Passion, pressure and pragmatism: how fertility clinic medical directors view IVF add-ons

Iacoponi, Olivia; Wiel, Lucy van de; Harper, Joyce

doi:10.1016/j.rbmo.2022.02.021

Cited by 8 publications

(8 citation statements)

References 21 publications

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“…This is one of the first studies to explore the perspectives of IVF clinicians, embryologists, and patients of the HFEA’s treatment add-ons website which uses a traffic light system (red, amber, and green) to label add-ons, based on evidence from RCTs. While there was widespread support for the website, particularly among IVF patients, many important limitations were recognised, some of which have also been raised in recent qualitative studies in the UK ( Perrotta & Geampana 2020 , Perrotta & Hamper 2021 , 2023 , Iacoponi et al 2022 ). Key themes included an overly simplistic traffic light system that failed to convey sufficient detail about the level of evidence and the type of patients this applied to specifically.…”

Section: Discussionmentioning

confidence: 99%

“…These findings align with recent qualitative research which also reports a wide variety of approaches to evidence interpretation among IVF patients and professionals in the UK ( Perrotta & Geampana 2020 , Perrotta & Hamper 2021 , 2023 ). Researchers of these studies described the professional divide as a tension between a science-first vs patient-first approach, noting that proponents of the latter sometimes viewed evidence-based medicine as in conflict with their approach and viewed the traffic light system as unnecessarily dissuasive ( Geampana & Perrotta 2022 , Iacoponi et al 2022 ). However, a suggested flaw with these labels is the implication that those practicing evidence-based medicine are not offering a patient-centred approach or not acting in the best interest of their patients.…”

Section: Discussionmentioning

confidence: 99%

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‘It all depends on why it’s red’: qualitative interviews exploring patient and professional views of a traffic light system for in vitro fertilisation add-ons

Lensen

Armstrong

Vaughan

et al. 2023

Reproduction and Fertility

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Background IVF add-ons are techniques, medicines or procedures used in addition to standard IVF with the aim of improving the chance of success. The United Kingdom’s IVF regulator, ( the Human Fertilisation Embryology Authority (HFEA) developed a traffic light system to categorise add-ons as either green, amber, or red, based on results of randomised controlled trials. Method Qualitative interviews were undertaken to explore understanding and views of the HFEA traffic light system among IVF clinicians, embryologists and IVF patients across Australia and the United Kingdom. Results A total of 73 interviews were conducted. Overall, participants were supportive of the intention of the traffic light system, however many limitations were raised. It was widely recognized that a simple traffic light system necessarily omits information which may be important to understanding the evidence base. In particular, the red category was used in scenarios that patients viewed as having different implications for their decision-making, including ‘no evidence’ and ‘evidence of harm’. Patients were surprised at the absence of any green add-ons and questioned the value of a traffic light system in this context. Many participants considered the website a helpful starting point, but desired more detail, including the contributing studies, results specific to patient demographics (e.g., <35 years and >35 years), and inclusion of more options (e.g. acupuncture). Overall, participants believed the website to be reliable and trustworthy, particularly due to the Government affiliation, and despite some concerns regarding transparency and an overly cautious regulator. Conclusion Participants identified many limitations with the current application of the traffic light system. These could be considered in any future updates to the HFEA website and for others developing similar decision support tools.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

‘It all depends on why it’s red’: qualitative interviews exploring patient and professional views of a traffic light system for in vitro fertilisation add-ons

Lensen

Armstrong

Vaughan

et al. 2023

Reproduction and Fertility

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“…, 2021 ). Healthcare professionals may be driven by the wish to do the best for the patients, pressure from the patients and sometimes also by competitive and/or commercial motives to go beyond standard treatment ( Iacoponi etal. , 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Good practice recommendations on add-ons in reproductive medicine

Lundin,

Bentzen,

Bozdag

et al. 2023

Human Reproduction

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STUDY QUESTION Which add-ons are safe and effective to be used in ART treatment? SUMMARY ANSWER Forty-two recommendations were formulated on the use of add-ons in the diagnosis of fertility problems, the IVF laboratory and clinical management of IVF treatment. WHAT IS KNOWN ALREADY The innovative nature of ART combined with the extremely high motivation of the patients has opened the door to the wide application of what has become known as ‘add-ons’ in reproductive medicine. These supplementary options are available to patients in addition to standard fertility procedures, typically incurring an additional cost. A diverse array of supplementary options is made available, encompassing tests, drugs, equipment, complementary or alternative therapies, laboratory procedures, and surgical interventions. These options share the common aim of stating to enhance pregnancy or live birth rates, mitigate the risk of miscarriage, or expedite the time to achieving pregnancy. STUDY DESIGN, SIZE, DURATION ESHRE aimed to develop clinically relevant and evidence-based recommendations focusing on the safety and efficacy of add-ons currently used in fertility procedures in order to improve the quality of care for patients with infertility. PARTICIPANTS/MATERIALS, SETTING, METHODS ESHRE appointed a European multidisciplinary working group consisting of practising clinicians, embryologists, and researchers who have demonstrated leadership and expertise in the care and research of infertility. Patient representatives were included in the working group. To ensure that the guidelines are evidence-based, the literature identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, recommendations were based on the professional experience and consensus of the working group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 46 independent international reviewers. A total of 272 comments were received and incorporated where relevant. MAIN RESULTS AND THE ROLE OF CHANCE The multidisciplinary working group formulated 42 recommendations in three sections; diagnosis and diagnostic tests, laboratory tests and interventions, and clinical management. LIMITATIONS, REASONS FOR CAUTION Of the 42 recommendations, none could be based on high-quality evidence and only four could be based on moderate-quality evidence, implicating that 95% of the recommendations are supported only by low-quality randomized controlled trials, observational data, professional experience, or consensus of the development group. WIDER IMPLICATIONS OF THE FINDINGS These guidelines offer valuable direction for healthcare professionals who are responsible for the care of patients undergoing ART treatment for infertility. Their purpose is to promote safe and effective ART treatment, enabling patients to make informed decisions based on realistic expectations. The guidelines aim to ensure that patients are fully informed about the various treatment options available to them and the likelihood of any additional treatment or test to improve the chance of achieving a live birth. STUDY FUNDING/COMPETING INTEREST(S) All costs relating to the development process were covered from ESHRE funds. There was no external funding of the development process or manuscript production. K.L. reports speakers fees from Merck and was part of a research study by Vitrolife (unpaid). T.E. reports consulting fees from Gynemed, speakers fees from Gynemed and is part of the scientific advisory board of Hamilton Thorne. N.P.P. reports grants from Merck Serono, Ferring Pharmaceutical, Theramex, Gedeon Richter, Organon, Roche, IBSA and Besins Healthcare, speakers fees from Merck Serono, Ferring Pharmaceutical, Theramex, Gedeon Richter, Organon, Roche, IBSA and Besins Healthcare. S.R.H. declares being managing director of Fertility Europe, a not-for-profit organization receiving financial support from ESHRE. I.S. is a scientific advisor for and has stock options from Alife Health, is co-founder of IVFvision LTD (unpaid) and received speakers’ fee from the 2023 ART Young Leader Prestige workshop in China. A.P. reports grants from Gedeon Richter, Ferring Pharmaceuticals and Merck A/S, consulting fees from Preglem, Novo Nordisk, Ferring Pharmaceuticals, Gedeon Richter, Cryos and Merck A/S, speakers fees from Gedeon Richter, Ferring Pharmaceuticals, Merck A/S, Theramex and Organon, travel fees from Gedeon Richter. The other authors disclosed no conflicts of interest. DISCLAIMER This Good Practice Recommendations (GPRs) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and are based on the scientific evidence available at the time of preparation. ESHRE GPRs should be used for information and educational purposes. They should not be interpreted as setting a standard of care or bedeemedinclusive of all proper methods of care, or be exclusive of other methods of care reasonably directed to obtaining the same results.Theydo not replace the need for application of clinical judgement to each individual presentation, or variations based on locality and facility type. Furthermore, ESHRE GPRs do not constitute or imply the endorsement, or favouring, of any of the included technologies by ESHRE.

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“…Even when aware of the limited evidence base, patients may reasonably conclude that if a consultant offers them an add-on, it is listed on the clinic's website or price list, or a clinician agrees to using an add-on following a patient request 'it must have some chance of working' (Brody, 1997;Wilkinson et al, 2019). Despite ample discussion and speculation about the drivers for add-on use (Iacoponi et al, 2022;Lensen et al, 2019;Wilkinson et al, 2019), there is currently little real life data available. Understanding why these unproven procedures are used in practice can inform efforts to improve evidence-based care and decision-making.…”

Section: Introductionmentioning

confidence: 99%

Is the use of IVF add-on treatments driven by patients or clinics? Findings from a UK patient survey

et al. 2023

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There are conflicting narratives over what drives demand for add-ons. We undertook an online survey of IVF patients to determine whether patients perceive that use of IVF add-ons is driven by patients or practitioners. People who underwent IVF in the UK in the previous five years were recruited via social media Survey questions focussed on the roles of clinician offer and patient request, including who first suggested use of add-ons in IVF consultations, where patients first heard about them, and which information sources they trusted. From a total of 261 responses, 224 met the inclusion criteria. Overall, 67% of respondents had used one or more IVF add-ons, most commonly: time-lapse imaging (27%), EmbryoGlue (27%), and endometrial scratching (26%). Overall, 81% of the add-ons used were offered to participants by clinicians (compared to 19% requested by themselves). Half (54%) reported being offered add-ons during consultations, compared to 24% who initiated discussion about add-ons. Higher proportions of private patients reported being offered (90%), requesting (47%) and using (74%) add-ons than those with NHS funding (74%, 29%, 52%, respectively). The main limitations of this study are the small sample size, recruitment via a convenience sample, and the self-reported data capture which is subject to recall bias.

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Passion, pressure and pragmatism: how fertility clinic medical directors view IVF add-ons

Cited by 8 publications

References 21 publications

‘It all depends on why it’s red’: qualitative interviews exploring patient and professional views of a traffic light system for in vitro fertilisation add-ons

‘It all depends on why it’s red’: qualitative interviews exploring patient and professional views of a traffic light system for in vitro fertilisation add-ons

Good practice recommendations on add-ons in reproductive medicine

Is the use of IVF add-on treatments driven by patients or clinics? Findings from a UK patient survey

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