P-499 Facilitators and barriers for home-based monitoring to time frozen embryo transfers in IVF
Authors: Zaat T , De Bruin J.P , Goddijn M , Van Wely M , Mol F 
Published: June 2022

Abstract

Study question
What are the facilitators and barriers concerning the implementation of home-based monitoring for natural-cycle-frozen-embryo-transfer (NC-FET) from perspective of patients and healthcare providers in the Netherlands?

Summary answer
Most important facilitator was optimal pregnancy chance, and most important barriers were risk of missing an ovulation for patients and laboratory capacity for healthcare providers.

What is known already
The number of FET cycles is increasing, mainly due to improvement in laboratory techniques. Based on current evidence, there is no difference in effectiveness when NC-FET is compared to artificial-cycle-FET (AC-FET) in ovulatory women. However, NC-FET is associated with lower risk of adverse obstetric and neonatal outcomes compared with AC-FET. NC-FET is performed based on ovulation monitoring, which can be hospital-based (ultrasounds and ovulation triggering) or home-based (LH-urine-tests). Home-based-monitoring has the advantage of being the most natural protocol for FET. A systematic approach for the implementation of home-based monitoring has to start with exploring the perspectives of all stakeholders.

Study design, size, duration
Both patients and healthcare providers participated in the present study. A panel of experts (n = 8) hypothesised on barriers and facilitators for the implementation of home-based-monitoring during the proposal phase of the Antarctica-2 randomised controlled trial. Two different questionnaires were developed in order to investigate facilitators and barriers for patients and for health care providers.

Participants/materials, setting, methods
The following stakeholders participated in the study:
Patients – represented by the Dutch Patient Organisation for Couples with Fertility Problems.
Healthcare providers – represented by gynaecologists (Netherlands Society of Obstetrics and Gynaecology), embryologists (Dutch Federation of Clinical Embryology) and fertility doctors.
Based on our power analysis we aimed for 300 completed questionnaires for the patients and a 90 completed questionnaires for the health care providers. Facilitators and barriers were analysed using frequencies, mean (SD) and ranking.

Main results and the role of chance
A total of 311 patients filled out the questionnaire of whom 86.8% underwent FET previously. The facilitators and barriers were ranked on a scale of 1-10 with 10 being very important. The highest priority for the patients was to implement the strategy with the highest chance of pregnancy (mean 9.7; 95% CI 9.6 – 9.7) and the lowest priority risk of missing the ovulation (mean 8.4; 95% CI 8.2 – 8.6)). A total of 96 health care providers filled out the questionnaire. According to health care providers patients would accept the strategy when it causes less interference with patients’ work and private life (mean 7.5; 95% CI 7.1 – 8.0) and with a low risk of missing the ovulation (mean 7.6; 95% CI 7.1 – 8.0). The most important facilitator for implementation of home-based monitoring for health care workers was optimising cumulative pregnancy rates (mean 8.1; 95% CI 7.7 – 8.4) and most important barrier the lack of laboratory capacity and flexibility (mean 6.4; 95% CI 5.8 – 7.0).

Limitations, reasons for caution
The barrier lack of laboratory capacity especially in weekends might differ between centres. We did not identify the number of centres who might experience this problem. Furthermore, these results only apply for the applicability of NC-FET in the Netherlands.

Wider implications of the findings
Our interpretation is that NC-FET is the preferred treatment in ovulatory women. We gained insight in the facilitators and barriers for implementation of NC-FET. Discussing results of this study with all stakeholders involved should stimulate incorporation in guidelines, especially as key professionals in guideline development took part in this study.

Trial registration number
The Antarctica-2 RCT (NTR: 27578) is supported by a grant of the Netherlands Organisation for Health Research and Development (ZonMw 843002807).