Fertility Treatment, Use of in Vitro Fertilization, and Time to Live Birth Based on Initial Provider Type

Abstract

Purpose To explore the relationship between initial clinician type (generalist versus subspecialist) seen by infertile women, type of treatment received, and time to pregnancy. Methods In a retrospective cohort design, we analyzed mixed-mode questionnaire data from 867 women with primary infertility enrolled through population- and fertility clinic-based sampling. We compared women presenting first to generalist providers with women presenting first to fertility subspecialists, with the main outcomes of receiving in vitro fertilization (IVF), time to pregnancy, and live birth. Results The first point of contact for most (84%) women with infertility was a generalist provider. Only 8% of women sought care first from a fertility subspecialist, and these women were more likely to be older and have been trying to conceive longer before seeking care. Women who presented first to a generalist provider were less likely to receive IVF (aOR 0.48, 95% CI 0.28, 0.82), were equally likely to achieve pregnancy, and had similar times to pregnancy (aHR 1.11, 95% CI 0.80, 1.53) compared to women who presented first to a subspecialist. Conclusions Generalist providers are frequently the first point of care for women with difficulty conceiving and are uniquely positioned to promote a balanced management of infertility.

Time as an outcome measure in fertility-related clinical studies: long-awaited

“…Across current literature, the STP for treatment measures is fairly homogeneous, with randomization being the start point for the majority of RCTs and, where stated, a clinical procedure or the start of MAR treatment for non-RCTs. In some instances, studies evaluate a time-related treatment measure with an STP that relies upon patient recall of, for example, ‘first intercourse after delivery’ and ‘decision of desire to have a child’ ( Boujenah et al , 2016 ; Boltz et al , 2017 ; Cayan et al , 2017 ).…”

Is ART utilization the best indicator of access to fertility care?

“…While ART is necessary for some couples to have a child, it is not required for many subfertile couples, and overuse of ART may potentially be harmful (Annual Capri Workshop Group, 2019). Focusing solely on ART as a metric may unnecessarily encourage overutilization (Boltz et al, 2017).…”

Restorative reproductive medicine for infertility in two family medicine clinics in New England, an observational study

“…Primary care physicians, and family physicians in particular, can serve an important role for infertility evaluation and treatment because infertility 1) is common; 2) is a couple’s issue; 3) involves coincident chronic disorders impacting fertility that can be addressed in primary care [ 4 , 6 ]. Initial management of infertility by primary care specialists with subsequent referral as needed can result in similar time to pregnancy as initial management by fertility subspecialists [ 7 ].…”