Fertility clinics have a duty of care towards patients who do not have children with treatment
Open accessAbstract
In medically assisted reproduction (MAR) success has mostly been measured in terms of achieving (healthy) livebirths. We argue this focus is too narrow and that success should be measured in terms of alleviating patient suffering caused by an unfulfilled child wish. The major implication is that clinics must better tailored care to effectively support patients who do not have child(ren) with treatment. First, we argue that clinics have a duty of care towards patients for whom MAR does not result in children because this is a common treatment outcome, because treatment is burdensome and creates new losses for patients, and because the field has the necessary expertise to provide support and it is part of patient-centred care. Then, we examine concerns about the adequacy of addressing the possibility that treatment may end without children, namely, that this may hinder patients' hope and put them off doing treatment, and that it may be perceived as a sign of clinical incompetence, as well as concerns about the required skill set. We end with a set of research-informed recommendations to promote healthy adjustment to ending fertility treatment without children. These focus on the need to reconceptualize 'success' and 'failure' in MAR, to promote open discussion about the possibility of treatment not resulting in children and encourage patients to develop 'plan(s) B', to support patients who end treatment without children, and to create the organizational structures needed to support clinics and healthcare professionals in this endeavour.
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Accumulated evidence, though fragmented, suggests an urgent need to manage infertility beyond medical care.
“Accumulated evidence, though fragmented, suggests an urgent need to manage infertility beyond medical care [54].”
From Psychosocial interventions for improving marital intimacy, sexual satisfaction, and quality of life of women and couples with infertility problems in low and middle-income countries: Systematic review protocol (2025) · cites this paper as [54]
The Introduction argues that measuring success by live births is too narrow and calls for care that alleviates suffering, while the Conclusion describes an ethical imperative to prepare and support patients. The discussion of clinics’ expertise also identifies gaps in existing support and evidence. The paper’s argument, however, is specifically about patients whose fertility treatment does not result in children, rather than infertility management generally. (LLM, conf=0.82)
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- Authors
- Gameiro, S., Leone, D., & Mertes, H.
- Affiliations
- Cardiff University (GB)
- Ospedale San Paolo (IT)
- Ghent University (BE)
- Corresponding author
- Gameiro, S
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2024-06-18
- Volume
- 39
- Issue
- 8
- Pages
- 1591-1598
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- PMC
- PMC11291940
- OpenAlex
- W4399827476
- Cited by
- 10
- References
- 66
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 1
- FWCI
- 3.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Human Reproduction (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion, cc-by)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Assisted Reproductive Technology and Twin Pregnancy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Keywords
- assisted reproduction, duty of care, patient-centered care, treatment outcome assessment, patient suffering, hope, clinical competence, Plan B
- MeSH terms
- Fertility Clinics, Female, Humans, Infertility, Pregnancy, Patient-Centered Care, Reproductive Techniques, Assisted
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