Abstract

Success rates in IVF improved only slightly over the last 10 years despite significant technological advances. Live birth rates per IVF/ICSI cycle are in the range of 20-40%; therefore, many couples will require multiple ART attempts to conceive. ART treatments are costly, stressful and highly unsuccessful, hence strategies to improve patient’s adherence to reproductive cycles are welcomed and of utmost importance either to improve a couple’s chance to obtain a live birth and to increase the reputation of an IVF Center as a successful organization.

IVF Centers, especially private ones, are complex organizations with several clinical, financial, administrative and organizational demands, and shall be run as a business. Every business has customers, and for any business to succeed it must understand, meet and exceed customers’ expectations. IVF Centers should focus on their patients as ‘customers’, and must be run as responsible businesses.  Physicians and scientists are highly focused on the technological aspects of IVF, but pay less attention to the reasons why patients are dissuaded to enter or continue treatment. For IVF to be optimized, it is critical to understand and improve the likelihood that a patient will enter and continue treatment. Patients who get discouraged and frustrated will not continue treatment no matter the technological apparatus a Center may have.

ANDROFERT, a private IVF Center in Brazil, has dedicated the last 10 years in making IVF treatment more patient-friendly. To achieve that, our program is continually improving three main organizational pillars: (i) patient stress reduction, (ii) intensive nursing care, and (iii) total quality management. We created an adjuvant healthcare program including psychological support, nutritional counseling and acupuncture that is offered to all patients enrolled in our IVF program without extra costs. Also, each patient is assigned to a nurse that provides several educational tools to aid patients to administer medication and to manage each treatment step. Additionally, a patient-dedicated website provides web-based IVF education and access to every document such as informed consents, orientation, etc. Moreover, a quality management system has been developed and high quality standards were set not only focusing in technical aspects but primarily in patient’s satisfaction. Our Center was the first in South America to obtain ISO 9001:2008 certification. These strategies allowed us to reduce dropout rates from 55% to 22%, and from 80% to 55% after the first and the third IVF cycles, respectively, in a country where treatment costs are not covered by government benefits or private health insurance.  

Strategies to reduce patient dropout from art treatment