Abstract
INTRODUCTION: Time to diagnosis of fertility disorders is reported to take up to 11 years and involves five to six physicians on average. Prolonged time to diagnosis is not just an immense burden on the health care system, but also means that in vitro fertilization (IVF) becomes necessary for couples who would have been able to conceive naturally had they been diagnosed sooner, often leaving these couples childless. This observational study evaluated how a clinical decision support software based on American Society for Reproductive Medicine, American College of Obstetricians and Gynecologists, and European Society of Human Reproduction and Embryology guidelines used by patients and obstetrician–gynecologists together can reduce the time to diagnosis of up to 65 conditions affecting female fertility. METHODS: One hundred eighty women aged 20–45 who had been trying to conceive for an average of 11 months were recruited to participate. Women completed a reproductive health assessment with a dynamic online questionnaire. The output of the assessment was a lab requisition with an individualized selection of female and male sex hormones, thyroid hormones, markers for glucose metabolism, vitamin deficiencies, complete blood count, as well as markers for immunology, genetics, and thrombophilia. The clinical decision support software combined the results from the online reproductive health assessment with the lab results to render recommendations for diagnosis, further diagnostics, and treatment. RESULTS: An average of four previously unknown health conditions affecting fertility were diagnosed with an average time of 8 weeks to diagnosis (range, 5–16). Diagnoses included polycystic ovarian syndrome, various forms of amenorrhea, premature ovarian insufficiency, vitamin and iron deficiency, hyperthyroidism and hypothyroidism, insulin sensitivity, and prolactinoma. CONCLUSION: An online clinical decision support tool can significantly reduce time to diagnosis of conditions affecting female fertility. It also reduces the number of patient–physician interactions and the time physicians spend on medical history and necessary patient education.
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