Tailored expectant management: Risk factors for non-adherence

N. M. Van Den Boogaard, K. Oude Rengerink, P. Steures, P. M. Bossuyt, P. G A Hompes, F. Van Der Veen, B. W J Mol, J. W. Van Der Steeg

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16 Citations (Scopus)

Abstract

INTRODUCTIONPrediction models for spontaneous pregnancy are useful tools to prevent overtreatment, complications and costs in subfertile couples with a good prognosis. The use of such models and subsequent expectant management in couples with a good prognosis are recommended in the Dutch fertility guidelines, but not fully implemented. In this study, we assess risk factors for non-adherence to tailored expectant management. Methods: Couples with mild male, unexplained and cervical subfertility were included in this multicentre prospective cohort study. If the probability of spontaneous pregnancy within 12 months was <40, expectant management for 612 months was advised. Multivariable logistic regression was used to identify patient and clinical characteristics associated with non-adherence to tailored expectant management. Results: We included 3021 couples of whom 1130 (38) had a <40 probability of a spontaneous pregnancy. Follow-up was available for 1020 (90) couples of whom 214 (21) had started treatment between 6 and 12 months and 153 (15) within 6 months. A higher female age and a longer duration of subfertility were associated with treatment within 6 months (OR: 1.06, 95 CI: 1.011.1; OR: 1.4; 95 CI: 1.11.8). A fertility doctor in a clinical team reduced the risk of treatment within 6 months (OR: 0.62; 95 CI: 0.390.99). Conclusions: In couples with a favorable prognosis for spontaneous pregnancy, there is considerable overtreatment, especially if the woman is older and duration of the subfertility is longer. The presence of a fertility doctor in a clinic may prevent early treatment.

LanguageEnglish
Pages1784-1789
Number of pages6
JournalHuman Reproduction
Volume26
Issue number7
DOIs
Publication statusPublished - 1 Jan 2011

Keywords

  • expectant management
  • guideline adherence
  • implementation
  • prognostic models
  • subfertility

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this

Van Den Boogaard, N. M., Oude Rengerink, K., Steures, P., Bossuyt, P. M., Hompes, P. G. A., Van Der Veen, F., ... Van Der Steeg, J. W. (2011). Tailored expectant management: Risk factors for non-adherence. Human Reproduction, 26(7), 1784-1789. https://doi.org/10.1093/humrep/der123