title: [Overtreatment in couples with unexplained subfertility].
abstract: OBJECTIVE
  To assess adherence to expectant management of 6-12 months in couples with unexplained subfertility, as recommended by the Dutch Networkguideline Subfertility.
  
  
  METHODS
  A retrospective cohort study in 25 clinics.
  
  
  METHODS
  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 network guideline 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.
  
  
  CONCLUSIONS
  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.
authors: * Dit is een bewerking van een onderzoek gepubliceerd in Human Reproduction (2015;30(1):71-80), met als titel 'Overtreatment in couples with unexplained infertility'. Afgedrukt met toestemming.
authors: Fleur A M
authors: FA
authors: Kersten
authors: Rosella P G M
authors: RP
authors: Hermens
authors: Didi D M
authors: DD
authors: Braat
authors: Annemieke
authors: A
authors: Hoek
authors: Ben Willem J
authors: BW
authors: Mol
authors: Mariëtte
authors: M
authors: Goddijn
authors: Willianne  L D M
authors: W
authors: Nelen
mesh_terms: D015331:Cohort Studies; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007246:Infertility / Q000628:therapy*; D008297:Male; D009426:Netherlands; D011336:Probability; D011379:Prognosis; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors