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Open Access Research article

Joint modeling of success and treatment discontinuation in in vitro fertilization programs: a retrospective cohort study

Pénélope Troude123*, Sophie Ancelet24, Juliette Guibert56, Jean-Luc Pouly7, Jean Bouyer123 and Elise de La Rochebrochard123

Author Affiliations

1 Ined, 133 boulevard Davout, F-75020, Paris, France

2 Inserm, CESP U1018, Site de Bicêtre, 82 rue du Général Leclerc, F-94276, Le Kremlin-Bicêtre, France

3 Univ Paris-Sud, UMRS 1018, F-94276, Le Kremlin-Bicêtre, France

4 Institute for Radiological Protection & Nuclear Safety, Laboratory of Epidemiology, BP 17, 92262, Fontenay-aux-Roses Cedex, France

5 Unité de Médecine de la Reproduction, Service de Gynécologie-Obstétrique II, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, F-75014, Paris, France

6 Laboratoire de Procréation Médicalement Assistée, Institut Mutualiste de Montsouris, 42 boulevard Jourdan, F-75014, Paris, France

7 Unité de FIV, CHU de Clermont-Ferrand, 58 rue Montalembert, F-63003, Clermont-Ferrand, France

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BMC Pregnancy and Childbirth 2012, 12:77  doi:10.1186/1471-2393-12-77

Published: 3 August 2012

Abstract

Background

As discontinuation in in vitro fertilization (IVF) programs has been associated with a poor prognosis, one hypothesis is that some couple-specific predictive factors in IVF may be shared with opposite effect by both success (i.e. live birth) and treatment discontinuation processes. Our objective was to perform a joint analysis of these two processes to examine the hypothesis of a link between the two processes.

Methods

Analyses were conducted on a retrospective cohort of 3,002 women who began IVF between 1998 and 2002 in two French IVF centers: a Parisian center and a center in a medium-sized city in central France. A shared random effects model based on a joint modelization of IVF treatment success and discontinuation was used to study the link between the two processes.

Results

Success and discontinuation processes were significantly linked in the medium-sized city center, whereas they were not linked in the Parisian center. The center influenced risk of treatment discontinuation but not chance of success. The well-known inverse-J relation between the woman’s age and chance of success was observed, as expected. Risk of discontinuation globally increased as the woman’s age increased.

Conclusions

The link between success and discontinuation processes could depend on the fertility center. In particular, the woman’s decision to pursue or to discontinue IVF in a particular center could depend on the presence of other IVF centers in the surrounding area.