IVF Add-Ons: The Quantitative and Qualitative Evidence Behind Their Use

Abstract Aims and objectives This thesis has three aims: (i) to generate, analyse and present the highest quality quantitative and qualitative evidence on in vitro fertilisation (IVF) add-ons; (ii) to advocate for evidence based medicine regarding add-ons, and; (iii) to be a source of trusted information to help inform policy, guidelines and recommendations for governmental regulators, professional societies, and those undergoing IVF. Methods Papers 2 and 3 are Cochrane systematic reviews exploring the efficacy and safety behind two commonly used add-ons (time-lapse incubation (TLS), and granulocyte-macrophage colony stimulating factor (GM-CSF) containing culture media). Paper 1 is a narrative review of the quantitative evidence surrounding laboratory add-ons. Papers 4 and 5 are the protocol and write-up of a qualitative semi-structured interview study exploring why patients and professionals opt to use add-ons. Results Paper 1: This review of laboratory add-ons did not find any high-quality evidence to support their routine use. Paper 2: TLS is no more or less effective than conventional incubation for clinical outcomes that reflect effectiveness and safety. Paper 3: GM-CSF containing culture media is no more or less effective than culture media not containing GM-CSF for clinical outcomes that reflect effectiveness and safety. Papers 4 and 5: 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 most influential, whereas for professionals it was patient driven. Conclusions Papers 1 to 5 represent the highest quality, transparent quantitative and qualitative evidence behind add-ons. They have already become a source of trusted information to help inform policy, guidelines, and recommendations for governmental regulators in the UK and Australia. Ongoing assessment of add-ons will continue to fall to the scientific community to ensure that patients and those caring for them can offer informed consent regarding their use.