Patient and professional perspectives about using in vitro fertilisation add-ons in the UK and Australia: a qualitative study

Sarah C. Armstrong, Emily Vaughan, Sarah Lensen, Lucy Caughey, Cynthia M. Farquhar, Allan Pacey, Adam H. Balen, Michelle Peate, Elaine Wainwright

Research output: Contribution to journalArticlepeer-review

1 Citation (SciVal)


OBJECTIVES: In vitro fertilisation (IVF) add-ons are additional procedures offered alongside an IVF cycle with the aim of improving live birth rates. They are controversial because of the paucity of evidence to support their efficacy and safety, alongside the additional financial cost they often pose to patients. Despite this, they are popular. However, there is limited qualitative research regarding their use. The aims of the VALUE Study were to understand the decision-making process surrounding using or recommending add-ons; report sources of information for add-ons; and explore concerns for safety and effectiveness when considering their use. DESIGN: 'VALUE' is a qualitative semistructured interview study using inductive thematic analysis of anonymised transcriptions. SETTING: Participants were recruited from a broad geographical spread across the UK and Australia from public and private clinical settings. PARTICIPANTS: Patients (n=25) and health professionals (embryologists (n=25) and clinicians (n=24)) were interviewed. A purposive sampling strategy was undertaken. The sampling framework included people having state-subsidised and private cycles, professionals working in public and private sectors, geographical location and professionals of all grades. RESULTS: Patients often made decisions about add-ons based on hope, minimising considerations of safety, efficacy or cost, whereas professionals sought the best outcomes for their patients and wanted to avoid them wasting their money. The driving forces behind add-on use differed: for patients, a professional opinion was the most influential reason, whereas for professionals, it was seen as patient driven. For both groups, applying the available evidence to individual circumstances was very challenging, especially in the sphere of IVF medicine, where the stakes are high. CONCLUSIONS: There is scope to build on the quality of the discourse between patients and professionals. Patients describe valuing their autonomy with add-ons, but for professionals, undertaking informed consent will be critical, no matter where they sit on the spectrum regarding add-ons. TRIAL REGISTRATION:

Original languageEnglish
Article numbere069146
JournalBMJ Open
Issue number7
Early online date26 Jul 2023
Publication statusPublished - 26 Jul 2023

Bibliographical note

Department of Obstetrics and Gynaecology Innovation Grant (University of Melbourne) (award number: N/A) and an NHMRC Investigator Grant (APP1195189). There were no restrictions or requirements affiliated with the funding. All participants were offered a £30 love2shop voucher or a $50 supermarket voucher as a thank you for their time.

Data availability statement
All data relevant to the study are included in the article or uploaded as supplemental information. During the planning phase of VALUE, it was determined following PPI that anonymised transcripts would not be shared owing to concerns that patient and professional participants may be identifiable by their unique clinical or professional stories.


  • Reproductive medicine
  • Subfertility

ASJC Scopus subject areas

  • General Medicine


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