Perceptions of reproductive healthcare providers regarding their involvement in offering expanded carrier screening in fertility clinics: a qualitative study

Abstract

Research questionWhat are the main arguments of reproductive healthcare providers in favour or against their involvement in offering expanded carrier screening (ECS) for recessive disorders in fertility clinics in the Netherlands? DesignSemi-structured interview study with 20 reproductive healthcare providers between May 2020 and January 2021. Participants included 11 gynaecologists, 7 fertility doctors, one nurse practitioner and one clinical embryologist, recruited in academic medical centres (N=13), peripheral facilities associated with academic centres (N=4), and independent fertility treatment centres (N=3) in the Netherlands. An interview guide was developed, and thematic content analysis was performed using ATLAS.ti software. ResultsArguments of reproductive healthcare providers in favour of their potential involvement in offering ECS included: (1) opportunities offered by the setting; (2) motivation to assist in reproduction and prevent suffering; and (3) to counter unwanted commercialization offers. Arguments against involvement included: (1) lack of knowledge and familiarity with offering ECS; (2) insufficient staff and resources and potential high costs for clinics and/or couples; (3) the emotional impact it might have on couples; (4) perceived complexity of counselling and expected elongation of waiting lists; and (5) expected low impact on reducing the burden of diseases. Participants believed that more evidence and research is needed prior to their involvement on the costs-benefits, implications, and demand. ConclusionWhile agreeing that the field of medically assisted reproduction provides a unique opportunity for offering ECS, reproductive health care workers feel a lack of capability and limited motivation to offer ECS to all or a selection of couples in their fertility clinic.