Recurrent miscarriage and infertility: a national service evaluation

Area of Science:

• Reproductive Medicine and Infertility
• Maternal-Fetal Medicine
• Clinical Quality Improvement

Background:

• International guidelines inadequately address the clinical care of women/couples with infertility and recurrent miscarriage (RM).
• Existing RM care is known to be variable and often deviates from recommended guidance.

Purpose of the Study:

• To evaluate the provision of clinical care for women/couples experiencing infertility and recurrent miscarriage (RM) across public and private healthcare sectors.
• To assess adherence to guideline-based key performance indicators (KPIs) for RM care, including investigations, treatments, and supportive care.

Main Methods:

• An online survey was administered to clinical leads and specialists in public (RM and fertility clinics) and private fertility clinics.
• The survey, conducted from November 2021 to February 2022, assessed care structure, investigations, treatments, counselling, supportive care, and outcomes.
• Data were analyzed based on adapted guideline-based KPIs for RM.

Main Results:

• A 73% response rate was achieved, with significant variation across provider types (Public RM care: 95%, Public fertility: 40%, Private fertility: 33%).
• Access to fertility expertise was limited in public RM clinics (39%). Investigations and treatments largely followed guidelines, but uncertainty existed regarding immunotherapies.
• Significant educational needs were identified in fertility counselling and supportive care resources. Clinical outcomes were rarely audited (9%).

Conclusions:

• Greater engagement with the private sector is crucial for unifying care and ensuring standardized, evidence-based practices for RM and infertility.
• Mandatory audit and outcomes reporting are essential for quality improvement in RM care.
• Incorporating the lived experiences of service users is vital for informing and improving current care structures.