P-518 Insights from patients: the role of multicycle counseling in enhancing treatment conversion and reducing discontinuation

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Abstract Study question How do patients perceive IVF counseling, and how does it impact conversion from second consultation to treatment, and likelihood of discontinuation after a failed attempt? Summary answer Being aware of psychological-support availability, diminished-ovarian-reserve, and stronger belief in a multicycle-approach associated with higher conversion-rate. Older women with no/fewer embryo-transfers failed showed lower treatment-discontinuation. What is known already ART has enabled millions of infertile women and men worldwide to seek treatment, yet it remains underutilized. Despite their strong motivation to achieve a live birth, treatment discontinuation after failure is a significant challenge. For ART patients, understanding realistic success probabilities and adopting a multicycle perspective are essential for empowering decision-making and preparing them to cope with potential setbacks. In this context, the role of reproductive counselling becomes pivotal. Effective counselling not only supports patients in navigating their journey but also addresses the reasons behind treatment discontinuation, ultimately improving the overall quality of infertility care and patient outcomes. Study design, size, duration Control arm of a prospective study (March-December 2024) comparing standard versus AI-based personalized prognostic counseling strategies. Out of 97 patients recruited after their second IVF counseling, 65 anonymously filled-in a survey (67%) to outline their opinion on factors impacting on IVF success, personal versus gynecologists’ expectations, and satisfaction with the information received. The outcomes were: conversion from second counseling to IVF treatment and treatment-discontinuation ≥3 months after a first failed IVF attempt. Participants/materials, setting, methods On average, the patients were 36 years-old, had 2.6ng/ml AMH and 24.3Kg/m2 BMI, 77% with an academic education, >70% with >1year of infertility, 34% with diminished-ovarian-reserve. Of them, 45% were already counseled and 5% treated elsewhere. The conversion-rate second counseling to treatment was 88% (N = 57/65). The treatment-discontinuation after a first failed IVF attempt was 46% (N = 11/24). We adopted Fisher’s exact-/t-tests to investigate the association between survey’s answers and these outcomes, accounting for confounders. Main results and the role of chance Among the patients, 89% prefer highly detailed IVF-counseling. 85% prioritized achieving a live-birth within short timeframe over less-invasive (12%) or less-expensive treatments (3%). When asked about factors impacting success, 69% acknowledged lifestyle-habits, 82% ovarian-reserve, 65% semen-quality, 55% infertility-diagnoses, 39% reproductive-history, and 52% BMI as significant contributors. All patients thoroughly read consent-forms and 66% declared graphical-material was used by gynecologists to estimate their prognosis; 27% had higher expectations than those provided. The possibility of requiring multiple-attempts was anticipated for 42 patients (65%), all acknowledging the importance of multicycle counseling; 83% to enhance their chances of success, 52% to shorten time between attempts, 88% to obtain realistic estimates of expenses, and 95% of time spent in treatment. Psychological-support was mentioned to 21 patients (32%). Patients were highly satisfied with the explanations regarding medications (4.3/5), techniques (4.8/5), costs (4.6/5), prognosis (4.5/5), consent-form (4.6/5), informative-materials (4.3/5), and gynecologists’ empathy (4.5/5). Features associated with higher conversion rates included awareness of psychological-support availability (N = 21/21,100% versus N = 36/44,82%;p=0.035), diminished-ovarian-reserve (N = 22/22,100% versus N = 35/43,81%,p=0.029), and stronger belief in a multicycle-approach (4.5/5 among converted versus 3.9/5 among non-converted patients). Features associated with higher treatment-discontinuation included younger maternal-age (36.2 versus 38.5years,p=0.011) and number of transferred blastocysts failing to implant/miscarrying (1.12 versus 0.2,p=0.008). Limitations, reasons for caution The small sample size precluded additional sub-analyses with sufficient statistical power (e.g., among different gynecologists). The continuation of the study will involve a larger sample size and will examine the influence of AI-based personalized prognostic counseling. The treatment-discontinuation rate is still incomplete as 18 first cycles are still ongoing. Wider implications of the findings Evidence-based counseling with a multicycle perspective could improve patient conversion rates and reduce treatment discontinuation, particularly among better-prognosis women experiencing implantation failures. Additionally, mentioning psychological support as an available option may provide further benefits. Trial registration number Yes

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