Reducing the burden of fertility treatments through research

When going through fertility care, many hopeful parents know that multiple clinic visits are a part of the process of trying to start a family. Depending on whether a person is undergoing egg freezing or IVF, the long and often stressful journey to parenthood can mean daily visits for blood tests and ultrasounds, often taking place before most people have had their morning coffee.

According to Choosing Wisely Canada, a non-profit group made up of a team from the University of Toronto, Canadian Medical Association and St. Michael’s Hospital, up to 30 per cent of medical tests, treatments, and procedures in Canada are potentially unnecessary. Dr. Jones, a reproductive endocrinology and infertility specialist at Sinai Health, knew those statistics also likely applied to fertility care.

“Fertility medicine is well-known for over testing and interventions that patients don’t necessarily need, so this is something I really wanted to focus on,” said Dr. Jones. “It was something I was already working on and then pandemic hit, so I said, ‘Let’s eliminate the unnecessary things.’”

In 2019, Dr. Jones approached her co-workers at Mount Sinai Fertility and floated the idea of eliminating unnecessary office visits, redefining which testing days were crucial, and which ones could be skipped, all the while ensuring there was no change to pregnancy success rates.

The team at Mount Sinai Fertility supported the idea and came up with a plan. They would launch a pilot looking at whether they could eliminate ‘Day 3’ appointments for intrauterine insemination, or IUI, patients, instead asking them to take a home pregnancy test and report back with the results.

Dr. Jones said they discovered that despite eliminating the office visit, there was no change in the number of successful pregnancies and patients were overall happier with being able to stay at home.

“Most patients really appreciated the break in office visits,” Dr. Jones said. “Even those who were more skeptical, eventually really came on board for their second and third cycles.”

In 2020 during the COVID-19 pandemic, the team took their research one step further with a quality improvement project, closely looking at which tests were absolutely crucial for IVF patients. By eliminating unnecessary office visits, Jones and her colleague Dr. Salina Kanji, managed to reduce the average of in-person appointments to just four visits per patient, down from the previous standard of eight in the same two week period.

Jones said throughout the process, they were constantly evaluating whether the changes had any impact on pregnancy outcomes. The team is now working to publish this data and share the results of their study countrywide.

“Despite the stress of COVID-19, or perhaps because of it, our fertility care has improved,” Dr. Jones said. “Not only are patients receiving better access to doctors and nurses from the comfort of their home but patients are also undergoing fewer unnecessary tests.”