Managing parental capacity concerns in IVF: the role of child welfare committees-a survey of unit directors.

Purpose: To examine whether Child Welfare Advisory Committees (CWCs) assist IVF unit directors in addressing concerns about prospective parental capacity (PC).

Methods: An anonymous online survey of 26 IVF unit directors in Israel was conducted in November 2023, focusing on referrals to CWCs, reasons for referral, and satisfaction with CWC services.

Results: Of the 26 directors, 23 responded (88%). Over a 3-year period, 21 (91%) reported referring candidates to CWCs, with referral counts ranging from 1 to "over 30." The most frequently cited concerns were cognitive developmental disability (16 directors, 72%), mental illness (also 16, 72%), and severe physical disability (10, 43%). Thirteen directors (57%) rated CWC availability and quality as reasonable, while five (21%) found services insufficient, and three (13%) reported no access at all. Ten directors (43%) used alternative strategies, including denying treatment without CWC input, referring patients elsewhere, or prolonging the assessment to encourage withdrawal. One in four respondents reported facing legal or administrative challenges following further evaluation requests or treatment refusals.

Conclusions: Concerns about prospective PC are relatively uncommon but present in all IVF units. The most frequent concerns relate to cognitive developmental disability, mental illness, and severe physical disabilities. While most directors consult CWCs in such cases, satisfaction with their function is mixed. These findings highlight the need for clearer guidelines and more accessible, consistent consultation structures to support clinicians in managing complex cases.