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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform

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Published on: April 12, 2021

Tailored expectant management: risk factors for non-adherence.

N M van den Boogaard¹, K Oude Rengerink, P Steures

¹Centre for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands. n.m.vandenboogaard@amc.uva.nl

Human Reproduction (Oxford, England)

|May 3, 2011

Summary

Subfertile couples with a good prognosis often receive unnecessary fertility treatments. Older women and longer subfertility duration increase early treatment risk, but fertility doctors can help prevent it.

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Area of Science:

Reproductive Medicine
Fertility Treatment
Subfertility Management

Background:

Prediction models for spontaneous pregnancy aid in preventing overtreatment in subfertile couples.
Dutch fertility guidelines recommend expectant management for couples with a good prognosis, but implementation is lacking.
This study investigates risk factors for non-adherence to tailored expectant management.

Purpose of the Study:

To identify patient and clinical characteristics associated with non-adherence to expectant management in subfertile couples.
To assess the rate of overtreatment in couples with a favorable prognosis for spontaneous pregnancy.

Main Methods:

A multicentre prospective cohort study included couples with mild male, unexplained, and cervical subfertility.
Expectant management was advised for 6-12 months if spontaneous pregnancy probability was ≥40%.
Multivariable logistic regression analyzed factors associated with non-adherence.

Main Results:

Of 3021 couples, 38% had a ≥40% chance of spontaneous pregnancy.
21% started treatment between 6-12 months, and 15% within 6 months.
Higher female age and longer subfertility duration correlated with earlier treatment; fertility doctor presence reduced this risk.

Conclusions:

Overtreatment is common in couples with a favorable prognosis, particularly with increased female age and subfertility duration.
The presence of a fertility doctor in a clinical team may reduce the likelihood of premature treatment initiation.