Implementing targeted expectant management in fertility care using prognostic modelling: a cluster randomized trial with a multifaceted strategy.

Study Question: What is the effectiveness of a multifaceted implementation strategy compared to usual care on improving the adherence to guideline recommendations on expectant management for couples with unexplained infertility?

Summary Answer: The multifaceted implementation strategy did not significantly increase adherence to guideline recommendations on expectant management compared to care as usual.

What Is Known Already: Intrauterine insemination (IUI) with or without ovarian hyperstimulation has no beneficial effect compared to no treatment for 6 months after the fertility work-up for couples with unexplained infertility and a good prognosis of natural conception. Therefore, various professionals and policy makers have advocated the use of prognostic profiles and expectant management in guideline recommendations.

Tailored expectant management in couples with unexplained infertility does not influence their experiences with the quality of fertility care.

Study Question: Do couples who were eligible for tailored expectant management (TEM) and did not start treatment within 6 months after the fertility work-up, have different experiences with the quality of care than couples that were also eligible for TEM but started treatment right after the fertility work-up?

Summary Answer: Tailored expectant management of at least 6 months in couples with unexplained infertility is not associated with the experiences with quality of care or trust in their physician.

What Is Known Already: In couples with unexplained infertility and a good prognosis of natural conception within 1 year, expectant management for 6-12 months does not compromise ongoing birth rates and is equally as effective as starting medically assisted reproduction immediately. Therefore, TEM is recommended by various international clinical guidelines.

Prognostic profiles and the effectiveness of assisted conception: secondary analyses of individual patient data.

Background: At present, it is unclear which treatment strategy is best for couples with unexplained or mild male subfertility. We hypothesized that the prognostic profile influences the effectiveness of assisted conception. We addressed this issue by analysing individual patient data (IPD) from randomized controlled trials (RCTs).

Improving the implementation of tailored expectant management in subfertile couples: protocol for a cluster randomized trial.

Background: Prognostic models in reproductive medicine can help to identify subfertile couples who would benefit from fertility treatment. Expectant management in couples with a good chance of natural conception, i.e.

Supportive care for women with recurrent miscarriage: a survey to quantify women's preferences.

Background: Supportive care is regularly offered to women with recurrent miscarriages (RMs). Their preferences for supportive care in their next pregnancy have been identified by qualitative research. The aim of this study was to quantify these supportive care preferences and identify women's characteristics that are associated with a higher or lower need for supportive care in women with RM.

[Reproduction in the year 2012: in vivo or in vitro?].

The Dutch Minister of Health has proposed reducing the number of reimbursed in vitro fertilisation (IVF) cycles per couple from 3 to 1, in order to save 30 million euro per year. In the Netherlands, the number of IVF cycles has increased by 50% in the past 13 years, resulting in, on average, one child conceived through IVF in every classroom today. The increase in the number of IVF treatments is also caused by expansion of the indications for IVF, despite the lack of evidence proving the effectiveness of IVF for some of these indications.

The prognostic profile of subfertile couples and treatment outcome after expectant management, intrauterine insemination and in vitro fertilisation: a study protocol for the meta-analysis of individual patient data.

Objective: The current evidence concerning the best treatment option for couples with unexplained and male subfertility is inconclusive. Most studies that have evaluated the effectiveness of treatment options, such as expectant management (EM), intrauterine insemination (IUI), with or without controlled ovarian stimulation (COS), and in vitro fertilisation (IVF), have not taken the couples' prognosis into account. It is very likely that the individual prognosis of the couple influences the effect of treatment.

Tailored expectant management: a nationwide survey to quantify patients' and professionals' barriers and facilitators.

Background: Prognostic models for natural conception help to identify subfertile couples with high chances of natural conception, who do not need fertility treatment yet. The use of such models and subsequent tailored expectant management (TEM) is not always practiced. Previous qualitative research has identified barriers and facilitators of TEM among patients and professionals.

Accessing fertility treatment in New Zealand: a comparison of the clinical priority access criteria with a prediction model for couples with unexplained subfertility.

Background: In New Zealand, public funding for assisted reproductive technology (ART) is restricted to subfertile women who are unlikely to conceive spontaneously, based on clinical and social criteria known as the clinical priority access criteria (CPAC) score. The objective of this study was to compare this CPAC score with a prediction model for predicting spontaneous conception, developed in the Netherlands (the Hunault model).

Methods: We performed a cohort study and included couples with unexplained subfertility and assessed the measure of agreement and the performance of the CPAC score and the Hunault prediction score.

Patients' and professionals' barriers and facilitators of tailored expectant management in subfertile couples with a good prognosis of a natural conception.

Background: European guidelines on fertility care emphasize that subfertile couples should receive information about their chances of a natural conception and should not be exposed to unnecessary treatments and risks. Prognostic models can help to estimate their chances and select couples with a good prognosis for tailored expectant management (TEM). Nevertheless, TEM is not always practiced.

Tailored expectant management: risk factors for non-adherence.

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.