The quality of information about elective oocyte cryopreservation (EOC) on Australian fertility clinic websites

Artificial intelligence and clinical guidance in male reproductive health: ChatGPT4.0's AUA/ASRM guideline compliance evaluation

BACKGROUND

Male infertility is defined as the inability of a male to achieve a pregnancy in a fertile female by the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM). Artificial intelligence, particularly in language processing models like ChatGPT4.0, offers new possibilities for supporting clinical decision-making. This study aims to assess the effectiveness of ChatGPT4.0 in responding to clinical queries regarding male infertility, which is aligned with AUA/ASRM guidelines.

METHODS

This observational study employed a design to evaluate the performance of ChatGPT4.0 across 1073 structured clinical queries categorized into true/false, multiple-choice, and open-ended. Two independent reviewers specializing in reproductive medicine assessed the responses using a six-point Likert scale to evaluate accuracy, relevance, and guideline adherence.

RESULTS

In the true/false category, the initial accuracy was 92%, which increased to 94% by the end of the study period. For multiple-choice questions, accuracy improved from 85% to 89%. The most significant gains were seen in open-ended questions, where accuracy rose from 78% to 86%. Initially, some responses did not fully align with the AUA/ASRM guidelines. However, by the end of the 60 days, these responses had become more comprehensive and clinically relevant, indicating an improvement in the model's ability to generate guideline-conformant answers (p < 0.05). The depth and accuracy of responses for higher difficulty questions also showed enhancement (p < 0.01).

CONCLUSION

ChatGPT4.0 can serve as a valuable support tool in managing male infertility, providing reliable, guideline-based information that enhances the accuracy of clinical decision-making tools and supports patient education.

ChatGPT: a reliable fertility decision-making tool?

The internet is the primary source of infertility-related information for most people who are experiencing fertility issues. Although no longer shrouded in stigma, the privacy of interacting only with a computer provides a sense of safety when engaging with sensitive content and allows for diverse and geographically dispersed communities to connect and share their experiences. It also provides businesses with a virtual marketplace for their products. The introduction of ChatGPT, a conversational language model developed by OpenAI to understand and generate human-like text in response to user input, in November 2022, and other emerging generative artificial intelligence (AI) language models, has changed and will continue to change the way we interact with large volumes of digital information. When it comes to its application in health information seeking, specifically in relation to fertility in this case, is ChatGPT a friend or foe in helping people make well-informed decisions? Furthermore, if deemed useful, how can we ensure this technology supports fertility-related decision-making? After conducting a study into the quality of the information provided by ChatGPT to people seeking information on fertility, we explore the potential benefits and pitfalls of using generative AI as a tool to support decision-making.

Social egg freezing as ambivalent materialities of aging

This commentary explores how the material-nonmaterial transactions around reproduction among women raise paradoxical questions of reproductive autonomy and commercialization of reproduction. Drawing from medical anthropological studies on human reproduction, the technology around social egg freezing has been conceived to proffer ambivalent possibilities of hope, despair, and repair as mature women recalibrate their reproductive identities, especially in pronatalist contexts. Building on the material-discursive critique of the 'material turn', I ask if social egg freezing offers an empowering biological reprieve for women who have 'chosen' a non-normative (i.e., a departure from heterosexual conjugality) life-course. Subsequently, how does one "do age" when material entanglements (here, reproductive technologies) disrupt the symbolic performance of the life-course? Or, does this reproductive autonomy actualized through social egg freezing align well with the neoliberal prerogatives of "successful aging," thereby intensifying the specter of the "Third Age"? Overall, through an analysis of (reproductive) technologies, as well as the question of choice and social bodies, I argue how new materialities and anxieties of growing old can undergird the material-cultural link in gerontology.

The first nationwide website survey of the availability and costs of medical and non-medical oocyte cryopreservation in Japan

Research question

How does the cost-related oocyte cryopreservation (OoC) vary by the facility in Japan, and what data is provided on the websites about OoC procedures?

Design

Website survey. The websites of all 621 facilities that provide assistive reproductive technology registered in Japan were surveyed in 2021. Data included the rates of explicit statements regarding the provision of OoC for only medical reasons (medical only group) or non-medical reasons (non-medical group). Based on whether or not facilities that perform OoC clearly stated the cost on their websites, we compared the costs of OoC and annual storage cost between medical only and non-medical groups. Furthermore, we examined the stated number of OoC procedures performed and their clinical outcomes.

Results

Of the 621 facilities, 146 (23.5%) clearly stated that they offer OoC on their websites. Of the 88 medical only groups and 58 non-medical groups, 24 (27.3%) and 42 (72.4%) clearly stated the OoC cost, and 27 (30.7%) and 44 (75.9%) clearly states the annual oocyte storage cost, respectively. The OoC costs were significantly higher for the non-medical group than in the medical group. In the medical only group, the annual storage cost remained almost the same regardless of the number of oocytes, while in the non-medical group, the annual storage cost was 2-3 times higher than in the medical only group. Only 16 facilities (16/146, 11.0%) had mentioned the number of OoC procedures, and five facilities (3.4%) provided information on the clinical outcomes after OoC.

Conclusion

Costs related to OoC are higher for the non-medical group in Japan. In addition, the websites contain scant information on the costs and clinical outcomes of OoC.

Fertility specialists' views, behavior, and attitudes towards the use of endometrial scratching in Italy

BACKGROUND

Endometrial scratching (ES) or injury is intentional damage to the endometrium performed to improve reproductive outcomes for infertile women desiring pregnancy. Moreover, recent systematic reviews with meta-analyses and randomized controlled trials demonstrated that ES is not effective, data on the safety are limited, and it should not be recommended in clinical practice. The aim of the current study was to assess the view and behavior towards ES among fertility specialists throughout infertility centers in Italy, and the relationship between these views and the attitudes towards the use of ES as an add-on in their commercial setting.

METHODS

Online survey among infertility centers, affiliated to Italian Society of Human Reproduction (SIRU), was performed using a detailed questionnaire including 45 questions with the possibility to give "closed" multi-choice answers for 41 items and "open" answers for 4 items. Online data from the websites of the infertility centers resulting in affiliation with the specialists were also recorded and analyzed. The quality of information about ES given on infertility centers websites was assessed using a scoring matrix including 10 specific questions (scored from 0 to 2 points), and the possible scores ranged from 0 to 13 points ('excellent' if the score was 9 points or more, 'moderate' if the score was between 5 and 8, and 'poor' if it was 4 points or less).

RESULTS

The response rate was of 60.6% (43 questionnaires / 71 infertility SIRU-affiliated centers). All included questionnaires were completed in their entirety. Most physicians (~ 70%) reported to offer ES to less than 10% of their patients. The procedure is mainly performed in the secretory phase (69.2%) using pipelle (61.5%), and usually in medical ambulatory (56.4%) before IVF cycles to improve implantation (71.8%) without drugs administration (e.g., pain drugs, antibiotics, anti-hemorrhagics, or others) before (76.8%) or after (64.1%) the procedure. Only a little proportion of infertility centers included in the analysis proposes formally the ES as an add-on procedure (9.3%), even if, when proposed, the full description of the indications, efficacy, safety, and costs is never addressed. However, the overall information quality of the websites was generally "poor" ranging from 3 to 8 and having a low total score (4.7 ± 1.6; mean ± standard deviation).

CONCLUSIONS

In Italy, ES is a procedure still performed among fertility specialists for improving the implantation rate in IVF patients. Moreover, they have a poor attitude in proposing ES as an add-on in the commercial setting.

Information and decision support needs: A survey of women interested in receiving planned oocyte cryopreservation information

PURPOSE

Identifying the information and decision support needs of women interested in receiving planned oocyte cryopreservation (POC) information.

METHODS

An online survey of Australian women, aged 18-45, interested in receiving POC information, proficient in English, with internet access. The survey covered POC information sources, information delivery preferences, POC and age-related infertility knowledge (study-specific scale), Decisional Conflict Scale (DCS), and time spent considering POC. Target sample size (n=120) was determined using a precision-based method.

RESULTS

Of 332 participants, 249 (75%) had considered POC, whilst 83 (25%) had not. Over half (54%) had searched for POC information. Fertility clinic websites were predominately used (70%). Most (73%) believed women should receive POC information between ages 19-30 years. Preferred information providers were fertility specialists (85%) and primary care physicians (81%). Other methods rated most useful to deliver POC information were online. Mean knowledge score was 8.9/14 (SD:2.3). For participants who had considered POC, mean DCS score was 57.1/100 (SD:27.2) and 78% had high decisional conflict (score >37.5). In regression, lower DCS scores were associated with every 1-point increase in knowledge score (-2.4; 95% CI [-3.9, -0.8]), consulting an IVF specialist (-17.5; [-28.0, -7.1]), and making a POC decision (-18.4; [-27.5, -9.3]). Median time to decision was 24-months (IQR: 12.0-36.0) (n=53).

CONCLUSION

Women interested in receiving POC information had knowledge gaps, and wanted to be informed about the option by age 30 years from healthcare professionals and online resources. Most women who considered using POC had high decisional conflict indicating a need for decision support.

'I feel that injustice is being done to me': a qualitative study of women's viewpoints on the (lack of) reimbursement for social egg freezing

Background

During the last decade, the possibility for women to cryopreserve oocytes in anticipation of age-related fertility loss, also referred to as social egg freezing, has become an established practice at fertility clinics around the globe. In Europe, there is extensive variation in the costs for this procedure, with the common denominator that there are almost no funding arrangements or reimbursement policies. This is the first qualitative study that specifically explores viewpoints on the (lack of) reimbursement for women who had considered to uptake at least one social egg freezing cycle in Belgium.

Methods

To understand the moral considerations of these women, drawing from twenty-one interviews, this paper integrates elements of a symbiotic empirical ethics approach and thematic analysis.

Results

We identify four themes: (1) being confronted with unclear information; (2) financial costs as ongoing concern; (3) necessity of coverage; (4) extent of reimbursement. In the first theme, we found that some women were concerned about the lack of clear information about the cost of social egg freezing. In the second theme, we report moral sentiments of injustice and discrimination which some women attributed to their struggles and needs not being recognised. The third theme illustrates diverse views on reimbursement, ranging from viewing social egg freezing as an elective treatment not appropriate for reimbursement to preferences for greater public responsibility and wider access. Finally, we describe the participants’ varying proposals for partial reimbursement and the idea that it should not be made available for free.

Conclusions

This research adds important empirical insights to the bioethics debate on social egg freezing, in particular by presenting (potential) users’ views on the lack of reimbursement. While there is much more to say about the ethical and political complexities of the reimbursement of this procedure, our study highlighted the voices of (potential) users and showed that at least some of them would welcome the coverage of SEF through the public healthcare insurance.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-022-00774-z.

Anti-Mullerian hormone (AMH) test information on Australian and New Zealand fertility clinic websites: a content analysis

OBJECTIVES

The anti-Mullerian hormone (AMH) test has been promoted as a way to inform women about their future fertility. However, data consistently show the test is a poor predictor of natural fertility potential for an individual woman. As fertility centre websites are often a primary source of information for reproductive information, it is essential the information provided is accurate and reflects the available evidence. We aimed to systematically record and categorise information about the AMH test found on Australian and New Zealand fertility clinic websites.

DESIGN

Content analysis of online written information about the AMH test on fertility clinic websites.

SETTING

Accredited Australian and New Zealand fertility clinic websites.

METHODS

Data were extracted between April and June 2020. Any webpage that mentioned the AMH test, including blogs specifically about the AMH test posted since 2015, was analysed and the content categorised.

RESULTS

Of the 39 active accredited fertility clinics' websites, 25 included information about the AMH test. The amount of information varied widely, and embodied four overarching categories; (1) the utility of the AMH test, (2) who the test is suitable for, (3) possible actions in response to the test and (4) caveats and limitations of the test. Eight specific statements about the utility of the test were identified, many of which are not evidence-based. While some websites were transparent regarding the test's limitations, others mentioned no caveats or included persuasive statements actively promoting the test as empowering for a range of women in different circumstances.

CONCLUSIONS

Several websites had statements about the utility of the AMH test that are not supported by the evidence. This highlights the need for higher standards for information provided on fertility clinic websites to prevent women being misled to believe the test can reliably predict their fertility.

The marketing of elective egg freezing: A content, cost and quality analysis of UK fertility clinic websites

To the authors' knowledge, this is the first UK-based study to analyse the marketing of elective egg freezing (EEF) by fertility clinics. Analyses were based on the websites of the top 15 UK clinics, which together provided 87.8% of all egg freezing cycles in the UK between 2008 and 2017 inclusive. The analyses included three phases: content analysis; systematic cost analysis and comparison; and quality analysis examining the information available on egg freezing and its adherence to the guidelines of the Human Fertilisation and Embryology Authority (HFEA). The results show that clinics frame EEF according to four main themes: as a new and exciting technology; as a solution to (a modern woman's) life circumstances; as a means to gain control, freedom and more reproductive options; and as a means to avoid the reproductive risks of ageing. This study also found that most clinics are not sufficiently clear and transparent about the 'true' cost of an EEF cycle, present an unbalanced view of EEF, and do not provide satisfactory data or information. Most importantly, none of the clinics adhere adequately to the HFEA guidelines regarding advertising and the provision of information. As the EEF market continues to grow, offered exclusively by private clinics, these findings require urgent attention. Clinics must improve the type and quality of EEF information on their websites such that potential patients can make informed choices, and this article provides 10 basic criteria which can be used as a checklist. It is suggested that the time may have come to grant greater economic regulatory powers to HFEA to avoid overcommercialization of the fertility industry.