• Andrea Bernabeu, Concepcion Carratala-Munuera, Jose A Quesada, Joaquin Llacer, Adriana Lopez-Pineda, Francisco Sellers, Vicente F Gil-Guillen, Rafael Bernabeu, Kamila Cheikh-Moussa, and Domingo Orozco-Beltran.
• Chair of Reproductive and Community Medicine, Miguel Hernandez University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550, Alicante, San Juan de Alicante, Spain.
• Ir J Med Sci. 2021 May 1; 190 (2): 677-684.

BackgroundThe main barrier for an appropriate primary management of the reproductive health was lack of knowledge about the risk factors and prevention measures for infertility and the main recommendations was to involve primary care physicians in reproductive health.AimsTo reach a consensus around barriers and enablers for appropriate primary management of the reproductive health.MethodsAn observational study was performed using the modified Delphi technique, from October 2017 to April 2018 in private and public assisted reproduction clinics in Spain. A questionnaire consisted of 58 items, divided into four blocks to explore consensus among a group of experts by synthesizing opinions.ResultsIn the first Delphi round, the response rate was 50% and panelists reached a 72.4% of consensus. In second round, the response rate was 55% and panelists reached a 25% of consensus. To minimize limitations related to the use of a structured questionnaire, a space for free text responses was provided. The following items yielded unanimous agreement: "It is necessary to promote reproductive planning-not just contraception-from secondary school," "The media should not trivialize pregnancies in women aged over 50," "Postponing family formation is the main cause of the increase in assisted reproduction treatments in Spain," and "Postponing motherhood implies an inherently decreased probability of having children."ConclusionsThese recommendations could set the basis for a public health action plan for primary management of reproductive health. The findings may be applicable to any country whose health services system provides primary healthcare.

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