Page 13 - Shared Guideline Development Experiences in Fertility Care

Fertility care 1 Fertility care concerns the infertile couple failing to conceive a er at least one year of
regular unprotected sexual intercourse [4]. e prevalence of infertility is estimated
to range from 4–30% and a ects approximately 80 million couples worldwide [5,
6]. In the Netherlands, the number of new cases of infertility in general practice is estimated at 9 per 1000 couples per year, a ecting 1 out of 7 couples [5]. Dutch fertility care has been publically arranged on three levels. Primary care is provided by general practitioners and may comprise a part of an initial fertility assessment. Subsequently, a general practitioner (GP) can refer couples to a gynaecologist in a general (secondary care) or a university (tertiary care) hospital. e gynaecologist can complete this initial fertility assessment, determine a cause of infertility and de ne a suitable treatment plan. e initial fertility assessment generally comprises four parts: assessing ovulation, screening for Chlamydia Trachomatis, performing a semen analysis, and assessing tubal patency. Main causes of infertility in couples are: low sperm count or quality (30%), ovulatory disorders (27%), tubal damage (14%), and in smaller proportions endometriosis and decreased cervical mucus hostility [7-10]. e presence of disorders in both the female and male partner has been reported to occur in about 39% of cases [11]. However, in 8–28% of the couples, a cause of infertility cannot be identi ed [12]. If a severe male factor is diagnosed, couples can be referred to a urologist.
Depending on the female’s age and the determined cause of infertility, couples can be treated with surgery, such as tubal reconstruction or various types of Medically Assisted Reproduction (MAR)-Techniques: Ovulation Induction (OI), Intra Uterine Insemination (IUI), In Vitro Fertilisation (IVF), and Intra Cytoplasmic Sperm Injection (ICSI), occasionally with surgically retrieved sperm [4].
Within assessments and preparations for MAR-Techniques, such as IVF, clinical chemists and embryologists are also involved. Since infertility has a high emotional and psychological impact, which also interferes with work, psychologists and occupational physicians are regularly involved in the care pathway. Dutch fertility care is organized around 13 licensed hospitals for IVF and ICSI, including: eight university hospitals, four general hospitals and one private clinic. OI and IUI are performed in all types of Dutch hospitals. OI, IUI cycles as well as the rst three IVF or ICSI treatment cycles are reimbursed as part of the basic healthcare package, according to the Health Insurance Act. In the Netherlands, approximately 1 out of 38 children is born a er IVF or ICSI treatment (www.nvog.nl).
Introduction
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