Couples dropping out of a reimbursed intrauterine insemination program What is their prognostic profile and why do they drop out

Capsule:
Dropping out of couples from fertility treatment is well known. An observational retrospective cohort study was performed to evaluate whether prognostic profiles differed between couples who drop out and couples that continue IUI.

Authors:
Inge M. Custers, M.D., Thierry H.J.H.M. van Dessel, M.D., Ph.D., Paul A. Flierman, M.D., Pieternel Steures, M.D., Ph.D., Madelon van Wely, Ph.D., Fulco van der Veen, Professor, Ben W. J. Mol, Professor

Volume 99, Issue 5, Pages 1294-1298, April 2013

Abstract:

Objective:
To evaluate whether baseline characteristics and prognostic profiles differed between couples who drop-out from IUI and couples that continue IUI, and the reasons for couples dropping-out from IUI programs.

Design:
Retrospective observational cohort study.

Setting:
Fertility centers.

Patients:
Consecutive subfertile couples undergoing IUI.

Interventions:
None.

Main Outcome Measure:
Characteristics and prognosis on ongoing pregnancy after IUI, calculated by the model of Steures et al., at the start of treatment, of couples that dropped-out compared to couples that continued treatment or achieved an ongoing pregnancy.

Results:
We studied 803 couples who underwent 3,579 IUI cycles of whom 221 couples dropped-out (28%). Couples dropping-out completed 2.8(SD±1.4) cycles per couple compared to 4.5(SD±2.3) cycles per couple for those continuing treatment. Couples dropping-out had a higher female age, longer subfertility duration and higher basal FSH. Mean prognosis to achieve an ongoing pregnancy after IUI at start of treatment was 7.9% (SD±2.4) per cycle for couples who dropped-out, and 8.5%(SD±2.5) per cycle for couples continuing treatment. Of the dropouts, 100 couples (45%) were actively censored from the IUI-programme of whom 87 couples (39%) because of poor prognosis. 121 Couples (55%) were passively censored from the program of whom 62 (28%) dropped-out due to personal reasons. 59 Couples (27%) were lost-to-follow-up.

Conclusions:
We found significant differences in prognostic p 50 rofile between couples continuing treatment and couples dropping-out, although these differences seem limited from a clinical perspective. We conclude that overestimation of ongoing pregnancy rates after IUI due to couples dropping-out is limited.

  • laurenwroth

    This is an interesting study looking at why couples drop out of IUI treatment in a country where treatment is reimbursed. Although there were statistical differences in terms of prognostic factors between those that continue and those that drop out, I agree with the authors that the differences don’t seem clinically significant. Because the study is retrospective, there are 2 main pieces of information that are missing that would be informative: actual reason for the couple leaving (rather than being assigned by the physician) and percentage proceeding to IVF.

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