‘Fertility awareness methods’ als eerste stap voor koppels met fertiliteitsproblemen

Abstract

Fertility awareness methods as the first step in subfertility management An unfulfilled child wish is due to unexplained or mild male subfertility in more than half of the consulting subfertile couples. Since many of these couples can still conceive naturally within 1 year without treatment, expectant management (6-12 months) is proposed. However, in practice it often proves to be difficult to adhere to this approach, resulting in a quick shift to expensive assisted reproductive therapy (ART). Recent fertility awareness methods (FAMs) train couples to distinguish fertile from infertile days of the menstrual cycle, allowing them to target sexual intercourse on the most fertile days. By incorporating FAMs into expectant management, the latter is made more effective, increasing the chances of pregnancy. Furthermore, the health risks associated with ART are reduced. The symptothermal method is a combination of the temperature-based and cervical mucus secretion method. By applying this FAM and having fertility-focused intercourse, 92% of the women had become pregnant after 1 year, compared to 82% in studies without FAMs. For a subfertile subgroup, the cumulative spontaneous pregnancy rate after 8 months was less (38%), but still significantly above the spontaneous pregnancy rate without fertility awareness training (21.6%). Via educational materials and a network of trained teachers, FAMs are proposed. In order to fulfil this role properly, FAMs need to be recognised as the first step in fertility care in Belgium. Integrating FAMs can cause a judicious reduction in healthcare costs by reducing the number of multiple pregnancies and selecting only couples who genuinely need ART.