The hidden costs of infertility treatment

Howard, Sally

doi:10.1136/bmj.k2204

Cited by 12 publications

(11 citation statements)

References 11 publications

(9 reference statements)

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“…Similarly, 52% and 20% fewer semen counts were observed in male respondents with iodine deficiency or iodine excess compared to those with optimal iodine levels (Column [3]). We did not observe a statistically significant association between iodine level and semen motility according to the results from Column [4]. Longer duration of time to pregnancy was found in male respondents with deficient or excess level of iodine compared to those in optimal group (3.54 and 1.48 more months to pregnancy of enrolled couples respectively).…”

Section: Potential Effects Of Iodine Intake On Semen Parameterscontrasting

confidence: 63%

“…The needs of infertility care have increased remarkably over the past few decades [1][2][3]. Some treatment is expensive, such as assisted reproductive techniques, leading to a heavy economic burden on infertile couples [4][5][6]. Hence, there is an increasing interest in examining the factors associated with decreasing semen quality since semen quality is a significant determinant of male fertility and is taken as a clinical measurement of male fecundity.…”

Section: Introductionmentioning

confidence: 99%

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The association between iodine intake and semen quality among fertile men in China

et al. 2020

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Background: Iodine intake is essential in the production of thyroid hormone but very few foods are rich in it. Iodine deficiency or excess iodine level may both lead to thyroid disorders, which further affects human fertility function. The objective of this study is to investigate the relationship between iodine intake and seminal parameters among fertile men in China. Methods: A total of 1098 couples were recruited by trained physicians at different family planning service stations in 2015. Semen and iodine samples were obtained from male respondents. A questionnaire survey inquired about demographic information from couples. The main outcome variables of semen quality were semen volume, semen concentration, semen motility, and sperm count, and time to pregnancy. Urinary iodine concentration (UIC) was used to measure iodine levels for male respondents. Ordinary least squared regressions and logistic regressions were performed to estimate the association between iodine intake level and semen quality parameters. Results: Male respondents with deficient or excess iodine levels had a 5% higher semen volume relative to those with optimal iodine intake (p < 0.1). Suboptimal iodine intake was negatively associated with semen concentration and semen counts (p < 0.01). Longer time of pregnancy was observed in iodine deficiency and excess group than those in the optimal group (p < 0.01). Conclusion: In general, iodine deficiency and excess were both associated with decreasing semen quality parameters in male respondents.

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Section: Potential Effects Of Iodine Intake On Semen Parameterscontrasting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

The association between iodine intake and semen quality among fertile men in China

et al. 2020

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“…2017 ; Van de Wiel 2019 ). Critics have advocated for stronger regulation of add-ons ( Hendriks and Pearson 2018 ; Howard, 2018 ; Rutherford 2017 ) as globally the requirements for introducing treatments into practice are relatively limited; for example, they do not include demonstration of effectiveness and safety in randomized controlled trials (RCTs). A particular concern is that, without performing high-quality trials, it cannot be known whether an add-on causes unanticipated harms or actually worsens treatment outcomes.…”

Section: Introductionmentioning

confidence: 99%

The prevalence, promotion and pricing of three IVF add-ons on fertility clinic websites

Wiel

Athanasiou

Harper

2020

Reproductive BioMedicine Online

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Research question How are IVF clinic websites advertising three common IVF add-ons: assisted hatching, time-lapse embryo imaging and preimplantation genetic testing for aneuploidies (PGT-A)? Design The Human Fertilisation and Embryology Authority ‘Choose a fertility clinic‘ website service was used to identify IVF clinics and their websites. Assisted hatching, time-lapse embryo imaging and PGT-A were examined to determine which websites advertised them, what price they charged and what claims they made in relation to the add-ons. Results Eighty-seven eligible clinics were identified, with 72 unique websites; 37 (43%) clinics were part of one of nine groups of IVF clinics, of sizes ranging from two to eight clinics in the UK. Time-lapse imaging (TLI) was the most frequently advertised of the three add-ons (67% of clinics), followed by PGT-A (47%) and assisted hatching (28%). Very few websites stated that the effectiveness of the add-on was in doubt or unclear (four, two and one websites for TLI, PGT-A and assisted hatching, respectively), and none raised the possibility that an add-on might have negative effects. Claims of efficacy were often based on upstream outcomes (e.g. implantation, pregnancy). Some claims that PGT-A and TLI improved live birth rates were found. There was substantial variation in pricing. Conclusions IVF clinic websites provide valuable information for patients seeking fertility treatment so it is key that the information is accurate and complete. There is a need for transparent information on interventions, including uncertainties and risks, to be made available by IVF clinics to support well-informed treatment decisions. The selected add-ons are widely advertised, and there is wide variation in pricing.

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“…Some of the methods advertised and used in such instances are not supported by proper scientific studies though the treatment cost is exorbitant. Nevertheless, this is a worldwide phenomenon observed even in the United Kingdom, as highlighted in some studies carried out at the University of Oxford and published in the British Medical Journal 10,11 . As a responsible organization the Sri Lanka College of Obstetricians and Gynaecologists (SLCOG) should not ignore such negative and unethical developments.…”

Section: Presidential Address 2019mentioning

confidence: 99%

“Towards excellence in maternal and reproductive health care”

Kaluarachchi

2019

Sri Lanka J Obstet & Gynae

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The hidden costs of infertility treatment

Abstract: Most in vitro fertilisation in the UK takes place outside the NHS, and practitioners and patients want clearer information about the costs and benefits of treatments. Sally Howard reports

Cited by 12 publications

References 11 publications

The association between iodine intake and semen quality among fertile men in China

The association between iodine intake and semen quality among fertile men in China

The prevalence, promotion and pricing of three IVF add-ons on fertility clinic websites

“Towards excellence in maternal and reproductive health care”

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