Top 10 priorities for future infertility research: an international consensus development study
Top 10 priorities for future infertility research: an international consensus development study
复制标题
DOI：
10.1016/j.fertnstert.2020.11.014
复制
发表时间：
2021-01-04
影响因子：
6.7
通讯作者：
Farquharf, C. M.
中科院分区：
文献类型：
--
作者：
Duffy, J. M. N.;Adamson, G. D.;Farquharf, C. M.
研究问题：能否确定未来不孕症研究的重点？摘要回答：确定了男性不育症、女性和不明原因不育症、医学辅助生殖以及生育问题患者的伦理、获取和护理组织四个领域的十大研究重点。已知情况：关于不孕症的预防、管理和后果的许多基本问题仍然没有答案。这是改善那些有生育问题的人所得到的护理的一个障碍。研究设计、规模、持续时间：从最初的国际调查、临床实践指南的系统综述和Cochrane系统综述中整理出潜在的研究问题。在一项临时国际调查中，确定了一份合理的研究不确定性清单。在协商一致的发展会议上讨论了优先研究的不确定性。使用正式的共识发展方法，即修改的名义群体技术，不同的利益相关者确定了男性不育症、女性和不明原因不育症、医学辅助生殖以及伦理、获取和组织护理的十大研究重点。参与者/材料、环境、方法：医疗保健专业人员、有生育问题的人以及其他人（医疗保健资助者、医疗保健提供者、医疗保健监管机构、研究资助机构和研究人员）使用詹姆斯·林德联盟倡导的正式共识方法，在一个公开透明的过程中聚集在一起。主要结果和机遇的作用：最初的调查由来自40个国家的388名参与者完成，并提交了423个潜在的研究问题。14项临床实践指南和162项Cochrane系统评价确定了另外236个潜在的研究问题。来自43个国家的317名受访者完成了一项临时优先排序调查，其中列出了231个已确认的研究不确定因素。在一次有来自11个国家的41名与会者参加的共识发展会议上，确定了男性不育症、女性和不明原因不育症（包括与年龄有关的不育症、卵巢囊肿、子宫腔异常和输卵管因素不育症）、医学辅助生殖（包括卵巢刺激、RH和体外受精）以及伦理、获取和护理组织的十大研究重点。这些研究重点是多种多样的，并寻求有关预防，治疗和不孕不育的长期影响的问题的答案。他们强调了开展经常被忽视的研究的重要性，包括解决不孕症的情绪和心理影响，改善获得生育治疗的机会，特别是在资源匮乏的环境中，以及确保适当的监管。解决这些优先事项将需要多种研究方法，包括基于实验室的科学、定性和定量研究以及人口科学。局限性，谨慎的原因：我们使用了共识发展方法，它有固有的局限性，包括参与者样本的代表性，由专业判断决定的方法，以及任意的共识定义。研究结果的更广泛含义：我们预计，确定的研究优先级，特别突出医疗保健专业人员、有生育问题的人以及其他人认为最紧迫的临床需求，将有助于研究资助组织和研究人员制定他们未来的研究议程。
Study Question: Can the priorities for future research in infertility be identified?Summary Answer: The top 10 research priorities for the four areas of male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care for people with fertility problems were identified.What is Known Already: Many fundamental questions regarding the prevention, management, and consequences of infertility remain unanswered. This is a barrier to improving the care received by those people with fertility problems.Study Design, Size, Duration: Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines, and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for each of the categories male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care.Participants/Materials, Setting, Methods: Healthcare professionals, people with fertility problems, and others (healthcare funders, healthcare providers, healthcare regulators, research funding bodies and researchers) were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance.Main Results and the Role of Chance: The initial survey was completed by 388 participants from 40 countries, and 423 potential research questions were submitted. Fourteen clinical practice guidelines and 162 Cochrane systematic reviews identified a further 236 potential research questions. A rationalized list of 231 confirmed research uncertainties were entered into an interim prioritization survey completed by 317 respondents from 43 countries. The top 10 research priorities for each of the four categories male infertility, female and unexplained infertility (including age-related infertility, ovarian cysts, uterine cavity abnormalities, and tubal factor infertility), medically assisted reproduction (including ovarian stimulation, RH, and IVF), and ethics, access, and organization of care, were identified during a consensus development meeting involving 41 participants from 11 countries. These research priorities were diverse and seek answers to questions regarding prevention, treatment, and the longer-term impact of infertility. They highlight the importance of pursuing research which has often been overlooked, including addressing the emotional and psychological impact of infertility, improving access to fertility treatment, particularly in lower resource settings, and securing appropriate regulation. Addressing these priorities will require diverse research methodologies, including laboratory-based science, qualitative and quantitative research, and population science.Limitations, Reasons for Caution: We used consensus development methods, which have inherent limitations, including the representativeness of the participant sample, methodological decisions informed by professional judgement, and arbitrary consensus definitions.Wider Implications of the Findings: We anticipate that identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with fertility problems, and others, will help research funding organizations and researchers to develop their future research agenda.