Worldwide prevalence of discontinuation in fertility treatment: A systematic review and meta-analysis

Abstract

Background: Fertility treatment discontinuation is of serious concern worldwide, yet the prevalence of discontinuation from fertility treatment has not been quantified at the regional or global level. Objectives: To perform a systematic review and meta-analysis of the global prevalence of fertility treatment discontinuation in infertile patients, and to examine the follow-up pregnancy/live birth rate after discontinuation of fertility treatment. Search Strategy: We searched PubMed, Embase, The Cochrane Library, Web of Science, CINAHL and American Psychological Association from inception to February 2024 without language or time restrictions. We also searched gray literature and hand-searched the list of relevant references. Selection Criteria: We included all original studies in the English language that reported prevalence data on discontinuation and its follow-up pregnancy/live birth rate. Data Collection and Analysis: Two independent reviewers performed study quality assessment, data extraction and analysis. A random-effects model was used to pool the overall prevalence estimates and 95% confidence intervals (95% CI). Main Results: A total of 62 studies involving 330 593 infertile patients from 20 countries were included in the review. The overall pooled prevalence of discontinuation across all fertility treatments was 0.36 (95% CI: 0.31–0.41). Specifically, the prevalence of discontinuation in assisted reproductive treatments was 0.37 (95% CI: 0.32–0.42). Prevalence rates of discontinuation show an increasing trend with the course of treatment, particularly within the first four treatment cycles, ranging from 23% after the first failed cycle to 36% after the fourth failed cycle. Among these discontinuers, the follow-up pregnancy rates were 0.22 (95% CI: 0.12–0.32), and the live birth rates were 0.21 (95% CI: 0.15–0.27). Conclusions: This review provides evidence that treatment discontinuation occurs in approximately one in every three infertile patients. Further research is warranted to develop effective intervention strategies for preventing and managing early treatment discontinuation in this population.