Page 28 - Shared Guideline Development Experiences in Fertility Care

Chapter 2
Materials and Methods
Setting
Infertility is de ned as the failure to conceive a er at least one year of regular unprotected intercourse [31,32]. Overall, Dutch fertility care has been publically arranged on three levels. Primary care is provided by the GP and comprises a part of an initial fertility assessment. Subsequently, the GP can refer couples to a gynaecologist in a general (secondary care) or a university (tertiary care) hospital. He/she can complete this initial fertility assessment, determine a cause of infertility and de ne a suitable treatment plan. If a severe male factor is diagnosed, couples can be referred to an urologist.
Study design
For assessing patients’ added value to the scope of a multidisciplinary guideline on infertility, we conducted explorative semi-structured interviews among infertile couples as well as focus group interviews with professionals involved in fertility care, using a similar interview guide, developed by three authors (E.M.E.D.B., W.L.D.M.N., R.P.M.G.H.). Consensus on the topics of the nal interview guide was reached through discussion.
First, eight di erent phases of fertility care, based on known patients’ clinical care pathways, were included in a topic list: (I) initial fertility assessment by a GP and/ or (II) gynaecologist, (III) treatment with OI, or (IV) IUI, or (V) IVF or (VI) ICSI by a gynaecologist, (VII) TEsticular Sperm Extraction (TESE) by a urologist and (VIII) a er care. Additionally, transitions between di erent phases of fertility care, such as referral from GP to gynaecologist were identi ed and added as topics. Furthermore, all inconsistencies within recommendations of the 11 actual Dutch monodisciplinary guidelines on infertility of the Dutch college of General Practitioners’ (GP), the Dutch Society of Obstetrics and Gynaecology’s (NVOG), the Dutch Society of Urologists and the Dutch Society of clinical embryologists and clinical chemists were identi ed and added as topics (www.nvog.nl; www.nhg. org; www.nvu.nl; www.embryologen.nl).
Interviews among patients (infertile couples)
Participating patients included infertile couples selected from all eight di erent phases of fertility care. ese couples were consecutively invited to participate by means of an information letter, conferred while they visited a gynaecological
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