Let’s talk about sex Optimising the management of unexplained infertility

This thesis aimed to optimise expectant management (EM) for couples with unexplained infertility, focusing on sexual health. While at least six months of EM is recommended for couples with a favourable prognosis for natural conception, pregnancy rates remain limited, and it often fails to meet their need for action and information, leading to non-adherence and overtreatment.
To address these issues, we explored couples’ experiences and identified a need for supportive interactions and advice on managing lifestyle, distress, and sexual challenges via a secure website. Using these insights, literature and expert input, we developed the Pleasure&Pregnancy (P&P) web-based programme, targeting sexual well-being- a critical but overlooked factor in fertility care.
A randomised controlled trial evaluated the programme’s effectiveness compared to standard EM. While the P&P programme did not improve pregnancy rates, it enhanced women’s sexual pleasure, orgasm, and satisfaction. Although coital frequency and male sexual functioning decreased in the overall population, engaged users experienced reduced declines in coital frequency and improved male sexual desire. A cross-sectional study revealed that 25% of recently diagnosed couples are at risk of sexual dysfunction, highlighting the importance of prioritising sexual health. Factors like age, anxiety, depression, and relationship distress were associated with poorer sexual functioning. Dyadic analysis confirmed the interdependence of partners’ sexual functioning, emphasising the need for couple-focused fertility research and treatments.
This thesis concludes that integrating sexual health support into EM can better address couples’ needs, improve sexual health, and may improve adherence. Further research into the P&P programme’s role in infertility care is recommended.