Low E-visibility of embryologists on fertility clinic websites: a web-based cross-sectional study

Abstract

Purpose

This study assessed the visibility of embryologists on fertility clinic websites among Society for Assisted Reproductive Technology (SART) and the Human Fertilisation and Embryology Authority (HFEA) member clinics.

Methods

During a 1-month interval (March 2022), all Society for Assisted Reproductive Technology (SART) and the Human Fertilisation and Embryology Authority (HFEA) member fertility clinic websites were evaluated. The professional representation of the primary care team was examined including specialties, the presence of headshots, and biographies.

Results

A total of 446 fertility clinic websites were scanned in the search. The embryology team has the least common professional identification by their names (53.58%) compared to gynecology clinicians (96.21%, p < 0.001) and nurses (55.58%, p < 0.001). This trend also applies to other types of professional identifiers, such as headshots and biographies. Professional headshots of embryologists (50.34%) were less prominent than those of gynecology clinicians (93.51%, p < 0.001). A similar trend was observed in the biographies of the embryology team (47.20%) compared to gynecology clinicians (95.08%, p < 0.001).

Conclusion

The present study revealed that embryologists have low professional visibility on fertility clinic websites. Fertility clinics may prioritize enhancing the online visibility of their embryology laboratory team. This approach could potentially enhance the recognition of their team, foster transparency, and provide accessible information about the skills and expertise of healthcare professionals involved in the treatment process.

Introduction

The deep-rooted relationship between technology and modern society has led to a paradigm shift in several sectors, including healthcare. In the field of reproductive health, the integration of technology and medicine has transformed the way patients seek and access specialist care and reproductive health information [1]. A significant proportion of patients nowadays are internet-savvy and prefer consulting fertility clinic websites as their primary source of information, with almost 28.1% of prospective patients relying on such websites [2]. As a result, initiatives have been taken to evaluate and rate the quality of these websites, with guidelines from professional societies and regulatory authorities emphasizing the need for transparency, evidence-based practices, and updated information for patients [3, 4]. While it is essential for fertility clinic websites to provide clinical information and success rates, it is also important to highlight the unique qualities of the practice, including the roles of the medical team members [3, 5]. Typically, the fertility clinic team consists of physicians, nurses, embryologists, and administrative staff [6]. Nevertheless, there has been a lack of research conducted to examine the information about staff composition that fertility clinics provide on their websites. One study conducted an evaluation of the quality of websites belonging to fertility clinics in the USA. Subsequently, in the analysis, the focus was solely on assessing how the gynecology clinicians were portrayed on those websites [7]. Embryologists are key members of the team and play a crucial role in the success of assisted reproductive technologies (ART) [8–12]. The responsibilities of a clinical embryologist in an ART laboratory are highly intricate and directly impact the outcome of therapeutic treatments [11]. Furthermore, these tasks have the potential for long-term adverse effects on the health and well-being of individuals conceived through ART procedures [13, 14]. A recently conducted study involving scientists in New Zealand revealed that embryologists carry out both the technical and emotional aspects of healthcare work in a manner unique to their profession, referred to as a hybrid care approach. Their emotional labor involves dealing with challenging patients, delivering difficult news in a supportive manner, devising strategies to maintain hope and purpose, and establishing rapport with individual patients [15]. For these and various other reasons, the prevalence of “burnout” among embryologists, characterized by emotional exhaustion, decreased productivity, and low morale, can be significant [16–18]. According to Murphy et al. (2022), approximately 71% of embryologists reported experiencing symptoms of burnout [19]. Additionally, unpublished data from Palmer et al. (2022) revealed that 51% of embryologists experienced work-related emotional exhaustion, 41% described mental health issues, 50% expressed an increased sense of cynicism and detachment from their job, and 56% reported a decrease in productivity and low morale [20]. The demanding nature of the profession, characterized by high stakes, long working hours, and immense pressure, contributes to elevated levels of burnout. Several approaches have been suggested to prevent burnout syndrome, such as implementing measures like recognizing the achievements of embryologists, which can effectively contribute to cultivating a positive and flourishing work environment [18, 21]. Nevertheless, there have been no studies that have examined the extent of visibility of embryologists on fertility clinic websites. The present study is aimed at assessing the extent to which embryologists are visible on fertility clinic websites through textual analysis.

Methods

Study design

A cross-sectional analysis was conducted through a web-based survey to assess the visibility of embryologists on fertility clinic websites. This study was reported in accordance with the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines [22]. Institutional review board approval was not required for this study, as all data were publicly available and did not involve patient or protected information.

Setting

Fertility clinic websites were collected from publicly accessible registries of the Society for Assisted Reproductive Technology (SART) (http://www.sart.org) and the Human Fertilisation and Embryology Authority (HFEA) (http://www.hfea.gov.uk) over a period of 1 month, from March 2022 to April 2022.

Participants

The team page of each clinic’s website was examined.

Measurements

Each website was comprehensively assessed for overall staff composition, personnel specialization (e.g., gynecology clinicians, administrative staff, nurses, embryology team which includes embryologists and/or embryology laboratory directors), professional headshot, and biography.

Data collection

All necessary data were independently extracted from the websites by all authors, using an Excel spreadsheet form.

Statistical analysis

The statistical analysis was performed using SPSS 23.0 (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp). Categorical data were presented as percentages, and the chi-square test was used to compare categorical data. Results were considered significant if p values were ≤ 0.05.

Results

Website characteristics

A total of 446 fertility clinic websites were reviewed, with 115 (25.7%) identified from the HFEA and 332 (74.4%) from the SART lists of registered clinics (Table 1). Of the 446 clinics, 80.04% were private clinics/centers, 9.19% were in academic centers, 5.60% were in public hospitals, and 5.15% were in private hospitals. Among those websites, 64.12% had their last website update in 2022, 8.52% in 2021, 4.70% in 2020, and 22.60% before 2019 (Table 1).

Table 1.

An overview of the characteristics of fertility clinic websites registered with HFEA and SART

Characteristics		Website number (%)
Location	UK HFEA registry	115 (25.7)
	US SART registry	332 (74.4)
Practice type	Academic center	41 (9.19)
	Private clinic/center	357 (80.04)
	Private hospital	23 (5.15)
	Public hospital	25 (5.60)
Last website update	2010	1 (0.22)
	2012	1 (0.22)
	2013	2 (0.44)
	2014	1 (0.22)
	2015	1 (0.22)
	2016	2 (0.44)
	2017	6 (1.34)
	2018	10 (2.24)
	2019	7 (1.56)
	2020	21 (4.70)
	2021	38 (8.52)
	2022	286 (64.12)

Data presented as n (%). SART Society for Assisted Reproductive Technology, HFEA Human Fertilisation and Embryology Authority

Visibility of embryologists compared to other professional groups

The query of these websites using the specific team page revealed that the embryology team is least likely to be identified by their names (53.58%) compared to gynecology clinicians (96.21%, p < 0.001) and nurses (55.58%, p < 0.001) (Fig. 1a). Additionally, these findings apply to professional headshots and biographies as well. For instance, regarding the professional headshots, gynecology clinicians (93.51%, p < 0.001) were more prominently featured than the embryology team (50.34%) (Fig. 1b). As for the biographies, embryologists (47.20%) were under-represented compared to gynecology clinicians (95.08%, p < 0.001) (Fig. 1c).

Fig. 1.

Professional identifiers of the embryology team on fertility clinic websites compared to gynecology clinician specialists, administrative staff, and nurses. ***p < 0.001 when compared to gynecology clinicians; ⁺⁺⁺p < 0.001 when compared to nurses; ^^^p < 0.05 when compared to administrative staff

A subgroup analysis revealed that compared to embryologists, embryology laboratory directors are more likely to be identified by their names (46.63% vs. 29.79%, p < 0.00001), professional headshots (43.52% vs. 26.94%, p < 0.00001), and biographies (42.23% vs. 19.43%, p < 0.00001) (Fig. 2a–c).

Fig. 2.

Professional identifiers of embryologists compared to embryology laboratory directors. ***p < 0.00001 when compared to embryology laboratory directors

Furthermore, in a subanalysis where we aimed to explore country-based variations in the visibility of embryology team names on websites, we identified a statistically significant difference between HFEA-member fertility clinics and their SART counterparts (63.15% vs. 50.30%, p < 0.05). Specifically, the significance was evident in the representation of embryology laboratory directors on UK clinic websites compared to those in the USA (59.09% vs. 42.59%, p < 0.005).

The embryology team members based in the UK were more prominently featured on websites compared to those from the USA. However, despite this disparity, the presence of the embryology teams on websites in both the UK and USA is statistically significantly lower when compared to gynecology clinicians. Intriguingly, in the USA, the embryology teams hold the third position in terms of representation on websites, trailing behind clinicians and nurses (Table 2).

Table 2.

Representation on websites

	HFEA-member fertility clinic websites	SART-member fertility clinic websites	p value
Gynecology clinicians	87.71a	99.39a	0.000
Nurses	58.77	54.51	0.430
Administrative staff	61.40	29.81b	0.000
Embryology team	63.15b	50.30c	0.018
Embryologists	26.31	30.42	0.406
Embryology laboratory directors	59.09	42.59	0.003

Values are presented as number (%). The p values represent overall differences across groups, as determined by Pearson’s chi-squared test

HFEA Human Fertilisation and Embryology Authority, SART Society for Assisted Reproductive Technology, embryology team embryologists and/or embryology laboratory directors

Different letters between rows denote significant differences between different staff members and the embryology team (p < 0.05)

Visibility of embryologists across various types of practices

There was no statistically significant difference observed in embryology team visibility across various types of practices (p = 0.294).

Embryology team gender breakdown

With regard to gender, our results from the two registries demonstrate a discrepancy between male and female embryologists on fertility clinic websites, with a majority of female embryologists (65.57%) compared to male embryologists (34.42%). However, this trend is reversed for embryology laboratory directors, with males comprising the majority (55.7%) compared to females (44.29%) (Fig. 2d, e).

Discussion

To our knowledge, this is the first study to assess the e-visibility of the embryology team on fertility clinic websites in the USA and the UK. The present study revealed that both embryologists and embryology laboratory directors have low levels of professional visibility on fertility clinic websites. One of the primary determinants of the overall success of a fertility clinic remains the embryology laboratory [8–11]. Healthcare professionals across various sectors, including the fertility field, commonly encounter significant levels of burnout and professional fatigue, leading to a workforce crisis that affects all aspects of healthcare. This burnout phenomenon is widespread among frontline workers and essential personnel, as well as under-recognized and lower-wage healthcare workers [21, 23]. Recognizing the contributions of employees has been established as an effective strategy for mitigating burnout [24–26]. Interestingly, our study identified that fertility clinic websites did not clearly and consistently provide information about the embryology team. Only 53.46% of fertility clinics showcased the embryology team on their websites. We subsequently conducted a subgroup analysis on the embryology team to assess the visibility of embryologists in comparison to embryology laboratory directors as portrayed on the websites. The inequality in reporting between laboratory directors and embryologists was observed, with laboratory directors being featured more often than embryologists (46.63% vs. 29.79%).

Our analysis, following the stratification of countries, has unveiled a significant disparity. The presence of the embryology team on the websites of UK fertility clinics is notably higher when compared to the USA (63.15% vs. 50.30%, p < 0.05). This discrepancy is particularly pronounced in the representation of embryology laboratory directors, wherein a substantial significance emerged between UK clinic websites and their counterparts in the USA (59.09% vs. 42.59%, p < 0.05).

This discrepancy could be attributed to the unique training pathways and recognition afforded to professionals in the UK. Notably, the UK has established “clinical embryologist” as a protected title, requiring registration with the Health and Care Professions Council. Furthermore, this recognition is accompanied by well-defined routes toward organized scientific training and education. This trajectory includes complex compulsory steps that align with medical education standards [27]. Moreover, it encompasses the opportunity to attain the esteemed status of a fellow of the Royal College of Pathologists, thus establishing parity with consultant medical peers.

However, it is important to note that despite the observed significant differences, the representation of the embryology team remains notably lower in both the UK and the USA compared to that of gynecology clinicians, and even in the USA, it ranks below the nursing team in terms of representation.

A possible reason is that managers are perceived as representatives of the laboratory team. It is unclear whether these depictions on websites were deliberate or unintentional. Yet, the landscape of clinical embryology has radically changed in recent decades, leading to the emergence of new professional roles for embryologists that are based on their expertise, education, and experience [9, 12, 28]. The redesign of the role(s) of embryologists has elevated their standing beyond the conventional pigeonholes as mere technicians. However, fertility clinic websites may obscure the professional role of embryologists, which can be problematic in terms of the overall recognition of embryologists. There are several possible explanations for the inadequate portrayal of embryology teams on websites, which we will explore. Initially, it may seem that the reason for under-representation of embryologists on fertility clinic websites is to downplay their qualifications, which can contribute to a perception that embryology is a less professional or qualified field. However, it is not surprising that gynecology clinicians are more prominently featured on these websites since they are often clinic owners or managers who can control the content. More so, the established roles and public perception of physicians can have an impact on how other healthcare professionals are viewed and can reinforce traditional hierarchies and professional identities [29]. Another potential factor contributing to this inequality is the limited professional recognition of the “clinical embryologist” as a distinct profession. In a study conducted across European countries, it was revealed that this profession was not recognized in 13 countries, while in 6 countries, it was only acknowledged by professional bodies. In 12 countries, at least, the profession was mentioned in governmental regulations. The European Society for Human Reproduction and Embryology (ESHRE) Clinical Embryologist Certificate received official recognition in eight countries. The process of becoming a clinical embryologist lacks standardization or structured, supervised practical training during internships or specialization, with the requirements varying from non-existent to complex and mandatory across different countries. This does not imply that embryologists lack proper training, but rather that the dedication and effort put into becoming a highly specialized healthcare professional are often not officially acknowledged. However, in particular, the UK is one of the few countries with compulsory and clear routes to governmental registration of embryologists, featuring standardized training programs and a protected recognized title [27]. Furthermore, the notion of dissonance in medical practice, which emphasizes territorialism and rigid role boundaries [30], may contribute to the inadequate and ambiguous portrayal of embryologists on fertility clinic websites. Medical practitioners may experience tension between allowing other practitioners to provide healthcare services and protecting their own medical practices. Similar dissonance may be present in the unequal and unclear website representation of embryologists. For instance, it is possible that in some cases, gynecology clinicians may tend to take the limelight for both the clinical and laboratory results that contribute to a successful outcome, overshadowing the contributions of other professionals. Another explanation of this under-shadowing is that websites tend to direct patients to staff they will encounter the most within the course of their treatment such as bedside practitioners and counter personnel. Moreover, this under-representation might also be the result of maintaining an effective “talented” workforce to prevent loss or poaching. Competitors may attempt to gain a competitive advantage by approaching skilled staff [31]. As a substantial portion of highly skilled embryologists nears retirement age, the challenge of maintaining a skilled and capable workforce becomes increasingly pronounced. More so, a notable rise in the intricacy and time demands of “contemporary IVF cycles” has been observed [32, 33]. Within this context, the demand for embryologists takes on a heightened significance.

Lastly, another reason for hiding embryologists on websites might be the looming liability to provide legal immunity to laboratory personnel. In ART treatments, there is plenty of room for blame [34], and embryologists may sometimes become targets of anger and scapegoat.

The findings on the gender distribution of embryologists showed that females outnumbered males in the field. However, despite the feminization of clinical embryology and the privileged positions that males still hold, gender disparities and stereotypical perceptions of professional roles still need to be addressed. Recognizing and addressing gender bias are essential to rectifying this matter. Therefore, it is crucial to involve fertility clinic leadership at all levels in website design to ensure that patients are aware of their healthcare providers and assets. Gaining insights into patients’ viewpoints on accessing comprehensive information about team care on websites is equally crucial. This involves examining whether the lack of recognition, transparency, and accessibility of information regarding the expertise of healthcare professionals involved in the treatment process can undermine patient trust and comprehension. Recognizing and appreciating the contributions of staff are a pivotal aspect that needs to be examined and comprehended in terms of its impact on their burnout levels. The pursuit of professional recognition for embryologists in various countries, particularly in relation to their title, continues to be an ongoing and significant endeavor. Exploring the potential correlation between this recognition in different countries and the visibility of information pertaining to embryologists on the internet presents an intriguing avenue for future research. This study has certain limitations, the most prominent of which is its cross-sectional design, offering only a singular snapshot of time. Furthermore, the study sample was restricted to registered fertility clinics in the USA and UK, potentially limiting the generalizability of the findings to other clinics.

Conclusion

This study represents the first attempt to investigate the under-researched representation of embryologists on fertility clinic websites. The analysis of registries from two continents provided a detailed and in-depth exploration of the representation of embryologists in fertility clinic websites. The results of this exploratory study highlight that little attention is given to the representation of the embryology team. Recognizing and appreciating the contributions of embryologists are a pivotal aspect that demands thoughtful attention, especially in terms of its potential influence on their susceptibility to burnout. Showcasing the embryology team on fertility practice websites might seem like a minor gesture, yet it has the potential to represent a straightforward yet impactful initiative aimed at fostering team cohesion and enhancing the well-being of team members. By understanding the root causes of this under-representation, professional societies can work together to raise awareness of the value of clinical embryologists. Additional longitudinal and cross-country studies would provide a more comprehensive insight into the development and trajectory of the clinical embryology profession. Moreover, conducting additional research that explores patient viewpoints regarding the visibility of embryologists on fertility clinic websites and social media platforms would also be of significant value. Going forward, it is advisable for fertility clinics to consider enhancing the professional internet presence of the embryology team. By strengthening human capital and improving the transparency of care, the clinic can gain a competitive advantage. The emerging presence of equity share companies has undoubtedly reshaped the IVF industry in recent years, presenting advantages in terms of market competitiveness. However, healthcare providers are simultaneously faced with the intricate challenge of adapting to this evolving landscape, which subsequently impacts both treatment care practices and employment dynamics [35].

Declarations

Ethics approval

This study is deemed exempt from IRB review as it did not involve any human subjects.

Conflict of interest

The authors declare no competing interests.