Overbehandeling bij onverklaarde subfertiliteit*

Objective

To assess adherence to expectant management of 6-12 months in couples with unexplained subfertility, as recommended by the Dutch Networkguideline Subfertility.

Design

A retrospective cohort study in 25 clinics.

Method

Couples were eligible to participate if they were diagnosed with unexplained subfertility and had a good prognosis of natural conception within one year (>30%), for these couples the networkguideline recommends an expectant management. Outcomes measures are overtreatment, i.e. couples that started treatment within six months, and three quality indicators: 1) prognosis not calculated, 2) no correct expectant management advised, 3) starting treatment too soon despite a correct advise. Data collection was obtained from medical records. Multilevel regression analyses were performed to investigate associations of overtreatment with patient and clinic characteristics.

Results

We included 544 couples. Overtreatment occurred in 36% (N=198). In 34% (N=186) of all couples no prognosis was calculated (1), and in 42% (N=230) of all couples expectant management was not advised correctly (2). When a correct expectant management of six to twelve months was advised, 16% (N=51) started treatment too soon anyway. Overtreatment occurred more frequently in childless couples, a higher female age, and a longer duration of infertility.

Conclusion

Our findings show that developing and publishing guideline recommendations on expectant management is not enough and that overtreatment still occurs frequently. To improve future care the next step is to evaluate a tailored implementation strategy to improve adherence to the recommendations on expectant management by the Dutch Networkguideline Subfertility.

Conflict of interest and financial support: the authors Braat and Mol have received financial support from pharmaceutical firms outside this article. ICMJE forms provided by the authors are available online along with the full text of this article.