Tailored expectant management: A nationwide survey to quantify patients and professionals barriers and facilitators

N. M. Van Den Boogaard*, A. M. Musters, S. W. Brühl, T. Tankens, J. A.M. Kremer, B. W.J. Mol, P. G.A. Hompes, W. L.D.M. Nelen, F. Van Der Veen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Background Prognostic models for natural conception help to identify subfertile couples with high chances of natural conception, who do not need fertility treatment yet. The use of such models and subsequent tailored expectant management (TEM) is not always practiced. Previous qualitative research has identified barriers and facilitators of TEM among patients and professionals. The aim of this study was to assess the prevalence of those barriers and facilitators and to evaluate which factors predict patients appreciation of TEM and professionals adherence to TEM.Methods We performed a nationwide survey. Based on the previously identified barriers and facilitators two questionnaires were developed and sent to 195 couples and 167 professionals. Multivariate analysis was performed to evaluate which factors predicted patients appreciation of TEM and professional adherence to TEM. Results In total, 118 (61) couples and 117 (70) professionals responded and 96 couples and 117 professionals were included in the analysis. Patients mean appreciation of TEM was 5.7, on a 10-point Likert scale. Patients with a lower appreciation of TEM had a higher need for patient information (P = 0.047). The professionals reported a mean adherence to TEM of 63. Adherence to TEM was higher when professionals were fertility doctors (P = 0.041). Facilitators in the clinical domain were associated with a higher adherence to TEM (P = 0.091). Barriers in the professional domain had a negative impact on adherence to TEM (P = 0.008). Conclusion s The limited implementation of TEM is caused by both patient and professional-related factors. This study provides practical tools to improve the implementation of TEM.

Original languageEnglish
Pages (from-to)1050-1057
Number of pages8
JournalHuman Reproduction
Issue number4
Publication statusPublished - Apr 2012


  • barriers
  • expectant management
  • implementation
  • infertility
  • prognostic models


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