BACKGROUNDChances of achieving parenthood are high for couples who undergo fertility treatment. However, many choose to discontinue before conceiving. A systematic review was conducted to investigate patients' stated reasons for and predictors of discontinuation at five fertility treatment stages.METHODSSix databases were systematically searched. Search-terms referred to fertility treatment and discontinuation. Studies reporting on patients' stated reasons for or predictors of treatment discontinuation were included. A list of all reasons for discontinuation presented in each study was made, different categories of reasons were defined and the percentage of selections of each category was calculated. For each predictor, it was noted how many studies investigated it and how many found a positive and/or negative association with discontinuation. RESULTSThe review included 22 studies that sampled 21 453 patients from eight countries. The most selected reasons for discontinuation were: postponement of treatment (39.18%, postponement of treatment or unknown 19.17%), physical and psychological burden (19.07%, psychological burden 14%, physical burden 6.32%), relational and personal problems (16.67%, personal reasons 9.27%, relational problems 8.83%), treatment rejection (13.23%) and organizational (11.68%) and clinic (7.71%) problems. Some reasons were common across stages (e.g. psychological burden). Others were stage-specific (e.g. treatment rejection during workup). None of the predictors reported were consistently associated with discontinuation.CONCLUSIONSMuch longitudinal and theory led research is required to explain discontinuation. Meanwhile, treatment burden should be addressed by better care organization and support for patients. Patients should be well informed, have the opportunity to discuss values and worries about treatment and receive advice to decide about continuing treatment.

Research shows that men diagnosed with male factor infertility experience more suffering than men with infertility due to other causes, and that it is socially unfavourable to be diagnosed with male factor infertility resulting in secrecy surrounding diagnosis, sometimes to the point that women take the blame for the couples' infertility. We investigated mental and physical health, support, and psychological and social stress in men (N = 256) prior to and after 12 months of unsuccessful treatment according to their diagnosis: unexplained, female factor, male factor, or mixed. Results suggest that men do not differ by diagnosis on any of the variables tested. When treatment was not successful, all men showed increased suffering in the form of decreased mental health, increased physical stress reactions, decreased social support, and increased negative social stress over time. These findings indicate that involuntary childlessness is difficult for all men, and is not dependent on with whom the cause lies. There was also a high level of agreement between couples and medical records on the cause of the couples' fertility arguing against the idea that women take the blame for male factor infertility.

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