NOT AS PRESCRIBED – UNDERSTANDING BARRIERS AND CHOICES LEADING TO DELAY(S) IN FERTILITY TREATMENT

Objective: To identify and understand patient behavior and decision-making factors contributing to delay or discontinuation in fertility treatment within a partially funded healthcare system. Design: Retrospective longitudinal analysis on a consecutive cohort of infertility patients. Materials and Methods: A retrospective review was conducted on 671 consecutive new patients seen at a university-affiliated fertility clinic between June 1, 2023, and March 31, 2024. Patient pathways were tracked from initial consultation through treatment initiation or discontinuation. Statistical analyses determined proportions and standard deviations (SD) for treatment progression and outcomes. Results: Of the 671 patients, 21% (±3% SD) discontinued care after the initial consultation. Another 31% (±3% SD) completed all investigations, received a diagnosis, and were provided a treatment plan but did not proceed with treatment. Among those who initiated care, 13% (±5% SD) achieved an ongoing pregnancy after their initial clinic visit, with over half occurring in couples referred for recurrent pregnancy loss. Regarding treatment selection, 12% (±5% SD) of couples chose cycle monitoring with oral ovulation induction agents and timed intercourse, a publicly funded service. Additionally, 22% (±2% SD) opted for partially funded intrauterine insemination (IUI). Only 3% (±1% SD) proceeded with in vitro fertilization (IVF), which required full out-of-pocket payment due to prolonged wait times for publicly funded IVF services. Conclusion: Most patients discontinued care before beginning fertility treatment, influenced by financial and accessibility barriers. These findings highlight the need to improve patient retention, streamline access to publicly funded fertility treatments, and support sub-fertile couples in navigating their options to optimize outcomes. Support: In-kind contribution from ONE Fertility.