Page 35 - Shared Guideline Development Experiences in Fertility Care

Key clinical issues among professionals
Domain I: guidelines
Unclear treatment criteria. e description of treatment criteria in actual guidelines
is unclear, resulting in di erent policies in the various hospitals (Table 4). Some gynaecologists treat women until the age of 40 years, others until the age of 43
years, resulting in ‘hospital-shopping’ of patients. 2
... age does not mean anything. For example: a 36-year-old woman may have a high FSH and a low AFC.
Unclear treatment policy. Treatment policies are seldom clearly described in actual guidelines, or still under discussion (i.e. lifestyle advices), just as criteria for referral, especially for GPs. Moreover, interpretation of the semen analysis’ results, the appropriate number of semen samples needed and best interval time to repeat them is unclear for GPs.
...if the test results of the semen analysis are poor, you have to consider the possibility of repeating the test. ...whether this is a er three months, or later, I am not sure.
Lack of evidence. While on some topics research is still in progress, on others the available evidence is unclear.
ere is still no consensus about the varicocele: some urologists treat it, others do not.
Domain II: professionals
Lack of respect and autonomy. Professionals mentioned the lack of partner involvement, especially by the GP, as a key clinical issue as well.
It is a classical problem, the male who is only seen as a jar of sperm.
Lack of emotional support. Overall, emotional support, o ered by professionals, is lacking. Moreover, timing is unclear and attention to childless couples is limited.
e process of loss is di erent for every couple, they have to let go of their wishes and dreams... every professional ought to be aware of this, but it is unclear who should actually provide emotional support.
Key clinical issues in fertility care
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