Discontinuation of infertility services or treatments in servicewomen aged 18-44 years: insights from the women's reproductive health survey.
TL;DR
To minimise early treatment discontinuation among active-duty servicewomen, the MHS should expand reproductive services to more facilities, integrate standardised psychological support and conduct qualitative research to explore uncaptured reasons for ADSW to discontinue care.
Abstract
INTRODUCTION Discontinuation of infertility care without achieving a still-desired pregnancy represents a potential failure to meet patient needs and indicates healthcare system inefficiencies. While specific reasons for premature treatment cessation are documented in various populations, no study has extensively examined its prevalence or drivers within the Military Health System (MHS). This study identifies predictors and reasons for early discontinuation among active-duty servicewomen (ADSW), whose unique sociodemographic circumstances influence how and where fertility care is accessed and sustained.
Methods
This cross-sectional secondary analysis used data from 3281 ADSW who received infertility services or treatments within the MHS, with a weighted response rate of 17.8%. We evaluated military and demographic characteristics, alongside care-related variables such as clinical setting, payment source, out-of-pocket expenses, care received both within and outside the MHS and unmet need for fertility services since joining the military. The outcome of the study was discontinuation of infertility treatments before achieving a desired pregnancy. A weighted binary logistic regression model calculated adjusted ORs (aORs) with 95% CIs to identify predictors of discontinuation before achieving pregnancy.
Results
The prevalence of early discontinuation among ADSW who received infertility services or treatments within the MHS was 28.2% (95% CI 26.2% to 30.2%). Factors that were related to early treatment cessation included: educational attainment of high school or less (aOR: 1.40, 95% CI 1.04 to 1.89), age 35-44 years (aOR: 1.33, 95% CI 1.07 to 1.65), receiving care both within and outside the MHS (aOR: 1.52, 95% CI 1.22 to 1.90), incurring out-of-pocket expenses (aOR: 1.31, 95% CI 1.04 to 1.65) and having an unmet need for fertility services since joining the military (aOR: 1.37, 95% CI 1.12 to 1.67).
Conclusions
To minimise early treatment discontinuation, the MHS should expand reproductive services to more facilities, integrate standardised psychological support and conduct qualitative research to explore uncaptured reasons for ADSW to discontinue care.