Tailored expectant management in couples with unexplained infertility does not influence their experiences with the quality of fertility care

• Published in: Human reproduction (Oxford) 2016-01, Vol.31 (1), p.108-116
• Main Authors: Kersten, F.A.M., Hermens, R.P.G.M., Braat, D.D.M., Tepe, E., Sluijmer, A., Kuchenbecker, W.K., Van den Boogaard, N., Mol, B.W.J., Goddijn, M., Nelen, W.L.D.M.
• Format: Article
• Language: English
• Subjects: Adult; Cross-Sectional Studies; Female; Guideline Adherence - standards; Humans; Infertility - therapy; Male; Netherlands; Patient Satisfaction; Patient-Centered Care - standards; Prognosis; Quality of Health Care - standards; Time Factors
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/dev277

Abstract STUDY QUESTION Do couples who were eligible for tailored expectant management (TEM) and did not start treatment within 6 months after the fertility work-up, have different experiences with the quality of care than couples that were also eligible for TEM but started treatment right after the fertility work-up? SUMMARY ANSWER Tailored expectant management of at least 6 months in couples with unexplained infertility is not associated with the experiences with quality of care or trust in their physician. WHAT IS KNOWN ALREADY In couples with unexplained infertility and a good prognosis of natural conception within 1 year, expectant management for 6–12 months does not compromise ongoing birth rates and is equally as effective as starting medically assisted reproduction immediately. Therefore, TEM is recommended by various international clinical guidelines. Implementation of TEM is still not optimal because of existing barriers on both patient and professional level. An important barrier is the hesitance of professionals to counsel their patients for TEM because they fear that patients will be dissatisfied with care. However, if and how adherence to TEM actually affects the couples' experience with care is unknown. Experiences with the quality care can be measured by evaluating the patient-centredness of care and the patients' trust in their physician. STUDY DESIGN, SIZE, DURATION This is a retrospective cross-sectional study. A survey with written questionnaires was performed among all couples who participated in the retrospective audit of guideline adherence on TEM in 25 Dutch clinics. PARTICIPANTS/MATERIALS, SETTING, METHODS Couples were eligible to participate if they were diagnosed with unexplained infertility and had a good prognosis (>30%) of natural conception within 1 year based on the Hunault prediction model. We used patient's questionnaires to collect data on the couples' experience with the quality of care and possible confounders for their experiences other than having undergone TEM or not. Multilevel regression analyses were performed to investigate case-mix adjusted association of TEM with the patient-centredness of care (PCQ-Infertility) and the patients' trust in their physician (Wake Forest Trust Scale). MAIN RESULTS AND THE ROLE OF CHANCE Couples who adhered to TEM experienced the quality of care on the same level as couples who were exposed to early treatment, i.e. started fertility treatment within 6 months after fertility work-up.