title: Tailored expectant management: risk factors for non-adherence.
abstract: BACKGROUND
  Prediction 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 6-12 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: 1.01-1.1; OR: 1.4; 95% CI: 1.1-1.8). A fertility doctor in a clinical team reduced the risk of treatment within 6 months (OR: 0.62; 95% CI: 0.39-0.99).
  
  
  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.
authors.affiliation: Centre for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands. n.m.vandenboogaard@amc.uva.nl
authors.forename: N M
authors.initials: NM
authors.lastname: van den Boogaard
authors.forename: K
authors.initials: K
authors.lastname: Oude Rengerink
authors.forename: P
authors.initials: P
authors.lastname: Steures
authors.forename: P M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: P G A
authors.initials: PG
authors.lastname: Hompes
authors.forename: F
authors.initials: F
authors.lastname: van der Veen
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.forename: J W
authors.initials: JW
authors.lastname: van der Steeg
mesh_terms: D005260:Female; D005306:Fertilization; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008423:Maternal Age; D015999:Multivariate Analysis; D009426:Netherlands; D011247:Pregnancy; D018873:Pregnancy Rate; D011336:Probability; D011379:Prognosis; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors