ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff.
OBJECTIVE
Based on the best available evidence in the literature, what is the optimal management of routine psychosocial care at infertility and medically assisted reproduction (MAR) clinics?


CONCLUSIONS
Using the structured methodology of the Manual for the European Society of Human Reproduction and Embryology (ESHRE) Guideline Development, 120 recommendations were formulated that answered the 12 key questions on optimal management of routine psychosocial care by all fertility staff.


BACKGROUND
The 2002 ESHRE Guidelines for counselling in infertility has been a reference point for best psychosocial care in infertility for years, but this guideline needed updating and did not focus on routine psychosocial care that can be delivered by all fertility staff.


METHODS
This guideline was produced by a group of experts in the field according to the 12-step process described in the ESHRE Manual for Guideline Development. After scoping the guideline and listing a set of 12 key questions in PICO (Patient, Intervention, Comparison and Outcome) format, thorough systematic searches of the literature were conducted; evidence from papers published until April 2014 was collected, evaluated for quality and analysed. A summary of evidence was written in a reply to each of the key questions and used as the basis for recommendations, which were defined by consensus within the guideline development group (GDG). Patient and additional clinical input was collected during the scoping and the review phase of the guideline development.


METHODS
The guideline group, comprising psychologists, two medical doctors, a midwife, a patient representative and a methodological expert, met three times to discuss evidence and reach consensus on the recommendations.
120 recommendations that aim at guiding fertility clinic staff in providing optimal evidence-based routine psychosocial care to patients dealing with infertility and MAR. The guideline is written in two sections. The first section describes patients' preferences regarding the psychosocial care they would like to receive at clinics and how this care is associated with their well-being. The second section of the guideline provides information about the psychosocial needs patients experience across their treatment pathway (before, during and after treatment) and how fertility clinic staff can detect and address these. Needs refer to conditions assumed necessary for patients to have a healthy experience of the fertility treatment. Needs can be behavioural (lifestyle, exercise, nutrition and compliance), relational (relationship with partner if there is one, family friends and larger network, and work), emotional (well-being, e.g. anxiety, depression and quality of life) and cognitive (treatment concerns and knowledge).


CONCLUSIONS
We identified many areas in care for which robust evidence was lacking. Gaps in evidence were addressed by formulating good practice points, based on the expert opinion of the GDG, but it is critical for such recommendations to be empirically validated.


CONCLUSIONS
The evidence presented in this guideline shows that providing routine psychosocial care is associated with or has potential to reduce stress and concerns about medical procedures and improve lifestyle outcomes, fertility-related knowledge, patient well-being and compliance with treatment. As only 45 (36.0%) of the 125 recommendations were based on high-quality evidence, the guideline group formulated recommendations to guide future research with the aim of increasing the body of evidence.
Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, CF10 3AT Cardiff, UK gameiros@cardiff.ac.uk.
S
S
Gameiro
Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, CF10 3AT Cardiff, UK.
J
J
Boivin
Leuven University Fertility Centre, University Hospitals Leuven, 3000 Leuven, Belgium Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands.
E
E
Dancet
Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam 3000 CA, The Netherlands.
C
C
de Klerk
Centre for Medically Assisted Procreation-CPMA, CH-1003 Lausanne, Switzerland.
M
M
Emery
Infertility Network UK, East Sussex TN40 1JA, UK.
C
C
Lewis-Jones
Practice for Couple and Family Therapy, 64546 Moerfelden, Germany.
P
P
Thorn
Leuven University Fertility Centre, University Hospitals Leuven, 3000 Leuven, Belgium.
U
U
Van den Broeck
Women's and Children's Health, St George Hospital, University of New South Wales, NSW 2217 Sydney, Australia.
C
C
Venetis
Department of Psychology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands.
C M
CM
Verhaak
Institute of Medical Psychology, Centre for Psychosocial Medicine, Heidelberg University Hospital, 69115 Heidelberg, Germany.
T
T
Wischmann
European Society for Human Reproduction and Embryology, 1852 Grimbergen, Belgium.
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N
Vermeulen
D055317:Evidence-Based Practice / Q000592:standards*; D006801:Humans; D007246:Infertility / Q000523:psychology / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011613:Psychotherapy / Q000592:standards*; D027724:Reproductive Techniques, Assisted / Q000523:psychology / Q000592:standards*
assisted reproduction; evidence-based; guideline; infertility; psychosocial care