Influence of Anecdotes of IVF Success on Treatment Decision Making: An Online Randomized Controlled Trial.

Abstract

BackgroundAlthough in vitro fertilization (IVF) has enhanced fertility opportunities for many people, it also comes with considerable burden. Concerns have been raised about patients holding unrealistic expectations and continuing treatment indefinitely. This study aimed to investigate whether anecdotes of IVF success affect hypothetical intentions to continue treatment despite very low chances of success.DesignOnline randomized controlled trial with a parallel 3-arm design, conducted in May 2022. After viewing a clinical vignette depicting 6 unsuccessful IVF cycles with less than 5% chance of subsequent treatment success, 606 females aged 18 to 45 years in Australia were randomized to receive either 1) an anecdote of IVF success despite limited chances, 2) the anecdote of success and an anecdote of failure, or 3) no anecdote. Outcomes were intention to undergo another IVF cycle, worry, likelihood of success, and narrative transportation.ResultsThere was a main effect of anecdote condition on intention to have another IVF cycle, with participants randomized to the positive and negative anecdote having higher intention than those given no additional information (mean difference = 0.65, 95% confidence interval [CI] = 0.12-1.18, P = 0.017). There were no differences between conditions regarding worry, likelihood of success, or narrative transportation. In adjusted analyses accounting for prior IVF experience, the main effect of anecdotes on intention was no longer statistically significant. Those with prior IVF experience reported a statistically higher likelihood of success and narrative transportation than those without prior IVF experience (mean difference [MD] = 34.28, 95% CI = 27.26-41.30, P < 0.001, and MD = 1.35, 95% CI = 0.96-1.74, P < 0.001, respectively).ConclusionHearing anecdotes may encourage continuation of IVF despite extremely low chances of success. These findings, along with our sample's overestimation of IVF success, illustrate the importance of frequent and frank discussions about expected treatment outcomes.Trial registration:ACTRN12622000576729.HighlightsThe presence of IVF anecdotes increased the intention to undergo another IVF cycle despite extremely low chances of success.Balancing an anecdote of success with an anecdote of failure had no attenuating effect on intention.IVF providers should be wary of the potential impact of success stories on patients' decision making.In the vignette depicting overuse of IVF, participants with previous IVF experience greatly overestimated the likelihood of success with another IVF cycle, supporting previous research finding that patients often have unrealistically high expectations about their own chance of success.