Modelling futility in the setting of fertility treatment

Author:

Polyakov Alex123ORCID,Gyngel Christopher45,Savulescu Julian56ORCID

Affiliation:

1. Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia

2. Royal Women’s Hospital, Reproductive Biology Unit, Melbourne, VIC, Australia

3. Melbourne IVF, East Melbourne, VIC, Australia

4. Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia

5. Murdoch Children’s Research Institute, Melbourne, VIC, Australia

6. Uehiro Chair in Applied Ethics, St Cross College, Oxford University, St Giles, Oxford, UK

Abstract

Abstract When is a fertility treatment futile? This question has great practical importance, given the role futility plays in ethical, legal and clinical discussions. Here, we outline a novel method of determining futility for IVF treatments. Our approach is distinctive for considering the economic value attached to the intended aim of IVF treatments, i.e. the birth of a child, rather than just the effects on prospective parents and the health system in general. We draw on the commonly used metric, quality-adjusted life years (QALYs), to attach a monetary value to new lives created through IVF. We then define futility as treatments in which the chance of achieving a live birth is so low that IVF is no longer a cost-effective intervention given the economic value of new births. This model indicates that IVF treatments in which the chance of a live birth are <0.3% are futile. This suggests IVF becomes futile when women are aged between 47 and 49 years of age. This is notable older than ages currently considered as futile in an Australian context (∼45). In the UK, government subsidized treatment with the couple’s own gametes stops at the age of 42, while privately funded treatments are self-regulated by individual providers. In most European countries and the USA, the ‘age of futility’ is likewise managed by clinical consensus.

Funder

Wellcome Trust

Publisher

Oxford University Press (OUP)

Subject

Obstetrics and Gynecology,Rehabilitation,Reproductive Medicine

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Response to comments on my paper on whole body gestational donation;Theoretical Medicine and Bioethics;2023-08

2. Video consultations in reproductive medicine: Safety, feasibility and patient satisfaction;European Journal of Obstetrics & Gynecology and Reproductive Biology;2023-07

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