Great Expectations: Patients Overestimate In Vitro Fertilisation Success - European Medical Journal
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Great Expectations: Patients Overestimate In Vitro Fertilisation Success

| Reproductive Health
Authors:
*Johanna Devroe,1,2 Karen Peeraer,1,2 Thomas D’Hooghe,2 Jacky Boivin,3 Joris Vriens,1 Eline A.F. Dancet1,2,4
Disclosure:

Prof Dr D’Hooghe is Vice President and Head of Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany. Dr Boivin reports personal fees from Theramex; and grants from Merck Serono Ltd., outside of the submitted work. The other authors have declared no conflicts of interest.

Support:

This study was conducted with the help of an unrestricted research grant from Merck N.V./S.A. and with the support of the KU Leuven.

Citation
EMJ Repro Health. ;6[1]:24-25. Abstract Review No: AR1.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND AND AIMS

The general public is known to overestimate the success rate of in vitro fertilisation (IVF).1,2 Qualitative interviews showed that well-informed females cryopreserving their oocytes were unrealistically optimistic about their chances for a live birth as they thought they and/or their gynaecologist would perform better than average.3 To the best of the authors’ knowledge, the live birth rates (LBR) expected by patients during their IVF cycle had yet to be studied and compared to the patient’s personalised IVF prognosis. In addition, whether these expected LBR are affected by factors such as sex and dispositional optimism is unknown.

MATERIALS AND METHODS

The expected LBR and degree of dispositional optimism of consenting couples who had an oocyte aspiration in the Leuven University Fertility Clinic, Leuven, Belgium, between March and December 2019 were prospectively surveyed. Participants (male and female) were asked to each fill out their own questionnaire. Additionally, couples’ personalised IVF prognoses were calculated using an adapted version of the van Loendersloot prognostic model after calibration on the authors’ clinic’s data (area under the receiver operating characteristics: 0.74).4,5 The model predicts the chance of success of one ‘complete’ cycle (i.e., all fresh and frozen embryo transfers from the same episode of ovarian stimulation). Eligible couples completed at least one IVF cycle (second through to the sixth) with their own gametes after a previous IVF cycle with the same partner in the same clinic. The level of dispositional optimism was assessed with the reliable Revised Life Orientation Test (LOT-R) questionnaire.6 The degree of misestimation was calculated with a formula: (expected IVF-LBR – prognosis)/prognosis. A positive sign shows overestimation, a negative sign shows underestimation, and the absolute value quantifies the extent of misestimation.

RESULTS

The 67 participating couples had a mean IVF prognosis (calculated LBR per completed IVF cycle, including fresh and frozen embryo transfers) of 31.8% (range: 4.8–59.4%; standard deviation [SD]: 16.90). Eighty-five percent of females overestimated their IVF-LBR (mean overestimation: 33.66%; SD: 20.02) and 47.8% expected their IVF-LBR to be more than double their calculated IVF prognosis (mean overestimation: 46.47%; SD: 16.10). Eighty-eight percent of males overestimated IVF-LBR (mean overestimation: 38.81; SD: 21.84) and 53.7% expected their IVF-LBR to be more than double of their calculated IVF prognosis (mean overestimation: 51.10%; SD: 17.75). Male patients expected significantly higher IVF-LBR compared to their female partners (64.4% versus 58.6%; paired t-test, p=0.028) and their degree of misestimation was also significantly higher (2.3 versus 1.8; paired t-test, p=0.013). Male and female partners did not differ in their levels of optimism (paired t-test, p=0.074) and the correlation between the level of optimism and expected IVF-LBR was rather weak (Pearson correlation coefficient in female patients: 0.428; p=0.000; and in male patients: 0.254; p=0.038). The correlation between the IVF prognosis and the level of optimism was also weak (Pearson correlation coefficient in female patients: 0.022; and in male patients: -0.163).

CONCLUSION

During IVF, patients, especially males, expected unrealistically high IVF-LBR and the difference between males and females was not explained by their level of dispositional optimism. Recruitment is ongoing to end up with a larger scale prospective cohort study with follow-up until the studied IVF cycle is completed by achieving a live birth or a negative pregnancy test after the transfer of the last (fresh and frozen) embryo. This study, however, already documented the extent of the interesting overestimation of IVF-LBR by couples going through IVF. Whether the couple’s overestimation leads to distress in the case of a negative pregnancy test which could ultimately result in IVF discontinuation, as suggested by qualitative interviews, will be followed up.7 In addition, couples’ actual LBR and association with expected IVF-LBR and with prognoses will be assessed.

References
Lampic C et al. Fertility awareness, intentions concerning childbearing, and attitudes towards parenthood among female and male academics. Hum Reprod. 2006;21(2):558-64. Skoog Svanberg A et al. Attitudes toward parenthood and awareness of fertility among postgraduate students in Sweden. Gender Medicine. 2006;3(3):187-95. De Groot M et al. Perceptions of oocyte banking from women intending to circumvent age-related fertility decline. Acta Obstet Gynecol Scand. 2016;95(12):1396-401. van Loendersloot L et al. Individualized decision-making in IVF: calculating the chances of pregnancy. Hum Reprod. 2013;28(11):2972-80. Sarais V et al. Predicting the success of IVF: external validation of the van Loendersloot's model. Hum Reprod. 2016;31(6):1245-52. Scheier M et al. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the life orientation test. J Pers Soc Psychol. 1994;67(6):1063-78. Peddie V et al. A qualitative study of women's decision-making at the end of IVF treatment. Hum Reprod. 2005;20(7):1944-51.