Top 10 priorities for future infertility research: an international consensus development study

Can the priorities for future research in infertility be identified? The top 10 research priorities for the four areas of male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care for people with fertility problems were identi...

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Published in:	Fertility and sterility Vol. 115; no. 1; pp. 180 - 190
Main Authors:	Duffy, J.M.N., Adamson, G.D., Benson, E., Bhattacharya, S., Bofill, M., Brian, K., Collura, B., Curtis, C., Evers, J.L.H., Farquharson, R.G., Fincham, A., Franik, S., Giudice, L.C., Glanville, E., Hickey, M., Horne, A.W., Hull, M.L., Johnson, N.P., Jordan, V., Khalaf, Y., Knijnenburg, J.M.L., Legro, R.S., Lensen, S., MacKenzie, J., Mavrelos, D., Mol, B.W., Morbeck, D.E., Nagels, H., Ng, E.H.Y., Niederberger, C., Otter, A.S., Puscasiu, L., Rautakallio-Hokkanen, S., Sadler, L., Sarris, I., Showell, M., Stewart, J., Strandell, A., Strawbridge, C., Vail, A., van Wely, M., Vuong, N.L., Wang, A.Y., Wang, R., Wilkinson, J., Wong, K., Wong, T.Y., Farquhar, C.M., AlAhwany, Hisham, Balaban, Ofra, Beebeejaun, Yusuf, Boivin, Jacky, Bosteels, Jan J.A., D’Angelo, Arianna, Dann, Leona F., De Jonge, Christopher J., du Mez, Elyce, Ferriani, Rui A., Gerval, Marie-Odile, Gingel, Lynda J., Greenblatt, Ellen M., Hartshorne, Geraldine, Helliwell, Charlie, Helliwell, Charlotte, Hughes, Lynda J., Jo, Junyoung, Jovanović, Jelena, Kiesel, Ludwig, Kietpeerakool, Chumnan, Kostova, Elena, Kucuk, Tansu, Lawrence, Robyn L., Lee, Nicole, Lindemann, Katy E., Loto, Olabisi M., Lutjen, Peter J., MacKinven, Michelle, Mascarenhas, Mariano, McLaughlin, Helen, Mills, David J., Nguyen, Linh K., Norman, Robert J., Olic, Maja, Overfield, Kristine L., Parker-Harris, Maria, Ramos, David G., Rendulic, Aleksandra, Repping, Sjoerd, Rizzo, Roberta, Salacone, Pietro, Saunders, Catherine H., Sengupta, Rinku, Sfontouris, Ioannis A., Silverman, Natalie R., Torrance, Helen L., Uphoff, Eleonora P., Wakeman, Sarah A., Wischmann, Tewes, Woodward, Bryan J., Youssef, Mohamed A.
Format:	Journal Article Conference Proceeding
Language:	English
Published:	United States Elsevier Inc 01-01-2021
Subjects:	and research priorities Consensus Consensus science methods Delphi Technique Female Fertility Clinics - organization & administration Fertility Clinics - standards Fertility Clinics - trends Humans infertility Infertility - etiology Infertility - therapy International Cooperation Male modified Delphi method modified Nominal Group Technique Practice Guidelines as Topic - standards Pregnancy reproductive medicine Reproductive Medicine - organization & administration Reproductive Medicine - standards Reproductive Medicine - trends Research - organization & administration Research - standards Research - trends reproductive medicine Consensus science methods infertility modified Delphi method and research priorities modified Nominal Group Technique
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Summary:	Can the priorities for future research in infertility be identified? The top 10 research priorities for the four areas of male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care for people with fertility problems were identified. Many fundamental questions regarding the prevention, management, and consequences of infertility remain unanswered. This is a barrier to improving the care received by those people with fertility problems. Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines, and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for each of the categories male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care. Healthcare professionals, people with fertility problems, and others (healthcare funders, healthcare providers, healthcare regulators, research funding bodies and researchers) were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance. The initial survey was completed by 388 participants from 40 countries, and 423 potential research questions were submitted. Fourteen clinical practice guidelines and 162 Cochrane systematic reviews identified a further 236 potential research questions. A rationalized list of 231 confirmed research uncertainties were entered into an interim prioritization survey completed by 317 respondents from 43 countries. The top 10 research priorities for each of the four categories male infertility, female and unexplained infertility (including age-related infertility, ovarian cysts, uterine cavity abnormalities, and tubal factor infertility), medically assisted reproduction (including ovarian stimulation, IUI, and IVF), and ethics, access, and organization of care, were identified during a consensus development meeting involving 41 participants from 11 countries. These research priorities were diverse and seek answers to questions regarding prevention, treatment, and the longer-term impact of infertility. They highlight the importance of pursuing research which has often been overlooked, including addressing the emotional and psychological impact of infertility, improving access to fertility treatment, particularly in lower resource settings, and securing appropriate regulation. Addressing these priorities will require diverse research methodologies, including laboratory-based science, qualitative and quantitative research, and population science. We used consensus development methods, which have inherent limitations, including the representativeness of the participant sample, methodological decisions informed by professional judgement, and arbitrary consensus definitions. We anticipate that identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with fertility problems, and others, will help research funding organizations and researchers to develop their future research agenda. The study was funded by the Auckland Medical Research Foundation, Catalyst Fund, Royal Society of New Zealand, and Maurice and Phyllis Paykel Trust. Geoffrey Adamson reports research sponsorship from Abbott, personal fees from Abbott and LabCorp, a financial interest in Advanced Reproductive Care, committee membership of the FIGO Committee on Reproductive Medicine, International Committee for Monitoring Assisted Reproductive Technologies, International Federation of Fertility Societies, and World Endometriosis Research Foundation, and research sponsorship of the International Committee for Monitoring Assisted Reproductive Technologies from Abbott and Ferring. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and editor for the Cochrane Gynaecology and Fertility Group. Hans Evers reports being the Editor Emeritus of Human Reproduction. Andrew Horne reports research sponsorship from the Chief Scientist’s Office, Ferring, Medical Research Council, National Institute for Health Research, and Wellbeing of Women and consultancy fees from Abbvie, Ferring, Nordic Pharma, and Roche Diagnostics. M. Louise Hull reports grants from Merck, grants from Myovant, grants from Bayer, outside the submitted work and ownership in Embrace Fertility, a private fertility company. Neil Johnson reports research sponsorship from Abb-Vie and Myovant Sciences and consultancy fees from Guerbet, Myovant Sciences, Roche Diagnostics, and Vifor Pharma. José Knijnenburg reports research sponsorship from Ferring and Theramex. Richard Legro reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. Ben Mol reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. Ernest Ng reports research sponsorship from Merck. Craig Niederberger reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. Jane Stewart reports being employed by a National Health Service fertility clinic, consultancy fees from Merck for educational events, sponsorship to attend a fertility conference from Ferring, and being a clinical subeditor of Human Fertility. Annika Strandell reports consultancy fees from Guerbet. Jack Wilkinson reports being a statistical editor for the Cochrane Gynaecology and Fertility Group. Andy Vail reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and of the journal Reproduction. His employing institution has received payment from HFEA for his advice on review of research evidence to inform their ‘traffic light’ system for infertility treatment ‘add-ons'. Lan Vuong reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the present work. All authors have completed the disclosure form. Not applicable. Las 10 principales prioridades para la investigación de la infertilidad futura: un estudio de desarrollo de consenso internacional * ¿Se pueden identificar las prioridades para la investigación futura en infertilidad? fueron identificadas las 10 principales prioridades de investigación para las cuatro áreas de infertilidad masculina, infertilidad femenina e inexplicable, reproducción médicamente asistida, ética, acceso y organización de la atención para personas con problemas de fertilidad. quedan sin respuesta muchas preguntas fundamentales relacionadas con la prevención, el manejo y las consecuencias de la infertilidad.. Esta es una barrera para mejorar la atención que reciben las personas con problemas de fertilidad. las posibles preguntas de investigación se recopilaron a partir de una encuesta inicial internacional, una revisión sistemática de guías de práctica clínica y revisiones sistemáticas Cochrane. Se priorizó una lista racionalizada de incertidumbres de investigación confirmadas en una encuesta internacional provisional. Las incertidumbres prioritarias de la investigación se discutieron durante una reunión de desarrollo de consenso. Usando un método de desarrollo de consenso formal, la técnica de grupo nominal modificado, diversas partes interesadas identificaron las 10 principales prioridades de investigación para cada una de las categorías de infertilidad masculina, infertilidad femenina e inexplicable, reproducción médicamente asistida y ética, acceso, y organización de la atención. profesionales de la salud, personas con problemas de fertilidad y otros (financiadores de la salud, proveedores de atención médica, reguladores de la atención médica, organismos de financiación de la investigación e investigadores) se reunieron en un marco abierto y transparente utilizando métodos formales de consenso propugnados por James Lind Alliance. La encuesta inicial fue completada por 388 participantes de 40 países, se enviaron 423 preguntas potenciales de investigación. Catorce guías de práctica clínica y 162 revisiones sistemáticas Cochrane identificaron unas 236 posibles preguntas de investigación. Se ingresó una lista racionalizada de 231 incertidumbres de investigación confirmadas en una encuesta de priorización provisional completada por 317 encuestados de 43 países. Las 10 principales prioridades de investigación para cada una de las cuatro categorías de infertilidad masculina, Infertilidad femenina e inexplicable (incluida la infertilidad relacionada con la edad, quistes ováricos, anomalías de la cavidad uterina y factor tubárico infertilidad), reproducción médicamente asistida (incluida la estimulación ovárica, IIU e FIV), ética, acceso y organización de cuidado, se identificaron durante una reunión de desarrollo de consenso en la que participaron 41 participantes de 11 países. Estas prioridades de investigación eran diversas y buscaban respuestas a preguntas sobre prevención, tratamiento y el impacto a largo plazo de la infertilidad. Ellos destacaron la importancia de realizar investigaciones que a menudo se han pasado por alto, incluido el tratamiento de los aspectos emocionales y impacto psicológico de la infertilidad, mejorando el acceso al tratamiento de fertilidad, particularmente en entornos de menores recursos, y asegurando una regulación apropiada. Abordar estas prioridades requerirá diversas metodologías de investigación, incluidos aspectos cientificos de laboratorio, investigación cualitativa y cuantitativa y as
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ISSN:	0015-0282 1556-5653
DOI:	10.1016/j.fertnstert.2020.11.014