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Apps for patients undergoing fertility treatment promoted with unsupported claims

6 September 2021
By Dr Isla Robertson and Professor Ying Cheong
Dr Isla Robertson is a clinical research fellow researching digital technologies in reproductive medicine at the University of Southampton and Professor Ying Cheong is professor of reproductive medicine at the University of Southampton.
Appeared in BioNews 1111

There is currently a proliferation of mobile apps in the women's health and fertility sectors. It is commonplace for women to use smartphone app-based menstrual and ovulation trackers when trying for a pregnancy. However, research published in the Journal of Obstetrics and Gynaecology Canada has questioned the predictive accuracy and quality of information in these apps and some report increased stress associated with use of these apps whilst trying to conceive, as reported in the Proceedings of the ACM on Human-Computer Interactions.

Less is known about the content and usefulness of apps that are designed to support patients during fertility treatment; a systematic review recently published in Human Fertility aimed to address this knowledge gap. 

A combined search of the smartphone appstores and electronic literature databases identified 46 digital tools (37 smartphone apps) designed exclusively for patient use alongside fertility treatments. The review explores common features and analyses patient perceptions of these digital tools using online app reviews. To explore user feedback, 484 reviews were downloaded from the worldwide Google Playstore and Apple Appstore and analysed using thematic analysis.

The most frequent feature identified within digital support tools was the provision of information regarding infertility, fertility treatments and clinic processes. Thirty-one of the 46 identified tools included these features. Most apps focus on information provision around the timing of treatment and cycle progress; with the aim to improve patients' knowledge and avoid overwhelming them with written or verbal information. Other commonly included features were interactive treatment and appointment calendars (n=22), and instructions around drug dosage and injections administration accompanied by step-by-step instructional videos. These features aim to reduce medication administration errors and also serve to reduce medication regimen complexity commonly seen in IVF treatments. Positive reviewers valued the organisational tools and accessibility of information within the apps.

Psychological and emotional support was a feature in 21 of the 46 identified tools. This support ranged from a discussion forum for peer support, to guided relaxation tracks, positive affirmations, and evidence-based psychological coping support tools. Where included, this psychological support was valued by reviewers, with some mentioning they felt cared for through the apps, which reduced their treatment associated anxiety. A direct messaging support tool was included in 16 apps. The value of direct messaging was raised in many positive online reviews, with patients particularly valuing the convenience of two-way messaging interactions. However, providing this interaction depends on staff having enough time to monitor patients' messages and send secure, accurate, timely and empathetic responses.

Most of the reviews of app content were positive, with negative comments overwhelmingly focused on cost and functionality. The majority of tools were free to access and download, but some incurred one-off payments, or subscription costs, and some had the option to make in-app purchases. Reviewers felt that costs associated with app downloads or accessing additional features were unfair, as they felt asking people who 'are spending thousands of pounds on fertility treatment to spend even more' on the most useful app features was unacceptable.

The thematic analysis of app reviews demonstrated that patients have high expectations of support apps. Users expect equivalent quality to their other familiar apps and are intolerant of poor login processes, technical glitches, and design flaws. The need for repeated logins and other security features was frequently mentioned as problematic, emphasising the fine balance between achieving protection of personal medical data and user interface convenience.

Some of the fertility apps have tens of thousands of users (eg, Wistim, eIVF, Salve), yet no published data to support their use. In this systematic review, nine published studies of web-based digital support tools were identified, but there was a complete absence of peer-reviewed studies of smartphone apps for fertility patients. Similarly, a recent review in Reproductive Biomedicine Online has shown that there are very few digital tools to mediate the psychological effects of infertility. 

Currently, websites of digital tools included in this systematic review make claims about their usefulness, for example that they increase the chance of having a baby, without specific reference to supporting evidence. As digital support tools for fertility treatment proliferate, focus is required for studies with pragmatic design, including randomised trials, to assess their impact on patients' outcomes and experiences as well as the efficiency of clinical processes. With strengthening of this evidence base, we can then confidently recommend the appropriate digital tools to help support our patients' individualised fertility journey.  

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