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Choosing Wisely’s 5 Questions helping couples navigate fertility treatments

Fertility treatment, including IVF, can take months or even years, and it doesn’t always work. It can be difficult for people to make decisions about which tests, treatments and add-ons will improve the chance of a baby. There are many options available that have little or no evidence to support them. The Victorian Assisted Reproductive Treatment Authority (VARTA) has adopted Choosing Wisely’s 5 Questions to help people make informed choices about the most effective treatments.

Every year, tens of thousands of Australians present to their doctors seeking assessments of their fertility and interventions to overcome problems.

The process of going through months or even years of in vitro fertilisation (IVF) treatment, which sometimes involves an ongoing cycle of hopes and disappointments, can leave people vulnerable to resorting to unconventional treatments. These are called ‘IVF add-ons’ and many claim to improve the chances of having a baby despite having little or no evidence to back them.

IVF add-ons are optional extras offered on top of standard IVF treatments and they usually come with an additional cost. They include tests, procedures, drugs, the use of new equipment, and alternative therapies. Examples include endometrial scratching, steroids, acupuncture,

Chinese herbal medicine, and preimplantation genetic testing for aneuploidy (PGT-A). Some are potentially harmful.

To help people make informed choices during this difficult time, the Victorian Assisted Reproductive Treatment Authority (VARTA) has adopted Choosing Wisely’s 5 Questions.

Education Program Manager, Dr Michelle le Roux, said: “Choosing Wisely’s 5 questions stood out as an excellent, practical list to recommend to people whenever an opportunity arose. Sometimes, we also added a sixth question in the context of fertility treatment: Will this improve my chance of having a baby?

“The 5 questions are a concise, memorable list for consumers to refer to when engaging with healthcare providers. The intent of the questions, and Choosing Wisely’s goals, align with VARTA’s role to share independent information free of commercial interests. In all our work, we prioritise the best interests of people having fertility treatment and their future children. A big part of this is empowering people with the knowledge to choose tests and treatments that are right for them.

“Using Choosing Wisely’s 5 Questions may also help people increase their chance of a baby with fertility treatment. Given IVF often takes several attempts, choosing to skip expensive add-ons can increase someone’s budget for more rounds of IVF if necessary.”

VARTA has included the 5 questions in blogs about add-ons, and when explaining the potential risks and benefits of using genetic tests for embryos (an expensive add-on). They were also covered during a free webinar for consumers about IVF add-ons and in an article about how to choose a fertility specialist.

In addition to this, Choosing Wisely resources have been published on VARTA’s website in various languages and embedded on pages where people are likely to be reading about tests and treatments. The 5 questions are also regularly shared on social media platforms such as Facebook and Twitter.

VARTA is an independent statutory authority funded by the Victorian Department of Health. VARTA’s role is to regulate registered assisted reproductive treatment providers in Victoria and educate the public and relevant professionals about fertility, infertility and fertility treatment.

It also translates research about fertility, infertility, assisted reproductive treatment and preconception health into education programs, campaigns and projects. Some of this work is done through Your Fertility, a national health promotion campaign that educates Australians of reproductive age about factors that affect their fertility.

Funded by the Australian Government Department of Health, Your Fertility is guided by the Fertility Coalition which includes: VARTA as the lead agency, Healthy Male, Jean Hailes for Women’s Health, Global and Women’s Health at Monash University and The Robinson Research Institute at the University of Adelaide.

‘Add-ons’ to IVF treatment are, in many cases, an example of unnecessary care. By using and promoting the Choosing Wisely 5 Questions, VARTA is supporting open and informed discussions to help people navigate fertility treatments wisely.

Stewardship toolkit for clinical educators

The Health Resource Stewardship for Clinical educators contains educational material about the Choosing Wisely initiative for use in universities, hospitals and health professional colleges

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5 Questions

5 questions to ask your doctor or other healthcare provider to make sure you end up with the right amount of care.

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