Systematic evaluation of the quality of clinical practice guidelines on the use of assisted reproductive techniques

Abstract

Objective: To conduct a systematic evaluation of clinical practice guidelines (CPGs) on the use of assisted reproductive technologies. Methods: We searched Medline, the Turning Research into Practice database, and guidelines-specific databases from December 2006 to November 2011. Three reviewers independently assessed each Guideline using the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument. A standardized score was calculated separately for each of the six domains. Results: Fourteen Guidelines were included. Overall, the quality of these was suboptimal. The scores for each AGREE II domain ranged between 37% and 80%. Three (22%) were deemed “Recommended”; nine (64%),“Recommended with modifications”; and two (14%), “Not recommended”. Agreement among reviewers was very good (Intraclass Correlation Coefficient: 0.915 [95% CI 0.807–0.970]). Conclusions: The overall quality of the CPGs on Assisted Reproduction Techniques published during the last 5 years is suboptimal. Most Guidelines present significant shortcomings in important domains such as “stakeholder involvement”, “rigor of development”, and “applicability”. Instruments such as the AGREE II and “the Grading of Recommendation Assessment Development and Evaluation” system could prove useful to improve CPGs in this field. Guideline users could benefit from the present results when choosing which guidelines to implement.

Keywords::

• Assisted reproduction techniques
• clinical practice guidelines
• in vitro fertilization
• assisted embryo transfer
• AGREE II instrument
• quality assessment

Acknowledgements

R.GV. is a PhD candidate at the Paediatrics, Obstetrics, and Gynaecology, Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona, Spain. She obtained a fellowship from the Ford Foundation International Fellowships Program.

We would like to acknowledge Hector Pardo for his help in the edition of the final version of the manuscript.

Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.

P.AC. is funded by a Miguel Servet contract by the Instituto de Salud Carlos III (CP09/00137).

Appendix 1: Full electronic search strategy for MEDLINE

((((((“Reproductive Techniques”[Mesh] OR “Fertilization in Vitro”[Mesh]) OR “Zygote Intrafallopian Transfer”[Mesh]) OR “Gamete Intrafallopian Transfer”[Mesh]) OR “Embryo Transfer”[Mesh]) OR “Cryopreservation”[Mesh]) OR “Surrogate Mothers”[Mesh]) OR “Oocyte Donation”[Mesh] OR “Reproductive Techniques, Assisted”[Mesh] AND Practice Guideline[ptyp] AND English[lang]) AND (“humans”[MeSH Terms] AND (“2006/12/1”[PDAT]: “2011/11/30”[PDAT]))

((((((“Reproductive Techniques”[Mesh] OR “Fertilization in Vitro”[Mesh]) OR “Zygote Intrafallopian Transfer”[Mesh]) OR “Gamete Intrafallopian Transfer”[Mesh]) OR “Embryo Transfer”[Mesh]) OR “Cryopreservation”[Mesh]) OR “Surrogate Mothers”[Mesh]) OR “Oocyte Donation”[Mesh] OR “Reproductive Techniques, Assisted”[Mesh] AND Guideline[ptyp] AND English[lang]) AND (“humans”[MeSH Terms] AND (“2006/12/1”[PDAT]: “2011/11/30”[PDAT]))

“Reproductive Techniques, Assisted”[Mesh] AND “Guidelines as Topic”[Mesh] AND #“humans”[MeSH Terms] AND English[lang]# AND (“humans”[MeSH Terms] AND English[lang] AND (“2006/12/1”[PDAT]: “2011/11/30”[PDAT]))

“Reproductive Techniques, Assisted”[Mesh] AND “Practice Guideline”[Publication Type] AND “humans”[All Fields] AND (“humans”[MeSH Terms] AND English[lang] AND (“2006/12/1”[PDAT]: “2011/11/30”[PDAT]))

“Fertilization in Vitro”[Mesh] AND “Guidelines as Topic”[Mesh] AND (“humans”[MeSH Terms] AND English[lang]) AND (“2006/12/1”[PDAT]: “2011/11/31”[PDAT])

“Embryo Transfer”[Mesh] AND “Guidelines as Topic”[Mesh] AND (“humans”[MeSH Terms] AND English[lang]) AND (“2006/12/1”[PDAT]: “2011/11/31”[PDAT])

(“ZygoteIntrafallopian Transfer”[Mesh]) AND “Guidelines as Topic”[Mesh] AND (“humans”[MeSH Terms] AND English[lang]) AND (“2006/12/1”[PDAT]: “2011/11/31”[PDAT])

“Gamete Intrafallopian Transfer”[Mesh] AND “Guidelines as Topic”[Mesh] AND (“humans”[MeSH Terms] AND English[lang]) AND (“2006/12/1”[PDAT]: “2011/11/31”[PDAT])

(“Cryopreservation”[Mesh] AND “Embryo Transfer”[Mesh]) AND “Guidelines as Topic”[Mesh] AND (“humans”[MeSH Terms] AND English[lang]) AND (“humans”[MeSH Terms] AND English[lang] AND (“2006/12/1”[PDAT]: “2011/11/31”[PDAT]))

(“Cryopreservation”[Mesh] AND “Oocytes”[Mesh]) AND “Guidelines as Topic”[Mesh] AND (“humans”[MeSH Terms] AND English[lang]) AND (“humans”[MeSH Terms] AND English[lang] AND (“2006/12/1”[PDAT]: “2011/11/31”[PDAT]))

“Directed Tissue Donation”[Mesh] AND “Guidelines as Topic”[Mesh] AND (“humans”[MeSH Terms] AND English[lang]) AND (“humans”[MeSH Terms] AND English[lang] AND (“2006/12/1”[PDAT]: “2011/11/31”[PDAT]))

((“Directed Tissue Donation”[Mesh] AND “Guidelines as Topic”[Mesh]) AND “Oocytes”[Mesh]) AND “Oocyte Donation”[Mesh] AND (“humans”[MeSH Terms] AND English[lang]) AND (“humans”[MeSH Terms] AND English[lang] AND (“2006/12/1”[PDAT]: “2011/11/31”[PDAT]))

(“Embryonic Structures”[Mesh] AND “Directed Tissue Donation”[Mesh]) AND “Guidelines as Topic”[Mesh] AND (“humans”[MeSH Terms] AND English[lang]) AND (“2006/12/1”[PDAT]: “2011/11/31”[PDAT]))

“Surrogate Mothers”[Mesh] AND “Guidelines as Topic”[Mesh] AND (“humans”[MeSH Terms] AND English[lang]) AND (“2006/12/1”[PDAT]: “2011/11/31”[PDAT]))