Women’s preferences concerning IVF treatment: a discrete choice experiment with particular focus on embryo transfer policy

Abstract

STUDY QUESTION What outcomes are important for women to decide on the day of embryo transfer in IVF? SUMMARY ANSWER The highest cumulative live birth rate per treatment (cLBR) was the most important treatment outcome for women undergoing an IVF treatment, regardless of the number of transfers needed until pregnancy and impact on quality of life. WHAT IS KNOWN ALREADY Cleavage stage (day three) and blastocyst stage (day five) embryo transfers are common transfer policies in IVF. The choice for one or the other day of embryo transfer differs between clinics. From the literature, it remains unclear whether the day of transfer impacts the cLBR. Patient preferences for the day of embryo transfer have not been examined yet. STUDY DESIGN, SIZE, AND DURATION A discrete choice experiment (DCE) was performed to investigate female patients’ preferences and their values concerning various aspects of an IVF treatment, with a particular focus on embryo transfer policy. A multicenter DCE was conducted between May 2020 and June 2020 in which participants were asked to choose between different treatments. Each treatment was presented using hypothetical scenarios containing the following attributes: the probability of a healthy live birth per IVF treatment cycle, the number of embryos available for transfer (for fresh and frozen-thawed embryo transfer), the number of embryo transfers until pregnancy, and the impact of the treatment on the quality of life. PARTICIPANTS/MATERIALS, SETTING, METHODS Women (n = 445) were asked to participate in the DCE at the start of an IVF treatment cycle in 10 Dutch fertility clinics. Participating women received an online questionnaire. The attributes’ relative importance was analyzed using logistic regression analyses. MAIN RESULTS AND THE ROLE OF CHANCE A total of 164 women participated. The most important attribute chosen was the cLBR. The total number of embryos suitable for transfer also influenced women’s treatment preferences. Neither the number of transfers needed until pregnancy, nor the impact on quality of life influenced the treatment preferences in the aggregated data. For women in the older age group (age ≥36 years) and the multipara subgroup the impact on quality of life was more relevant. Naive patients (patients with no prior experience with IVF treatment) assigned less value to the number of embryo transfers needed until pregnancy and assigned more value to the cLBR than the patients who had experienced IVF. LIMITATIONS REASONS FOR CAUTION An important limitation of a DCE study is that not all attributes can be included, which might be relevant for making choices. Patients might make other choices in real life as the DCE scenarios presented here are hypothetical and might not exactly represent their personal situation. We tried to avoid potential bias by selecting the attributes that mattered most to the patients obtained through patient focus groups. Final selection of attributes and the assigned levels was established using the input of an expert panel of professionals and by performing a pilot study to test the validity of our questionnaire. Furthermore, because we only included women in our study, we cannot draw any conclusions on preferences for partners. WIDER IMPLICATIONS OF THE FINDINGS The results of this study may help fertility patients, clinicians, researchers, and policy makers to prioritize the most important attributes in the choice for the day of embryo transfer. The present study shows that cLBR per IVF treatment is the most important outcome for women. However, currently there is insufficient information in the literature to conclude which day of transfer is more effective regarding the cLBR. Randomized controlled trials on the subject of day three versus day five embryo transfers and cLBR are needed to allow evidence-based counseling. STUDY FUNDING/COMPETING INTEREST(S) This work received no specific funding and there are no conflicts of interest. TRIAL REGISTRATION NUMBER None.

Driving factors in treatment decision-making of patients seeking medical assistance for infertility: a systematic review

“…The characteristics of included studies are described in Table 1 . Twelve studies had a DCE design ( Musters et al , 2011 ; van Empel et al , 2011 ; Huppelschoten et al , 2014 ; van den Wijngaard et al , 2014 , 2015 ; Weiss et al , 2017 ; Hendriks et al , 2019 ; Braam et al , 2020 ; Abdulrahim et al , 2021 ; Cornelisse et al , 2022 ; Skedgel et al , 2022 ; Keller et al , 2023 ), one study included both a DCE and a survey ( Hendriks et al , 2016 ), one was designed as CAs study ( Palumbo et al , 2011 ), and six were survey and/or interview studies ( Bayram et al , 2005 ; Steures et al , 2005 ; van Weert et al , 2007 ; Sills et al , 2012 ; Duthie et al , 2017 ; Stormlund et al , 2019 ).…”

“…Of the 20 studies, 11 had been conducted in the Netherlands ( Bayram et al , 2005 ; Steures et al , 2005 ; van Weert et al , 2007 ; Musters et al , 2011 ; van Empel et al , 2011 ; Huppelschoten et al , 2014 ; van den Wijngaard et al , 2014 , 2015 ; Weiss et al , 2017 ; Braam et al , 2020 ; Cornelisse et al , 2022 ), two studies were conducted in both the Netherlands and Belgium ( Hendriks et al , 2016 , 2019 ), two studies were carried out in the USA ( Sills et al , 2012 ; Duthie et al , 2017 ), one in Australia ( Keller et al , 2023 ), one in the UK ( Abdulrahim et al , 2021 ), one in Denmark ( Stormlund et al , 2019 ), and one in Spain ( Palumbo et al , 2011 ). The largest study included multiple countries: the USA, the UK, Denmark, Norway, Sweden, Finland, Spain, and China ( Skedgel et al , 2022 ).…”

Protocol for improving the costs and outcomes of assistive reproductive technology fertility care pathways: a study using cost measurement and process mining

“…We further aim to contribute to the patient-centred fertility care literature22 30 34 by introducing TDABC to the field and by reporting real patient journey costs and outcomes (in a baseline value assessment) that can serve as a benchmark for other clinics. Other clinics will be able to input their annual costs into the model while assuming the same time-based equations.…”

“…Patients have repeatedly indicated that expectation management and information sharing are important aspects of patient satisfaction 22 30 37 38. By incorporating patient journey information in a value-based dashboard, we aim to provide gynaecologists with the tools to better discuss likelihoods and time-to-pregnancy with patients.…”

“…RQ2 builds on this by setting out to determine the value of the care by considering outcomes in relation to costs. A short time-to-pregnancy is considered the key outcome as emphasised by patients,22 alongside process and experience measures 22 30. To determine value, we will consider total costs across the patient journey in relation to the time-to-pregnancy.…”