LAUSR

What do infertility patients value most when making treatment decisions? Patients’ treatment decision-making was mostly based on effectiveness, followed by safety, burden, costs and patient centeredness. Couples may undergo several infertility treatments that differ in effectiveness, side-effects, administration and cost. This underpins why patients need to be involved in the treatment decision. In order to improve this process, we need to understand what treatment attributes patients value most. We searched Medline and Embase up to January 24, 2022. Discrete choice experiments (DCEs), surveys, questionnaires or conjoint analyses (CA) were included. Studies on fertility preservation were excluded, as well as studies that did not describe attributes relating to two or more of the following: costs, safety, burden, effectiveness, genetic parenthood and patient centeredness. Participants were men and women with unfulfilled child-wish in the fertile age range. All analyses were performed on an intention-to-treat basis. We extracted the absolute and relative importance of the attributes from each study. The methodological quality of the studies was evaluated using the assessment constructed by Mandeville or a checklist of the center for Evidence-Based Management, depending on design. The search generated 99 studies. Twelve studies were included: ten DCEs and two survey studies, in all DCEs trade-offs were studied. In total 2902 patients participated in the studies, ranging per study from 71 to 925. The majority of the studies were from the Netherlands (67%). Most articles used five attributes (42%) usually attributes related to burden, cost and effectiveness. Women represented 63% of the participants. The mean age of the participants was 34 years (SD 2.4). Patients’ treatment decision-making was mostly based on effectiveness, followed by safety, burden, costs and patient centeredness. Results suggest that women are prepared to trade - off some effectiveness for better safety, less burden and patient centeredness. When safety was evaluated, the safety of the child was considered more important than that of the mother. Burden (cancellations, number of injections, number of hospital visits, time) was more often accepted by women when gaining effectiveness, safety or lower costs. Also non-genetic parenthood did not have an impact on decision-making. Concerning patient centeredness, ‘information provision’ and ‘physician attitude’ were considered most important, followed by involvement in decision-making, and being treated by the same physician. The main limitation of this review is the heterogeneity in questionnaires and methodology. Studies varied in the number of attributes, kinds of attributes and levels. Results of this study can be used in future preference studies, as well as in patient-centered approaches. Not applicable