Wilkinson, J., Vail, A., & Roberts, S. A. (2017). Direct-to-consumer advertising of success rates for medically assisted reproduction: a review of national clinic websites. BMJ Open. https://doi.org/10.1136/bmjopen-2016-012218
Wilkinson J, Vail A, Roberts SA. Direct-to-consumer advertising of success rates for medically assisted reproduction: a review of national clinic websites. BMJ Open. 2017. doi:10.1136/bmjopen-2016-012218
Wilkinson, J., et al. "Direct-to-consumer advertising of success rates for medically assisted reproduction: a review of national clinic websites." BMJ Open, 2017.
UK IVF clinic websites report success rates in many inconsistent ways
A review of 79 UK IVF clinic websites found that clinics reported success rates in many different ways, usually without context such as sample size. Of the 53 clinics that reported outcomes, only one met the national fertility regulator's reporting standard.
Key Findings
A website was found for 79 of the 81 UK clinics offering IVF, and 53 of those 79 (67%) reported outcomes on it.
Among the 53 clinics reporting outcomes, 27 (51%) gave live birth rates in 9 different ways, and 43 (81%) gave clinical pregnancy rates, most often per transfer procedure (55%).
Among the 53 clinics, 38 (72%) presented at least some outcomes without sample size, and 50 (94%) presented outcomes without stating how many patients did not complete treatment.
Only one clinic reported live birth per cycle started with patient age, sample size, included treatments, fresh or frozen cycles, donor gametes and reporting period all clear.
Eleven clinics (21%) reported multiple birth or pregnancy rates, one clinic provided information on adverse events, and league tables comparing clinics appeared on 9 (11%) of the 79 websites.
Interpretation
This cross-sectional review examined UK clinic websites searched in early 2015. The review describes reporting at one point in time, and social media and other advertising channels fell outside its scope. Clinics were classed as NHS or private by the NHS logo on the front page, a method the authors call imperfect. The review recorded the numerators, denominators and contextual details that each clinic presented. The authors conclude that binding guidance is required for consistent reporting.
RRM Context
Restorative reproductive medicine (RRM) organizes care around finding the cause of reduced fertility in each couple. Outcomes then belong to a diagnosis and a defined group of couples. IVF bypasses the underlying cause, so its advertised rates summarize a procedure and say nothing about whether the cause was found.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objectives
To establish how medically assisted reproduction (MAR) clinics report success rates on their websites.
Setting
Websites of private and NHS clinics offering in vitro fertilisation (IVF) in the UK.
Participants
We identified clinics offering IVF using the Choose a Fertility Clinic facility on the website of the Human Fertilisation and Embryology Authority (HFEA). Of 81 clinics identified, a website could not be found for 2, leaving 79 for inclusion in the analysis.
Primary and Secondary Outcome Measures
Outcome measures reported by clinic websites. The numerator and denominator included in the outcome measure were of interest.
Results
53 (67%) websites reported their performance using 51 different outcome measures. It was most common to report pregnancy (83% of these clinics) or live birth rates (51%). 31 different ways of reporting pregnancy and 9 different ways of reporting live birth were identified. 11 (21%) reported multiple birth or pregnancy rates. 1 clinic provided information on adverse events. It was usual for clinics to present results without relevant contextual information such as sample size, reporting period, the characteristics of patients and particular details of treatments.
Conclusions
Many combinations of numerator and denominator are available for the purpose of reporting success rates for MAR. The range of reporting options available to clinics is further increased by the possibility of presenting results for subgroups of patients and for different time periods. Given the status of these websites as advertisements to patients, the risk of selective reporting is considerable. Binding guidance is required to ensure consistent, informative reporting.
Centers for Disease Control and Prevention, 2020·Report
Assisted Reproduction › Registries and Reporting › Success Rate Reporting · Ethics and Policy › Advocacy and Public Understanding › Media and Representation
PMID 28082363 28082363 DOI 10.1136/bmjopen-2016-012218 10.1136/bmjopen-2016-012218 Wilkinson et al. 2017, Wilkinson 2017
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