How do patient perceived determinants influence the decision-making process to accept or decline preimplantation genetic screening?

Fertil Steril. 2016 Jan;105(1):188-93. doi: 10.1016/j.fertnstert.2015.09.022. Epub 2015 Oct 24.


Objective: Identify the determinants that influence the patient's decision-making process when deciding to accept or decline preimplantation genetic screening (PGS) in a given IVF cycle.

Design: Pilot, retrospective, cross-sectional study that used a questionnaire containing a combination of quantitative and qualitative items.

Setting: Private practice IVF clinic.

Patient(s): Patients and partners initiating an IVF treatment cycle, both autologous and donor, between October 2012 and January 2015.

Intervention(s): None.

Main outcome measure(s): Identification of patient perceived determinants and the importance of each on the decision to accept or decline PGS.

Result(s): Responses from the questionnaire (N = 117) were returned, and of these, 60% accepted PGS. The female response rate was 75% (N = 88) and the male response rate was 25% (N = 29). Ninety-eight percent were Christian (N = 112) and 88% college educated (N = 102) with 39% (N = 40) having some postgraduate education. Sixty-eight percent (N = 79) had no knowledge of PGS before the IVF cycle; however, after provider education, 92% (N = 108) correctly identified that PGS was elective and 93% (N = 109) reported sufficient knowledge to make an informed decision to accept or decline PGS. The additional cost of screening, the provider information and influence, and social support or acceptance from partner, family, and/or friends, were the three statistically significant variables affecting the decision.

Conclusion(s): This is the first study, to the authors' knowledge, to identify and assess the determinants of the patient decision-making process when presented with the choice of PGS. Several factors contribute to the patient-perceived determinants when choosing to accept or decline PGS, including cost, religious and ethical beliefs and values, social and family support, provider influences, and the past reproductive experience of the patient.

Keywords: Patient decision-making; in vitro fertilization; preimplantation genetic screening; shared decision-making.

MeSH terms

  • Choice Behavior*
  • Cross-Sectional Studies
  • Cultural Characteristics
  • Family Relations
  • Female
  • Fertilization in Vitro* / economics
  • Genetic Testing* / economics
  • Health Care Costs
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Patient Acceptance of Health Care*
  • Patient Participation
  • Perception*
  • Pilot Projects
  • Predictive Value of Tests
  • Pregnancy
  • Preimplantation Diagnosis / economics
  • Preimplantation Diagnosis / methods*
  • Religion and Medicine
  • Retrospective Studies
  • Social Support
  • Surveys and Questionnaires