Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Amsterdam University Medical Center, University of Amsterdam Amsterdam, The Netherlands; Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda MD, USA.
Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Amsterdam University Medical Center, University of Amsterdam Amsterdam, The Netherlands.
Reprod Biomed Online. 2019 Jul;39(1):103-110. doi: 10.1016/j.rbmo.2019.02.008. Epub 2019 Mar 12.
How much do patients with severe infertility and their gynaecologists value genetic parenthood relative to other key treatment characteristics?
A discrete choice experiment included the following treatment characteristics: genetic parenthood, pregnancy rate, curing infertility, maternal health, child health and costs. The questionnaire was disseminated between 2015 and 2016 among Dutch and Belgian patients with severe infertility and their gynaecologists.
The questionnaire was completed by 173 patients and 111 gynaecologists. When choosing between treatments that varied in safety, effectiveness and costs, the treatment's ability to lead to genetic parenthood did not affect the treatment preference of patients with severe infertility (n = 173). Genetic parenthood affected the treatment preference of gynaecologists (n = 111) less than all other treatment characteristics. Patients indicated that they would switch to a treatment that did not enable genetic parenthood in return for a child health risk reduction of 3.6%, a cost reduction of €3500, an ovarian hyperstimulation risk reduction of 4.6%, a maternal cancer risk reduction of 2.7% or a pregnancy rate increase of 18%. Gynaecologists made similar trade-offs.
While awaiting replication of this study in larger populations, these findings challenge the presumed dominant importance of genetic parenthood. This raises questions about whether donor gametes could be presented as a worthy alternative earlier in treatment trajectories and whether investments in novel treatments enabling genetic parenthood, like in-vitro gametogenesis, are proportional to their future clinical effect.
患有严重不孕症的患者及其妇科医生相对于其他关键治疗特征，对遗传父母身份的重视程度如何？
离散选择实验包括以下治疗特征：遗传父母身份、怀孕率、治愈不孕症、孕产妇健康、儿童健康和成本。问卷于 2015 年至 2016 年在荷兰和比利时的严重不孕症患者及其妇科医生中进行了分发。
173 名患者和 111 名妇科医生完成了问卷。当在安全性、有效性和成本不同的治疗方法之间进行选择时，治疗方法导致遗传父母身份的能力并不影响严重不孕症患者（n=173）的治疗偏好。遗传父母身份对妇科医生（n=111）的治疗偏好影响小于所有其他治疗特征。患者表示，他们愿意转而选择一种无法实现遗传父母身份的治疗方法，以换取儿童健康风险降低 3.6%、成本降低 3500 欧元、卵巢过度刺激风险降低 4.6%、母亲癌症风险降低 2.7%或怀孕率提高 18%。妇科医生也做出了类似的权衡。
在等待更大人群对这项研究进行复制的同时，这些发现对遗传父母身份的假定重要性提出了挑战。这引发了一些问题，即是否可以在治疗过程的早期更早地将供体配子作为一种有价值的替代方案，以及是否对能够实现遗传父母身份的新型治疗方法（如体外配子发生）进行投资与其未来的临床效果成正比。
