Development and Evaluation of Guidelines and an Intervention for Moving on from IVF in Women with a Low Chance of Success
Over 34,000 Australian women use In Vitro Fertilisation (IVF) each year in the hope of achieving a pregnancy, of which 60% will not have a baby that year. Whilst there are guidelines and clinical consensus around starting IVF, there is almost no evidence-based information about when to stop. The personal, social and financial consequences of continued unsuccessful attempts at IVF are profound. Consequences of continued IVF failure include cumulative psychological, financial and physical burden, and life goals being put on hold. Also, failure to engage with alternative options which may include egg or embryo donation, adoption or child free etc. Very few previous studies have addressed the reasons why women continue to undergo IVF when success is low and the reasons that clinicians continue to treat them. Additionally, there are concerns about the psychological health and wellbeing of those who have discontinued IVF without a successful pregnancy. Women who remain childless following IVF generally experience poorer psychological health, suggesting that current processes for moving on poorly manage psychological sequelae. This study will use mixed methods to address the following specific aims:
  1. To develop an evidence-based consensus definition for low chance of success from IVF (using a woman’s own eggs) using clinical criteria (e.g. age, number of failed cycles, egg quality) in order to help women and clinicians identify when to discuss moving on from IVF.
  2. To use a qualitative approach to determine why patients continue IVF when the chances of success are low and what support is needed to facilitate good quality decision-making that supports long-term psychological adjustment.
  3. To use these findings to plan, develop and evaluate an intervention to help couples with the decision-making process around continuation or discontinuation of treatment.
To our knowledge this proposal is the first internationally to address why women and clinicians continue IVF when success is unlikely. Given the burgeoning use of IVF internationally and the generous Medicare subsidy of repeated cycles of IVF in Australia, we are well placed to address this growing problem. Many developed countries offer limited state funded IVF treatment, but with strict criteria around patient age, reasons for infertility with the number of cycles generally limited to. In Australia, there are no criteria that limit government subsidies. Whilst this program optimises access to IVF, it may also lead to inefficient use of resources which are costly for the tax payer and without benefit for the unsuccessful patient. There is an urgent need to establish a consensus around “low chance of success”, addressing patient and clinician reasons for continuing treatment in these circumstances and developing a high quality intervention to facilitate decision-making around treatment continuation. The Australian environment, where the role of cost in motivating the discontinuation of IVF is reduced, is ideal for the exploration of this issue. Further, with a better understanding of the support needs of this group, an intervention will be developed that we anticipate will lead to more efficient use of resources and improvements in psychological adjustment, informed choice, and improved satisfaction with their experience in the longer term.