{"id":278,"date":"2019-12-17T14:50:21","date_gmt":"2019-12-17T14:50:21","guid":{"rendered":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/?p=278"},"modified":"2020-02-17T11:07:54","modified_gmt":"2020-02-17T11:07:54","slug":"pets-annual-conference-reality-check-questions-of-evidence","status":"publish","type":"post","link":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/?p=278","title":{"rendered":"PET\u2019s annual conference: Reality check! Questions of evidence"},"content":{"rendered":"

The Progress Educational Trust\u2019s (PET) annual conference has become an established event in our December calendar and this year we continued the tradition. This year’s conference was entitled \u2018Reality check: A realistic look at assisted reproduction\u2019<\/strong> and dealt with a range of topics including evidence, regulation, informed choice for patients and the ongoing \u2018add-on debate\u2019 (which I wrote about in a previous post<\/a>). In total, there were 14 talks across the day, with each session followed by an opportunity for the audience to ask questions or offer comments to the speakers. In this post, I am going to reflect on some issues around evidence that emerged throughout the day.<\/p>\n

We have entered \u2018an era of profound unreliability\u2019 said James Duffy in his talk about the production of evidence in which he detailed how research being done in the field of assisted reproduction often falls short of accepted standards of scientific rigour. For instance, findings from trials that are run entirely in one clinic cannot be translated to other clinics or patient populations, and he contended that research is often driven by commercial interests rather than an interest in the production of ‘gold standard’ evidence. Yet Nick Macklon explained how the reliance on randomised control trials (RCTs) in assisted reproduction research sets a very high bar for what counts as acceptable evidence, at the risk of ignoring other valuable data that are produced outside of the RCT framework. While RCTs are, with good reason, considered to offer the highest level of evidence in medicine, there are significant barriers to conducting RCTs in infertility research; challenges include the large required sample size, the long timeline from research design to implementation and results, and the issue of the trial sample not reflecting the patient group due to strict participant selection criteria. We were reminded that IVF was highly controversial and not supported by an RCT when developed in the 1970s (as I learnt from my visit to the Science Museum<\/a>), which could serve as an argument both for tighter regulation and monitoring, as well as the benefit of allowing space for technological and scientific innovation. Sally Cheshire, chair of the Human Fertilisation and Embryology Authority (HFEA), brought the attention back to the patient in her speech (available in full here<\/a>), emphasising that while it is crucial to continuously develop and improve IVF procedures we need to critically question whether it is fair for patients to pay for this knowledge production, especially if it could potentially cause physical, psychological or financial harm.<\/p>\n

Another point that complicates the issue of evidence in contemporary fertility treatment is the discrepancy between what is offered in IVF clinics and the recommendations provided by the HFEA. S\u00f8ren Ziebe opened the first session with a provocation whereby he questioned why over half of IVF cycles use pre-implantation genetic screening (PGS) when the HFEA determines this procedure to be without reliable evidence that it improves chances of pregnancy. Later in the day, Chris Barratt also argued that intracytoplasmic sperm injection (ICSI, where the sperm is injected directly into the egg) is vastly overused in fertility clinics. ICSI is used in over half of IVF cycles despite the HFEA and National Institute for Health and Care Excellence (NICE) guidelines stating that this procedure should only be used for male-factor infertility, which accounts for only about a third of infertility cases.<\/p>\n

The fact that practices of fertility clinics go against national recommendations on such a large scale sends contradictory messages to patients, which can cause feelings of confusion and suspicion of professional judgement. These feelings are further amplified by the issue of significant gaps in current knowledge about reproductive biology and assisted reproduction; unexplained infertility and failed implantation emerged several times across the day as significant grey areas with an urgent need for better understanding. In the discussion sessions there was some conversation about the complexities of doctor-patient consultations as sites where the practice of evidence-based medicine intersects with individual clinical practice and patients\u2019 needs, wants and choices. While debates about add-ons have been ongoing for years, it is on the ground, in the fertility clinic consultation room, that the actual discussions with patients about add-ons takes place. One practicing fertility specialist noted how, rather than simply running a search for evidence in a medical database and recommending fertility treatment based on this, consultations are more akin to a conversation and negotiation between the doctor and patient. Others noted how it can be extremely difficult to say \u2018no\u2019 to a patient who has a strong belief in or desire for a particular treatment or test regardless of its evidence-base, especially when the patient will potentially go elsewhere and pay for it. Explaining the mixed evidence for certain procedures is challenging in a situation where patients are often willing to take great chances in the hope that a treatment might<\/em> work.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

The Progress Educational Trust\u2019s (PET) annual conference has become an established event in our December calendar and this year we continued the tradition. This year’s conference was entitled \u2018Reality check: A realistic look at assisted reproduction\u2019 and dealt with a range of topics including evidence, regulation, informed choice for patients and the ongoing \u2018add-on debate\u2019 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"spay_email":"","footnotes":"","jetpack_publicize_message":"","jetpack_is_tweetstorm":false,"jetpack_publicize_feature_enabled":true},"categories":[8,4],"tags":[],"class_list":["post-278","post","type-post","status-publish","format-standard","hentry","category-conferences","category-events"],"jetpack_featured_media_url":"","jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p9YI6o-4u","jetpack-related-posts":[{"id":262,"url":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/?p=262","url_meta":{"origin":278,"position":0},"title":"British Sociological Association Human Reproduction Study Group Annual Conference 2019","date":"20th June 2019","format":false,"excerpt":"Last week we were delighted to attend the BSA Human Reproduction Study Group Annual Conference, held on June 12 at De Montfort University (DMU) in Leicester. During one of the late afternoon sessions, Manuela Perrotta (pictured below) presented our paper-in-progress on professional attitudes towards the role of evidence-based-medicine (EBM) in\u2026","rel":"","context":"In "Conferences"","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/remakingthehumanbody.sbm.qmul.ac.uk\/wp-content\/uploads\/2019\/06\/IMG_2468.jpg?resize=350%2C200&ssl=1","width":350,"height":200},"classes":[]},{"id":225,"url":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/?p=225","url_meta":{"origin":278,"position":1},"title":"Patients and IVF add on treatments","date":"15th January 2019","format":false,"excerpt":"Since the start of the \u2018Remaking the Human Body\u2019 project there have been some significant developments in debates around the state of fertility treatment in the UK. Just over two years ago, BBC Panorama presented a documentary entitled Inside Britain\u2019s Fertility Business\u00a0(28 November 2016) that questioned the quality of scientific\u2026","rel":"","context":"In "Topical"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":678,"url":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/?p=678","url_meta":{"origin":278,"position":2},"title":"Our Poster at ESHRE 2022","date":"6th July 2022","format":false,"excerpt":"This week, I have been attending the ESHRE conference online. Despite my fervent hope, the long-awaited moment to return to in-person conferences has not transpired and I had to revert to virtual participation. Being able to attend remotely was, unexpectedly, a great opportunity. The conference platform was highly effective, and\u2026","rel":"","context":"In "Uncategorised"","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/remakingthehumanbody.sbm.qmul.ac.uk\/wp-content\/uploads\/2022\/07\/image.png?resize=350%2C200&ssl=1","width":350,"height":200},"classes":[]},{"id":600,"url":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/?p=600","url_meta":{"origin":278,"position":3},"title":"What can we do to support informed decisions?","date":"30th November 2021","format":false,"excerpt":"Over the past few months, the research team has participated in a number of events where we have discussed our findings and engaged in stimulating conversations with IVF patients and professionals (you can see a list of our past events and links to event reports on the Events page). In\u2026","rel":"","context":"In "Events"","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/remakingthehumanbody.sbm.qmul.ac.uk\/wp-content\/uploads\/2021\/11\/image-16.png?resize=350%2C200&ssl=1","width":350,"height":200},"classes":[]},{"id":428,"url":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/?p=428","url_meta":{"origin":278,"position":4},"title":"Workshop with IVF professionals","date":"10th August 2021","format":false,"excerpt":"As part of our public engagement programme, we had the pleasure to host an extremely fascinating event 'Time-lapse Imaging and the Debate on Evidence: A Social Science Perspective', which we organised with the Progress Educational Trust (PET). For this event, we invited professionals involved in various aspects of IVF treatment\u2026","rel":"","context":"In "Events"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":530,"url":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/?p=530","url_meta":{"origin":278,"position":5},"title":"Event report: The question of add-ons and evidence","date":"30th November 2021","format":false,"excerpt":"On November 9th we had the pleasure to host another stimulating workshop, organised in cooperation with the Progress Educational Trust. For this online workshop we invited health professionals, researchers and fertility patient advocates to discuss the topics of evidence production and fertility treatment add-ons. This workshop was the third in\u2026","rel":"","context":"In "Events"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]}],"_links":{"self":[{"href":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/index.php?rest_route=\/wp\/v2\/posts\/278","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=278"}],"version-history":[{"count":2,"href":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/index.php?rest_route=\/wp\/v2\/posts\/278\/revisions"}],"predecessor-version":[{"id":294,"href":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/index.php?rest_route=\/wp\/v2\/posts\/278\/revisions\/294"}],"wp:attachment":[{"href":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=278"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=278"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/remakingthehumanbody.sbm.qmul.ac.uk\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=278"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}