From frustration to fertility: a look at how patients' active engagement transforms their fertility care journey

The purpose of this study was to determine the differences in parameters of patient engagement in care comparing patients who are discharged to obstetrical care with an ongoing pregnancy to patients who discontinue treatment without achieving a pregnancy. A retrospective cohort study of all new patient visits at a single university-affiliated IVF center from 2019 to 2021 was performed assessing the time it takes from patients’ first visit to various milestones in care including diagnostic work up (first physical exam where body mass index (BMI) is measured, anti-mullerian hormone (AMH) testing, measurement of antral follicle count (AFC), partner’s semen analysis (SA), hysterosalpingogram (HSG), and saline sonogram (SIS)), and proceeding to treatment with intrauterine insemination (IUI), vaginal oocyte retrieval (VOR), and/or frozen embryo transfer (FET)). Comparison was made between those who were discharged to obstetrical care with an ongoing pregnancy of gestational age >8 weeks (n=7824) and those who discontinued care without achieving a pregnancy and were not seen for at least six months (n=7311). Patients who were seen in the six months prior to data collection were not included in either group as they were considered still to be engaged in care (n=966). There were significant differences between those who were successful vs those who discontinued care regarding patients’ age (33.6±4.2 vs 36±5.2 p<0.001), BMI (26.7±6.1 vs 28.6±7.5; p<0.001), AMH (4.4±4.7 vs 3.1±3.9; p<0.001), AFC (22±14.2 vs 17±13.1; p<0.001), partner’s age (35±5.4 vs 37.9±6.7; p<0.001), and total motile sperm count (131M±124M vs 112M±115M; p<0.001), which were all controlled for in the subsequent linear regression analyses. When controlling for these variables, successful group had shorter time until patient’s diagnosis (10.5 +/- 54.4 days vs 13.9-+/- 57.1 days; p = 0.03), and until partner's diagnosis (19.4+/- 59.7 days vs 23.4+/- 58.4 days; p = 0.03). However, time (days) until first physical exam, AMH and AFC testing, HSG, SIS, SA, IUI, VOR, or FET were not significantly different between the groups. On average, patients who reached successful discharge to OBGYN were in care for 277 days (SD±198 days). Their partners had their SA on average after 47d (SD±114d), they went to IUI after 108 days (SD±141d) or had their retrieval after 181 days (SD±179d) and their FET after 265d (SD±190d). The patient's intrinsic characteristics are important to completion of the fertility journey, however time to patient and partner's diagnosis also affect the likelihood of continued engagement in care to successful completion of the journey. Patients should be scheduled as quickly as possible in order to complete their care, however the time it takes for them to move through care beyond diagnostics does not predict their likelihood of success.