Structured counselling and its association with IVF cycle cancellations and patient adherence

Is structured pre-stimulation counselling associated with reduced cycle cancellation and improved patient adherence during ovarian stimulation and endometrial preparation for frozen embryo transfer (FET)?

This retrospective cohort study included 8084 women initiating IVF treatment at a tertiary centre in the United Arab Emirates. First ovarian stimulation cycles performed between June 2015 and August 2025 and first endometrial preparation cycles for FET between January 2017 and July 2025 were analysed. Exposure was defined as completion of a structured pre-stimulation counselling session before treatment initiation. Outcomes were compared between counselled (n = 6813) and non-counselled (n = 1271) women. Modified Poisson regression models were used to estimate adjusted relative risks (aRR).

During ovarian stimulation, cancellation rates were lower among counselled women compared with non-counselled women (6.4% versus 23.0%), corresponding to an aRR of 0.31 (95% CI 0.27-0.36). Preventable cancellations (patient decision and medication errors) were also reduced (2.9% versus 13.3%; aRR 0.23, 95% CI 0.19-0.29). Non-adherence behaviours during ovarian stimulation were less frequent among counselled women (3.6% versus 14.8%; P = 0.001). In contrast, cancellation rates during endometrial preparation for FET did not differ between counselled and non-counselled women (27.8% versus 30.2%; aRR 0.96, 95% CI 0.79-1.16 for hormone replacement therapy cycles; 37.8% versus 43.5%; aRR 0.86, 95% CI 0.72-1.01 for natural cycles).

Structured counselling was associated with reduced preventable cancellations and improved adherence during ovarian stimulation. However, patients who declined counselling may differ systematically from those who accepted counselling.