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Male infertility affects millions of couples worldwide, arising from various factors that impact different stages of the reproductive process. An endocrine imbalance resulting from conditions like hypogonadism, Klinefelter syndrome, or pituitary disorders can disrupt hormone levels and reduce sperm production. Testicular defects, such as tumors, cryptorchidism, atrophic testes, abnormal sperm morphology, and low sperm count or motility, may arise due to genetic factors, structural...
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Treatment Model for Young Patients with Psychogenic Erectile Dysfunction and Resultant Infertility
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[Overtreatment in couples with unexplained subfertility].

Fleur A M Kersten1, Rosella P G M Hermens, Didi D M Braat

  • 1* Dit is een bewerking van een onderzoek gepubliceerd in Human Reproduction (2015;30(1):71-80), met als titel 'Overtreatment in couples with unexplained infertility'. Afgedrukt met toestemming.

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|April 16, 2015
PubMed
Summary

Overtreatment remains common in unexplained subfertility despite guidelines recommending expectant management. Adherence to subfertility guidelines needs improvement through tailored implementation strategies.

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Area of Science:

  • Reproductive Medicine
  • Clinical Guidelines
  • Healthcare Quality Improvement

Background:

  • Unexplained subfertility affects many couples seeking fertility treatment.
  • Guidelines recommend expectant management for 6-12 months for couples with a good prognosis.
  • Adherence to these guidelines is crucial for appropriate patient care.

Purpose of the Study:

  • To assess adherence to the Dutch Network guideline on expectant management for unexplained subfertility.
  • To identify the rates of overtreatment and specific quality indicators related to guideline adherence.
  • To investigate factors associated with overtreatment in unexplained subfertility.

Main Methods:

  • Retrospective cohort study involving 544 couples across 25 clinics.
  • Data collected from medical records to assess prognosis calculation, advice on expectant management, and timing of treatment initiation.
  • Multilevel regression analyses used to explore associations between overtreatment and patient/clinic characteristics.

Main Results:

  • Overtreatment occurred in 36% of couples.
  • No prognosis was calculated for 34% of couples, and correct expectant management was not advised for 42%.
  • Even with correct advice, 16% started treatment prematurely; overtreatment was linked to higher female age and longer infertility duration.

Conclusions:

  • Guideline recommendations alone are insufficient to prevent overtreatment in unexplained subfertility.
  • Frequent overtreatment highlights a gap in adherence to expectant management guidelines.
  • A tailored implementation strategy is needed to improve adherence and optimize care for subfertile couples.