontinuation rate is high. The rate was higher in the Paris center where couples could easily continue their treatment in another center. However, even when the IVF center is geographically isolated (limiting the possibility of obtaining an appointment with another center), at least 1 in 4 couples discontinue treatment after the first failed cycle. The decision to discontinue treatment may be linked to psychological issues [4]. It is important to take discontinuation rates into account when estimating success rates, so that IVF performance can be better assessed and so that couples starting an IVF program can be better informed of their chances of having a baby.