OBJECTIVE: After the diagnosis of infertility, some patients halt reproductive efforts before utilizing advanced reproductive technologies (ART). In addition to medical considerations, sociodemographic and psychological patient factors may predict patient choices to abandon treatment efforts. Utilizing a US infertility cohort, we sought to determine reasons for and rates of not pursuing infertility care. DESIGN: Prospective cohort study. MATERIALS AND METHODS: Infertile couples were recruited from 8 reproductive endocrinology practices for a longitudinal study of the impact of infertility. From questionnaires administered at recruitment, sociodemographic, reproductive, and psychological factors were assessed. Couples were followed for 18 months with interviews and medical records were abstracted to determine any treatments pursued. Multivariate logistic regression was used to determine factors that predicted patients' choices not to pursue ART. RESULTS: 448 couples were analyzed. In all, 121 couples (27%) did not pursue any form of ART. Reasons given for not pursuing treatment were financial (58%), life conflicts (i.e. moving, death in family; 38%), and medical futility (26%). On multivariable regression, a 5-point increase in the depressive symptoms score (CESD), led to a 20%∗ increase in odds of not pursuing treatment. A 5-year increase in age also led to an 62%∗ increased odds of not pursuing treatment. In contrast, higher education (≥college), lowered the odds of not pursuing treatment by 78%∗. Higher income showed a trend toward lowering the odds of not pursuing treament (p=0.06). ∗p≤0.05 CONCLUSIONS: Baseline sociodemographic and psychologic variables can predict couples at increased odds of not pursuing ART. While financial concerns remain prominent in our U.S. cohort, depression also appears to be a barrier; detecting and treating depression may be useful in helping patients achieve their reproductive goals.