Attitude and acceptability of IVF add-ons to improve reproductive outcomes: a focus group qualitative study

What factors are important for patients when evaluating the efficacy, safety, cost, and acceptability of IVF add-ons?

Although efficacy is the most important factor for patients, interim markers of success can also be important.

IVF add-ons are increasingly offered alongside assisted conception despite limited evidence of their efficacy, safety, or value for money. Capturing patient perspectives on their acceptability and outcome priorities is essential to guide ethical clinical practice and inform future research.

Three online focus groups were conducted with 12 people who had used assisted reproductive technologies and were not currently in treatment. The focus groups were conducted in small groups of three to five people with each focus group lasting ∼2 h.

Participants were recruited through fertility charities and patient advocacy groups. All 12 participants were women and lived in the UK. All were currently in a relationship, and most had prior experience of using IVF add-ons. Online focus groups were conducted to discuss views on the efficacy, safety, and acceptability of IVF add-ons, and to identify preferred outcomes.

Nearly all participants defined the most important outcome of using an add-on to be achieving a live birth. However, they recognized that a live birth could feel a distant endpoint within the IVF treatment and therefore valued interim milestones as indicators of success. The main theme found in relation to understanding the risks involved was the need for patients to balance risk with desperation to have a baby. In terms of cost, two themes emerged, the need to balance cost with needing money for future treatments and the differing views on what is an acceptable cost. When receiving information about add-ons, participants reflected on the importance of finding reputable sources while also having to navigate conflicting information. Overall, the effectiveness of an add-on was valued over cost and safety, although cost and the risk of regret remained important considerations in decision-making. Most participants would not regret using add-ons, although some said they may regret not having used them.

All participants were women, and most were White. Findings may not be applicable to other populations.

Capturing participants' views on efficacy, safety, cost, and acceptability is essential not only to guide future research priorities but also to inform ethical clinical practice and policy. By incorporating patient perspectives, future trials can ensure that outcomes reflect what matters most to those undergoing treatment, thereby improving the relevance and impact of research in reproductive medicine.

AFFINITY is funded by a public research grant from the National Institute for Health and Care Research's (NIHR) Efficacy and Mechanism Evaluation (EME) programme-Award ID NIHR168789.

The authors have no conflict of interest to declare.

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