TITLE

Tailored expectant management: risk factors for non-adherence

AUTHOR(S)
van den Boogaard, N.M.; Oude Rengerink, K.; Steures, P.; Bossuyt, P.M.; Hompes, P.G.A.; van der Veen, F.; Mol, B.W.J.; van der Steeg, J.W.
PUB. DATE
July 2011
SOURCE
Human Reproduction;Jul2011, Vol. 26 Issue 7, p1784
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
INTRODUCTION Prediction 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 6–12 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: 1.01–1.1; OR: 1.4; 95% CI: 1.1–1.8). A fertility doctor in a clinical team reduced the risk of treatment within 6 months (OR: 0.62; 95% CI: 0.39–0.99). 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.
ACCESSION #
61387475

 

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