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Overtreatment in couples with unexplained infertility.
Hum Reprod 2015; 30(1):71-80HR

Abstract

STUDY QUESTION

What is the percentage of overtreatment, i.e. fertility treatment started too early, in couples with unexplained infertility who were eligible for tailored expectant management?

SUMMARY ANSWER

Overtreatment occurred in 36% of couples with unexplained infertility who were eligible for an expectant management of at least 6 months.

WHAT IS KNOWN ALREADY

Prognostic models in reproductive medicine can help to identify infertile couples that would benefit from fertility treatment. In couples with unexplained infertility with a good chance of natural conception within 1 year, based on the Hunault prediction model, an expectant management of 6-12 months, as recommended in international fertility guidelines, prevents unnecessary treatment.

STUDY DESIGN, SIZE, DURATION

A retrospective cohort study in 25 participating clinics, with follow-up of all couples who were seen for infertility in 2011-2012.

PARTICIPANTS/MATERIALS, SETTING, METHODS

In all, 9818 couples were seen for infertility in the participating clinics. Couples were eligible to participate if they were diagnosed with unexplained infertility and had a good prognosis of natural conception (>30%) within 1 year based on the Hunault prediction model. Data to assess overtreatment were collected from medical records. Multilevel regression analyses were performed to investigate associations of overtreatment with patient and clinic characteristics.

MAIN RESULTS AND THE ROLE OF CHANCE

Five hundred and forty-four couples eligible for expectant management were included in this study. Among these, overtreatment, i.e. starting medically assisted reproduction within 6 months, occurred in 36%. The underlying quality indicators showed that in 34% no prognosis was calculated and that in 42% expectant management was not recommended. Finally, 16% of the couples for whom a correct recommendation of expectant management for at least 6 months was made, started treatment within 6 months anyway. Overtreatment was associated with childlessness, higher female age and a longer duration of infertility. No associations between overtreatment and clinic characteristics were found.

LIMITATIONS, REASONS FOR CAUTION

The response rate was low compared with other fertility studies. Evaluation of possible selection bias showed that responders had a higher socio-economic status than non-responders.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings show that developing and publishing guideline recommendations on tailored expectant management (TEM) is not enough and that overtreatment still occurs frequently. Future research should focus on tailored efforts to implement guideline recommendations on TEM.

STUDY FUNDING/COMPETING INTERESTS

Supported by Netherlands Organisation for Health Research and Development (ZonMW). ZonMW had no role in designing the study, data collection, analysis and interpretation of data or writing of the report. Competing interests: none.

TRIAL REGISTRATION NUMBER

www.trialregister.nl NTR3405.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, The Netherlands.Scientific Institute for Quality of Healthcare, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, The Netherlands.Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, The Netherlands.Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands.The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 5005 SA Adelaide, Australia.Centre for Reproductive Medicine, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, The Netherlands.Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, The Netherlands willianne.nelen@radboudumc.nl.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25336712

Citation

Kersten, F A M., et al. "Overtreatment in Couples With Unexplained Infertility." Human Reproduction (Oxford, England), vol. 30, no. 1, 2015, pp. 71-80.
Kersten FA, Hermens RP, Braat DD, et al. Overtreatment in couples with unexplained infertility. Hum Reprod. 2015;30(1):71-80.
Kersten, F. A., Hermens, R. P., Braat, D. D., Hoek, A., Mol, B. W., Goddijn, M., & Nelen, W. L. (2015). Overtreatment in couples with unexplained infertility. Human Reproduction (Oxford, England), 30(1), pp. 71-80. doi:10.1093/humrep/deu262.
Kersten FA, et al. Overtreatment in Couples With Unexplained Infertility. Hum Reprod. 2015;30(1):71-80. PubMed PMID: 25336712.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Overtreatment in couples with unexplained infertility. AU - Kersten,F A M, AU - Hermens,R P G M, AU - Braat,D D M, AU - Hoek,A, AU - Mol,B W J, AU - Goddijn,M, AU - Nelen,W L D M, AU - ,, Y1 - 2014/10/21/ PY - 2014/10/23/entrez PY - 2014/10/23/pubmed PY - 2016/4/5/medline KW - expectant management KW - guideline adherence KW - implementation KW - prognostic models KW - unexplained infertility SP - 71 EP - 80 JF - Human reproduction (Oxford, England) JO - Hum. Reprod. VL - 30 IS - 1 N2 - STUDY QUESTION: What is the percentage of overtreatment, i.e. fertility treatment started too early, in couples with unexplained infertility who were eligible for tailored expectant management? SUMMARY ANSWER: Overtreatment occurred in 36% of couples with unexplained infertility who were eligible for an expectant management of at least 6 months. WHAT IS KNOWN ALREADY: Prognostic models in reproductive medicine can help to identify infertile couples that would benefit from fertility treatment. In couples with unexplained infertility with a good chance of natural conception within 1 year, based on the Hunault prediction model, an expectant management of 6-12 months, as recommended in international fertility guidelines, prevents unnecessary treatment. STUDY DESIGN, SIZE, DURATION: A retrospective cohort study in 25 participating clinics, with follow-up of all couples who were seen for infertility in 2011-2012. PARTICIPANTS/MATERIALS, SETTING, METHODS: In all, 9818 couples were seen for infertility in the participating clinics. Couples were eligible to participate if they were diagnosed with unexplained infertility and had a good prognosis of natural conception (>30%) within 1 year based on the Hunault prediction model. Data to assess overtreatment were collected from medical records. Multilevel regression analyses were performed to investigate associations of overtreatment with patient and clinic characteristics. MAIN RESULTS AND THE ROLE OF CHANCE: Five hundred and forty-four couples eligible for expectant management were included in this study. Among these, overtreatment, i.e. starting medically assisted reproduction within 6 months, occurred in 36%. The underlying quality indicators showed that in 34% no prognosis was calculated and that in 42% expectant management was not recommended. Finally, 16% of the couples for whom a correct recommendation of expectant management for at least 6 months was made, started treatment within 6 months anyway. Overtreatment was associated with childlessness, higher female age and a longer duration of infertility. No associations between overtreatment and clinic characteristics were found. LIMITATIONS, REASONS FOR CAUTION: The response rate was low compared with other fertility studies. Evaluation of possible selection bias showed that responders had a higher socio-economic status than non-responders. WIDER IMPLICATIONS OF THE FINDINGS: Our findings show that developing and publishing guideline recommendations on tailored expectant management (TEM) is not enough and that overtreatment still occurs frequently. Future research should focus on tailored efforts to implement guideline recommendations on TEM. STUDY FUNDING/COMPETING INTERESTS: Supported by Netherlands Organisation for Health Research and Development (ZonMW). ZonMW had no role in designing the study, data collection, analysis and interpretation of data or writing of the report. Competing interests: none. TRIAL REGISTRATION NUMBER: www.trialregister.nl NTR3405. SN - 1460-2350 UR - https://www.unboundmedicine.com/medline/citation/25336712/Overtreatment_in_couples_with_unexplained_infertility_ L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/deu262 DB - PRIME DP - Unbound Medicine ER -