Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia.
Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC, Australia.
Hum Reprod. 2021 Jun 18;36(7):1854-1861. doi: 10.1093/humrep/deab098.
What is the prevalence and pattern of IVF add-on use in Australia?
Among women having IVF in the last 3 years, 82% had used one or more IVF add-on, most commonly acupuncture, preimplantation genetic testing for aneuploidy and Chinese herbal medicine.
IVF add-ons are procedures, techniques or medicines which may be considered nonessential to IVF, but usually used in attempts to improve the probability of conception and live birth. The use of IVF add-ons is believed to be widespread; however, there is little information about the prevalence and patterns of use in different settings.
STUDY DESIGN, SIZE, DURATION: An online survey was distributed via social media to women in Australia who had undergone IVF since 2017. Women were excluded if they were gestational surrogates, used a surrogate, or underwent ovarian stimulation for oocyte donation or elective oocyte cryopreservation only. The survey was open from 21 June to 14 July 2020.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Survey questions included demographics, IVF and medical history, and use of IVF add-ons including details of the type of add-on, costs and information sources used. Participants were also asked about the relative importance of evidence regarding safety and effectiveness, factors considered in decision-making and decision regret.
A total of 1590 eligible responses were analysed. Overall, 82% of women had used one or more add-ons and these usually incurred an additional cost (72%). Around half (54%) had learned about add-ons from their fertility specialist, and most reported that the decision to use add-ons was equally shared with the specialist. Women placed a high level of importance on scientific evidence for safety and efficacy, and half (49%) assumed that add-ons were known to be safe. Most women experienced some regret at the decision to use IVF add-ons (66%), and this was more severe among women whose IVF was unsuccessful (83%) and who believed that the specialist had a larger contribution to the decision to use add-ons (75%).
LIMITATIONS, REASONS FOR CAUTION: This retrospective survey relied on patient recall. Some aspects were particularly prone to bias such as contributions to decision-making. This approach to capturing IVF add-on use may yield different results to data collected directly from IVF clinics or from fertility specialists.
There is a very high prevalence of IVF add-on use in Australia which may be generalisable to other settings with similar models of IVF provision. Although women placed high importance on scientific evidence to support add-ons, most add-ons do not have robust evidence of safety and effectiveness. This suggests that IVF patients are not adequately informed about the risks and benefits of IVF add-ons, or are not aware of the paucity of evidence to support their use.
STUDY FUNDING/COMPETING INTEREST(S): This research was supported by a McKenzie Postdoctoral Fellowship Grant (University of Melbourne), a Department of Obstetrics and Gynaecology Innovation Grant (University of Melbourne) and an NHMRC Investigator Grant (APP1195189). A.P. declares that he provides fertility services at Melbourne IVF (part of Virtus Health). J.W. reports grants from Wellcome Trust, during the conduct of the study, and that publishing benefits his career. The remaining authors report no conflict of interest.
N/A.
在澳大利亚，试管婴儿附加治疗的使用情况和模式是什么？
在过去 3 年中接受试管婴儿治疗的女性中，82%使用过一种或多种试管婴儿附加治疗，最常见的是针灸、胚胎植入前遗传学检测非整倍体和中药。
试管婴儿附加治疗是指在试管婴儿过程中可能被认为非必要但通常用于提高受孕和活产概率的程序、技术或药物。人们普遍认为试管婴儿附加治疗的使用较为广泛；然而，关于不同环境下的使用情况和模式，相关信息甚少。
研究设计、规模、持续时间：通过社交媒体向 2017 年以来接受过试管婴儿治疗的澳大利亚女性分发了在线调查。如果女性是代孕者、使用代孕者、或仅因卵母细胞捐赠或选择性卵母细胞冷冻而接受卵巢刺激，则将其排除在外。调查于 2020 年 6 月 21 日至 7 月 14 日开放。
参与者/材料、设置、方法：调查问题包括人口统计学、试管婴儿和医疗史，以及试管婴儿附加治疗的使用情况，包括附加治疗类型、费用和使用的信息来源。参与者还被问及关于安全性和有效性的证据的相对重要性、决策中考虑的因素以及决策后悔。
共分析了 1590 份符合条件的回复。总体而言，82%的女性使用过一种或多种附加治疗，这些治疗通常会产生额外的费用（72%）。大约一半（54%）的女性从生育专家那里了解到附加治疗，大多数人报告说，使用附加治疗的决定与专家共同做出。女性对安全性和有效性的科学证据非常重视，有一半（49%）假设附加治疗是安全的。大多数女性对使用试管婴儿附加治疗的决定感到有些后悔（66%），对于试管婴儿不成功的女性（83%）和认为专家在使用附加治疗的决定中有更大贡献的女性（75%），这种后悔感更为严重。
局限性、谨慎的原因：这项回顾性调查依赖于患者的回忆。有些方面特别容易出现偏差，例如对决策的贡献。这种捕捉试管婴儿附加治疗使用情况的方法可能会产生与直接从试管婴儿诊所或从生育专家那里收集的数据不同的结果。
在澳大利亚，试管婴儿附加治疗的使用非常普遍，这可能与其他具有类似试管婴儿提供模式的环境具有可推广性。尽管女性对支持附加治疗的科学证据非常重视，但大多数附加治疗都没有安全性和有效性的可靠证据。这表明试管婴儿患者没有充分了解试管婴儿附加治疗的风险和益处，或者不知道支持其使用的证据不足。
研究资金/利益冲突：本研究得到了麦肯齐博士后奖学金（墨尔本大学）、墨尔本大学妇产科创新基金和澳大利亚 NHMRC 研究员基金（APP1195189）的支持。A.P. 声明他在墨尔本 IVF（Virtus Health 的一部分）提供生育服务。J.W. 报告在研究期间获得了惠康信托基金的资助，并且出版对他的职业生涯有益。其余作者没有报告利益冲突。
无。
