Patient and professional perspectives about using in vitro fertilisation add-ons in the UK and Australia: a qualitative study.

Objectives: In vitro fertilisation (IVF) add-ons are additional procedures offered alongside an IVF cycle with the aim of improving live birth rates. They are controversial because of the paucity of evidence to support their efficacy and safety, alongside the additional financial cost they often pose to patients. Despite this, they are popular. However, there is limited qualitative research regarding their use. The aims of the VALUE Study were to understand the decision-making process surrounding using or recommending add-ons; report sources of information for add-ons; and explore concerns for safety and effectiveness when considering their use.
Design: 'VALUE' is a qualitative semistructured interview study using inductive thematic analysis of anonymised transcriptions.
Setting: Participants were recruited from a broad geographical spread across the UK and Australia from public and private clinical settings.
Participants: Patients (n=25) and health professionals (embryologists (n=25) and clinicians (n=24)) were interviewed. A purposive sampling strategy was undertaken. The sampling framework included people having state-subsidised and private cycles, professionals working in public and private sectors, geographical location and professionals of all grades.
Results: Patients often made decisions about add-ons based on hope, minimising considerations of safety, efficacy or cost, whereas professionals sought the best outcomes for their patients and wanted to avoid them wasting their money. The driving forces behind add-on use differed: for patients, a professional opinion was the most influential reason, whereas for professionals, it was seen as patient driven. For both groups, applying the available evidence to individual circumstances was very challenging, especially in the sphere of IVF medicine, where the stakes are high.
Conclusions: There is scope to build on the quality of the discourse between patients and professionals. Patients describe valuing their autonomy with add-ons, but for professionals, undertaking informed consent will be critical, no matter where they sit on the spectrum regarding add-ons.
Trial Registration: osf.io/vnyb9.
Competing Interests: Competing interests: SCA is a consultant gynaecologist and subspecialist in reproductive medicine and surgery. She is an editor for Cochrane Gynaecology and Fertility, and Human Fertility. In the past 12 months, she has been an invited speaker for ESHRE, receiving expenses for travel. She has no financial relationships or affiliations with any commercial companies. EV is an obstetrics and gynaecology registrar; from 2020 to 2022, she was a National Institute for Health and Care Research (NIHR) Academic Clinical Fellow with the University of Bristol. She currently works as a Clinical Fellow in an NHS Reproductive Medicine Unit, at University College London Hospital. She has no financial relationships or affiliations with any commercial companies. SL is a clinical triallist and methodologist, employed by the University of Melbourne. She has a strong interest in randomised controlled trials and systematic reviews and is an editor for the Cochrane Gynaecology and Fertility Group. She has no financial relationships or affiliations with any commercial companies and has received research funding from only government and not-for-profit organisations. LC has no conflicts of interest to declare. CMF is a professor of obstetrics and gynaecology, University of Auckland, New Zealand. She is a fertility specialist, clinical director of Gynaecology and Fertility Plus, Auckland District Health Board, New Zealand and coordinating editor of the Cochrane Gynaecology and Fertility Group. She has no financial relationships with any commercial companies or fertility clinics. She is an invited speaker for ESHRE 2022, receiving expenses for travel. AP is the editor in chief of Human Fertility, trustee of the Progress Educational Trust and chairman of the advisory committee of the UK National External Quality Assurance Schemes in Andrology (all unpaid). In the last 24 months, he has undertaken paid consultancy, speaker fees or contributor fees from Cryos International, Cytoswim, Exseed Health and Merck Serono Limited, but all monies associated with these are paid to the University of Sheffield. MP is a behavioural scientist employed by the University of Melbourne. She is president-elect for the Australian Society for Psychosocial Obstetrics and Gynaecology and is on the editorial board for Journal of Psychosocial Oncology Research and Practice. She is an invited speaker for ESHRE 2022, receiving expenses for travel. She has no financial relationships or affiliations with any commercial companies and has received research funding from only government and not-for-profit organisations. AHB is an NHS consultant in reproductive medicine, honorary chair and clinical lead for Leeds Centre for Reproductive Medicine, Leeds Teaching Hospitals NHS Trust. He is also a consultant at CARE Fertility, Leeds, and chair of the CARE Fertility UK Innovation and Research Board. He is Fellows’ Representative, RCOG Council for Northern, Yorkshire and Humber, a trustee of the British Fertility Society (BFS) and a member of the WHO Guideline Development Group on Infertility. He is a director of Balance Reproductive Health and a member of the advisory board on PCOS and weight reduction, NovoNordisk Pharmaceuticals, for which he has received speaker’s fees for attending meetings. EW is a chartered psychologist (academic) employed by the Universities of Aberdeen and Bath and with an Honorary Research Fellowship at Bath Spa University. She has a strong interest and expertise in qualitative methods as applied to health services research. She has no financial relationships or affiliations with any commercial companies and has received research funding from only government and not-for-profit organisations.
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