FERTILITY COUNSELLING

The importance of offering patients psychosocial care throughout the whole course of their fertility treatment was the bottom line of this recent Campus meeting, held in Prague in March. However, while reviewing approaches which may have been neglected or justify further discussion, a further focus of the meeting lay in specific evidence-based digital support interventions. Key moments for routine care highlighted during the Campus included the period after unsuccessful treatment, the management of recurrent pregnancy loss, the use of third-party donation and the use of fertility preservation for oncological indications, and gender reassignment.

All recommendations made during the meeting were consistent with the ESHRE guidelines, in particular those on routine psychosocial care and information provision in third-party donation.(1,2)

Clear from these guidelines is that all fertility patients are in high need of psychosocial support before, during and after treatment. This is irrespective of the patient’s profile, medical history and the reasons why they are referred to treatment. At the end of the meeting, it became clear how psychosocial support should be holistic and multidisciplinary (ie, provided by a combination of fertility staff) and routine practice in all fertility clinics.

This prompted much discussion among those in attendance, and it was noticeable how different healthcare professionals from multiple backgrounds approach the extent of support in different ways. The aim, however, is to meet a single objective, to maximise and improve clinical decision-making and provide the patient with support at all times. The latter is based on a combination of evidence-based practice (patient values, characteristics, preferences and circumstances) and the best available research evidence (design, evaluation and implementation).(3)

Several research-informed and evidence-based interventions were presented to promote patient well-being before, during, and/or after treatment. Isla Robertson from the University of Southampton, UK, went through a recent narrative systematic review on digital support tools for patients to use throughout their treatment.(4) Thirty-seven smartphone apps, eight web-based tools and one SMS-based tool were retrieved. The most common features among them were the provision of information (about fertility, treatment and clinical process), interactive calendars (with treatment dates and appointments), direct messaging (between patients and staff), and psychological and emotional support (46%), mainly comprising online peer support and coping strategies.

Specific self-help online interventions were discussed, such as the MediEmo - a smartphone app that aims to provide patients with medication and emotional support during treatment; the MyJourney app (an online self-guided psychosocial intervention for people with an unmet parenthood goal aiming to improve well-being; a brief coping intervention (PRCI) to help patients manage the waiting time before the beta hCG test, with promising results when used during the wait for a new pregnancy following recurrent pregnancy loss.(5,6,7,8,9) Although the latter is not a digital tool, it does represent a self-help intervention which patients can use independently at their own pace.

It remains necessary to investigate the best way to introduce and incorporate these digital support interventions within a clinical context. Their positive features and increased usage may overcome the barriers presently found in traditional support - no travel-related barriers, low or no associated costs, and flexible use - and they may constitute a promising adjuvant to the face-to-face routine care offered at clinics.

1. https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Psychosocial-care-guideline
2. https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Information-provision-in-donation
3. Spring B. Evidence‐based practice in clinical psychology: What it is, why it matters; what you need to know. J Clin Psychol 2007; 63: 611-631. doi.org/10.1002/jclp.20373
4. Robertson I, Ogundiran O, Cheong Y. Digital support tools for fertility patients - a narrative systematic review. Hum Fertil 2021; 1-10. doi.org/10.1080/14647273.2021.1953711
5. Robertson I, Harrison C, Ng KYB, et al. Development, implementation and initial feasibility testing of the MediEmo mobile application to provide support during medically assisted reproduction. Hum Reprod 2022; 37: 1007-1017. doi.org/10.1093/humrep/deac046
6. https://myjourney.pt
7. Rowbottom B, Galhardo A, Donovan E, Gameiro S. Feasibility randomized controlled trial of a self-guided online intervention to promote psychosocial adjustment to unmet parenthood goals. Hum Reprod 2022; 37: 2412-2425. doi.org/10.1093/humrep/deac168
8. Lancastle D, Boivin J. A feasibility study of a brief coping intervention (PRCI) for the waiting period before a pregnancy test during fertility treatment. Hum Reprod 2008; 23: 2299-2307. doi.org/10.1093/humrep/den257
9. Bailey S, Boivin J, Cheong Y, et al. Effective support following recurrent pregnancy loss: a randomized controlled feasibility and acceptability study. Reprod Biomed Online 2020; 40: 729-742. doi.org/10.1016/j.rbmo.2020.01.022