Is it ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it?

J Med Ethics. 2019 May;45(5):346-350. doi: 10.1136/medethics-2018-104983. Epub 2019 Feb 11.

Abstract

In vitro fertilisation (IVF) 'add-ons' are therapeutic or diagnostic tools developed in an endeavour to improve the success rate of infertility treatment. However, there is no conclusive evidence that these interventions are a beneficial or effective adjunct of assisted reproductive technologies. Additionally, IVF add-ons are often implemented in clinical practice before their safety can be thoroughly ascertained. Yet, patients continue to request and pay large sums for such additional IVF tools. Hence, this essay set out to examine if it is ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it. In order to determine what is ethical-namely, morally good and righteous, the question was considered in relation to three key values of medical ethics-autonomy, beneficence and non-maleficence. It was determined that providing IVF add-ons might be morally acceptable in specific circumstances, if true informed consent can be given, there is a potential of cost-effective physiological or psychological benefit and the risk of harm is minimal, particularly with regard to the unborn child.

Keywords: clinical ethics; in vitro fertilization and embryo transfer; interests of woman/fetus/father; obstetrics and gynaecology; reproductive medicine.

MeSH terms

  • Commerce / ethics*
  • Evidence-Based Medicine
  • Female
  • Fertility Agents / therapeutic use
  • Fertilization in Vitro / economics
  • Fertilization in Vitro / ethics*
  • Fertilization in Vitro / methods
  • Health Care Costs
  • Humans
  • Morals
  • Patient Safety
  • Pregnancy
  • Reproductive Techniques, Assisted / economics
  • Reproductive Techniques, Assisted / ethics*
  • Treatment Outcome
  • Unnecessary Procedures / economics
  • Unnecessary Procedures / ethics*

Substances

  • Fertility Agents