Centre for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Hum Reprod. 2011 Jul;26(7):1784-9. doi: 10.1093/humrep/der123. Epub 2011 Apr 30.
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.
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.
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).
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.
对于具有良好预后的不孕夫妇，预测自然妊娠的模型是一种有用的工具，可以避免过度治疗、并发症和费用。荷兰生育指南建议在具有良好预后的夫妇中使用此类模型和随后的期待管理，但并未完全实施。在这项研究中，我们评估了不遵守个体化期待管理的风险因素。
本研究纳入了轻度男性因素、不明原因和宫颈性不孕的夫妇。如果 12 个月内自然妊娠的概率≥40%，则建议进行 6-12 个月的期待管理。采用多变量逻辑回归分析确定与个体化期待管理不依从相关的患者和临床特征。
共纳入 3021 对夫妇，其中 1130 对（38%）有≥40%的自然妊娠概率。1020 对夫妇（90%）可获得随访结果，其中 214 对（21%）在 6-12 个月内开始治疗，153 对（15%）在 6 个月内开始治疗。女性年龄较高和不孕持续时间较长与 6 个月内开始治疗相关（OR：1.06，95%CI：1.01-1.1；OR：1.4；95%CI：1.1-1.8）。临床团队中有生育医生可降低 6 个月内治疗的风险（OR：0.62；95%CI：0.39-0.99）。
对于自然妊娠预后良好的夫妇，存在相当大的过度治疗，尤其是女性年龄较大且不孕持续时间较长时。临床团队中有生育医生可能会预防早期治疗。
