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

Area of Science:

• Reproductive Medicine
• Healthcare Implementation Science

Background:

• Intrauterine insemination (IUI) offers no proven benefit over expectant management for unexplained infertility.
• Guideline recommendations advocate for expectant management based on prognostic profiles.

Purpose of the Study:

• To evaluate the effectiveness of a multifaceted implementation strategy in improving adherence to expectant management guidelines for unexplained infertility.

Main Methods:

• A cluster randomized controlled trial involving 25 clinics in the Netherlands.
• Compared a multifaceted implementation strategy (13 clinics) against usual care (12 clinics).
• Data collected retrospectively from medical records and patient questionnaires.

Main Results:

• Guideline adherence increased in both groups but the difference between the intervention (69%) and control (61%) groups was not statistically significant.
• No significant difference in ongoing pregnancy rates between the intervention (25%) and control (27%) groups.

Conclusions:

• The tested implementation strategy did not significantly enhance adherence to expectant management guidelines compared to usual care.
• Further research is needed to understand implementation barriers and optimize strategies in different healthcare settings.