Adding value in the creation of life

Unfulfilled child wish has a major and many times underestimated impact on the life of women and couples. Many patients suffer in silence and it raises questions about the existential meaning of life. Unfulfilled child wish has impact throughout life, in many social domains. Not becoming a mother or father, automatically means not becoming grandparent while in the meantime always and everywhere patients will be confronted with children. In this way, it is invalidating for life.

In close collaboration with patient couples we have defined for the patient truly relevant clinical outcome measures along with patient reported outcomes measures (PROMs) and experience measures (PREMs). Also, we have mapped in detail our treatment pathways and thus have provided the basis for a cost analysis. This will enable us, by improving outcomes for equal or lower costs, to add value for the patient.

Fertility treatments usually consist of multiple treatment cycles where switching from less invasive treatment options like ovulation induction or intra uterine insemination to more invasive treatments like in vitro fertilisation is common. Traditionally, clinical outcomes are measured by the (ongoing) pregnancy rates per treatment cycle (http://www.nvog.nl/voorlichting/IVF-resultaten/default.aspx). Only in the recent years this has shifted more and more to the live birth rate and in the case of IVF, also the cumulative live birth rate taking cryopreserved embryos into account. Besides, many mainly process indicators are in use.

However, truly relevant for the patient is not the per cycle success rate nor these process indicators. Instead, the prime outcome measure for patients is the chance of having a live and healthy baby after the full cycle of care which may consist of several treatment pathways which in turn may consist of multiple treatment cycles. This patient journey start with referral to a fertility centre and ends with discharge from the fertility centre. Nearly as important is the time to pregnancy, so patients and professionals can manage the mutual expectations. And finally, side effects from treatment and medication is registered so patients can be properly counselled.

It is well known that in the case of unfulfilled child wish, the psychological impact is enormous. Therefore, the most important psychological parameters were defined, such as quality of life in general, depression and anxiety, but also the impact on social life and work and the relationship between partners including satisfaction with the sexual relationship. Validated questionnaires were selected and will be sent out to patients  on a regular basis. This will help us to identify patients at risk and making proper interventions if necessary.

An IPU is in place, bringing together representatives from all involved professionals, i.e. gynaecologists, fertility doctors, nurses, clinical embryologist, technicians and administrative personnel. On a regular basis, this VBHC team meets with patient for instance in a Grand Café setting, to receive input on how to improve our treatment pathways and patient journey and the relevance of clinical and patient reported outcome measures. We have just begun our VBHC journey. Already we have exciting results and thus look forward to help implementing VBHC in fertility centres across The Netherlands and ultimately, internationally. This will be the next stage in our process of implementing VBHC.