Tailored expectant management: Risk factors for non-adherence

INTRODUCTIONPrediction models for spontaneous pregnancy are useful tools to prevent overtreatment, complications and costs in subfertile couples with a good prognosis. The use of such models and subsequent expectant management in couples with a good prognosis are recommended in the Dutch fertility guidelines, but not fully implemented. In this study, we assess risk factors for non-adherence to tailored expectant management. Methods: Couples with mild male, unexplained and cervical subfertility were included in this multicentre prospective cohort study. If the probability of spontaneous pregnancy within 12 months was <40, expectant management for 612 months was advised. Multivariable logistic regression was used to identify patient and clinical characteristics associated with non-adherence to tailored expectant management. Results: We included 3021 couples of whom 1130 (38) had a <40 probability of a spontaneous pregnancy. Follow-up was available for 1020 (90) couples of whom 214 (21) had started treatment between 6 and 12 months and 153 (15) within 6 months. A higher female age and a longer duration of subfertility were associated with treatment within 6 months (OR: 1.06, 95 CI: 1.011.1; OR: 1.4; 95 CI: 1.11.8). A fertility doctor in a clinical team reduced the risk of treatment within 6 months (OR: 0.62; 95 CI: 0.390.99). Conclusions: In couples with a favorable prognosis for spontaneous pregnancy, there is considerable overtreatment, especially if the woman is older and duration of the subfertility is longer. The presence of a fertility doctor in a clinic may prevent early treatment.