This document provides an overview of 3 key findings from a study on current internet applications in reproductive medicine. (1) Internet applications help fill the gap between patients' needs for support and information and what clinics can provide. For example, online support groups and decision aids. (2) Many internet applications are connected to the primary care process by providing information and support related to IVF treatment and coping with infertility. (3) Improving quality of fertility care by making it more patient-centered is a goal of internet applications, such as personal health records and peer support online. The study calls for more research with longer follow up periods to better understand effectiveness.

1. An overview of challenges and possibilities of
the Internet in fertility care
Annemijn Aarts,
Pieter van den Haak, WillianneNelen, Wouter Tuil, Marjan Faber, Jan Kremer
Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
Medicine 2.0 Maastricht 2010

2. 80.000.000 infertilepeopleworldwide
1 out of every 4 couples1
Anyform of reducedfertilitywithprolonged time of unwanted non-conception2
Cause
Male
Female
Both
Unexplained
1Nachtingall, FertilSteril2006
2Gnoth et al., Hum Reprod 2005

3. Itdoesn’tcome easy…
Reproductivetechniques, such as
IVF
1Verhaak et al., Hum Reprod Update 2007
2Schmidt, Lancet 2006

4. Fertility and reproductionembedded in our lives…

5. Ideal Internet population1,2
Emotional impact
Stigmatisingcondition
Young
Highlyeducated
Need forinformation
Want to beinvolved
Lookingfor support
1Weismann et al., FertilSteril 2000
2Haagen et al., Hum Reprod 2003

6. However, notintegratedintousual care.. yet!
eHealth Clinicalpractice

7. Studyobjectives
1. Overview of current Internet applications in
reproductivemedicine
2. Methodologicalconsiderations and
recommendationsforfuture research

8. METHODS

9. 5 databases
1217 studies
Patient-focused
eHealth
18 studies

10. Data extraction and synthesis
1. Type of usage and behaviour of web-basedapplications
2. Effects of web-basedapplications

11. RESULTS

12. Infertilityspecific Internet applications
Online support groups
- Qualitative research
- Social and emotional support
Decisionaid
- Oncologicalpatientsfacinginfertilitydue to chemotherapy
- RCT and before-after design: small sample sizes
- Knowledge, decisional conflict
Psychoeducationaltreatment
- Aim: reducing stress, anxiety, depression
- RCT: No orsmalleffectsfound

13. Infertilityspecific internet applications (cntd)
Personal Health Record
- Generic and personalinformation
- Communication (private forum and chatroom)
- Online behaviour
- RCT: no effect onpatientempowerment
Expert Forum
- Multidisciplinary team
- Content of requestsstudied
- Patientssatisfied

14. Summary of findings
• Patients are enthusiastic
• Patientsfindithelpful and supporting
• Effectivenesscouldnotbeestablished, which is
neededforsuccesfulintegrationintoclinical care
However….
• Someinterestingconclusionscanbedrawn

15. DISCUSSION & CONCLUSIONS

16. (1) Fills the gap betweenpatients’ needsand the
supportclinicscan offer
PHR (Tuil et al., 2009)
Stages of IVF treatment

17. (1) Filling the gap betweenpatients’ needsand the
supportclinicscan offer
DA (Meneseset al.; Huyghe et al.2010)
Oncologistscannotfullfil the
informationneed of
oncologicalpatientsonfertilitypr
eservation

18. (1) Filling the gap betweenpatients’ needsand the
supportclinicscan offer
Forum (Malik, 2008)
Support forinfertile
men

19. (2) Connected to primary care process
Chat topics van Selm, et al. 2008
1. IVF treatment
2. Childlessness
Requestson Expert forum Himmel, et al. 2008
1. Information and explanation
2. Guidance in decisionsduringtreatment
Online support groupse.g. Malik &Coulson, 2008, 2010
1. Lookingforpatientswhowereundergoing the same at that moment

20. (3) Improvingquality of fertility care bymakingit more
patient-centred
Tailoring care to individualneeds and preferences (Berwick, 2002)
Core elements of patient-centredfertility care
Dancet et al, 2010 Online peer support
Van Empel et al, 2010 Access to theirmedicalhealth record
Patientinvolvement
Accurate and complete information
Collective level
Patientscanunite online  Votewiththeirfeet  Qualityimprovement

21. METHODOLOGICAL CONSIDERATIONS &
RECOMMENDATIONS

22. (1) Itrequires time to mature
• Follow up period
• Not mentionedor maximum of 6 months
Hansen, 2007
9 months to mature

23. (2) Prevent high attritionrates
Sextonet al. 2010 67% %
Haemmerliet al.2009 50%
Especially in fertility care
-Drop out1
-Pregnant along the way
time
User-centredintervention:
Patients as anintegral part of development team
E.g.Personal Health Record (Tuil et al)
1Brandes et al., Hum Reprod 2009

24. (3) Study design: Randomizedcontrolled trial not the gold
standard
• RCT is not patient-centred2
• eHealth is patient-orientedinstead of disease- or doctor-oriented1
Patients free to choosewhat to use
• Dynamic and changingcharacter of the Internet3
1Swan; 2Bensing, 2000; 3Potts, 2006

25. (4) The value of observational and qualitative studies in
eHealth research
• Choosingappropriate ‘ingredients’ requiresknowledge of
workingmechanism
Shedlightonwhyitworks (ordoesn’t)3
• More able to detectpossible‘sideeffects’ and
chooseappropriateoutcome measures1-3
1Smulder, 2010; 2Kohler 2009; 3Shrier, 2007

26. eHealth in fertility care is promisingfrom a
patient’sperspective, although more research is needed
Twitter:
aartsja.aarts@obgyn.umcn.

27. Questions are
guaranteed in life;
answersaren’t
(Francis Bacon)
Thankyouforyourattention!
Twitter:
aartsja.aarts@obgyn.umcn.