The prevalence, promotion and pricing of three IVF add-ons on fertility clinic websites

Lucy Van De Wiel,Jack Wilkinson,Pantelitsa Athanasiou,Joyce Harper

doi:10.1016/j.rbmo.2020.07.021

Abstract

Research questionHow are IVF clinic websites advertising three common IVF add-ons: assisted hatching, time-lapse embryo imaging and preimplantation genetic testing for aneuploidies (PGT-A)? DesignThe Human Fertilisation and Embryology Authority ‘Choose a fertility clinic‘ website service was used to identify IVF clinics and their websites. Assisted hatching, time-lapse embryo imaging and PGT-A were examined to determine which websites advertised them, what price they charged and what claims they made in relation to the add-ons. ResultsEighty-seven eligible clinics were identified, with 72 unique websites; 37 (43%) clinics were part of one of nine groups of IVF clinics, of sizes ranging from two to eight clinics in the UK. Time-lapse imaging (TLI) was the most frequently advertised of the three add-ons (67% of clinics), followed by PGT-A (47%) and assisted hatching (28%). Very few websites stated that the effectiveness of the add-on was in doubt or unclear (four, two and one websites for TLI, PGT-A and assisted hatching, respectively), and none raised the possibility that an add-on might have negative effects. Claims of efficacy were often based on upstream outcomes (e.g. implantation, pregnancy). Some claims that PGT-A and TLI improved live birth rates were found. There was substantial variation in pricing. ConclusionsIVF clinic websites provide valuable information for patients seeking fertility treatment so it is key that the information is accurate and complete. There is a need for transparent information on interventions, including uncertainties and risks, to be made available by IVF clinics to support well-informed treatment decisions. The selected add-ons are widely advertised, and there is wide variation in pricing.

Highlights

S ince the birth of Louise Brown in 1978 (Steptoe and Edwards, 1978), millions of children have been born following IVF, and assisted reproduction has become a relatively privatized and lucrative medical industry
Both the Human Fertilisation and Embryology Authority (HFEA), which is the UK regulator of IVF, and recent scientific reviews have found that there is limited high-quality evidence to support the use of add-ons in routine practice (Armstrong et al, 2019; Farquhar, 2019; Harper et al, 2017; HFEA 2018)
Time-lapse imaging (TLI) was the most frequently advertised of the three add-ons (67%), followed by preimplantation genetic testing for aneuploidies (PGT-A) (47%) and assisted hatching (28%) (TABLE 1, FIGURE 2)

Summary

Introduction

S ince the birth of Louise Brown in 1978 (Steptoe and Edwards, 1978), millions of children have been born following IVF, and assisted reproduction has become a relatively privatized and lucrative medical industry. Adjuncts are defined as any technique that is a variation of, or add-on to, the ‘normal’ IVF cycle This includes laboratory, clinical and complementary treatments. IVF clinics seek to help patients increase their chances of having a baby by offering add-ons, the evidence base for their effectiveness is variable but generally limited. Both the Human Fertilisation and Embryology Authority (HFEA), which is the UK regulator of IVF, and recent scientific reviews have found that there is limited high-quality evidence to support the use of add-ons in routine practice (Armstrong et al, 2019; Farquhar, 2019; Harper et al, 2017; HFEA 2018)

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