Infertility counseling, evaluation and treatment by obstetrician-gynecologists and family medicine physicians: a survey

Abstract

OBJECTIVE: To describe infertility practice patterns of family medicine (FM) and generalist obstetrics and gynecology (OG) physicians in a state mandating insurance coverage for certain infertility treatments (Massachusetts, MA) and another without a mandate (Kansas, KS).DESIGN: Cross sectional survey.MATERIALS AND METHODS: An anonymous survey was sent to licensed OG and FM physicians in each state. To be eligible for analysis, respondents needed to report they were in active FM or OG practice in KS or MA. Data were analyzed using SPSS (Pearson Chi-Square or Fisher's Exact).RESULTS: Of 4699 surveys mailed, 1033 were returned (21.9% response rate) and 859 (83.2%) of respondents met eligibility criteria. During the past 5 years, 72.5% of FM and 98.0% of OG reported counseling patients about infertility (P<0.0001). Of the FM, 86.2% in MA and 70.7% in KS reported such counseling (P<0.02), whereas 97.9% of MA and 98.2% of KS OG reported counseling (P=1.0). In analyzing counseling by gender, 63.9% of male and 87.8% of female FM (P<0.0001), and 97.5% of male and 98.4% of female OG reported such counseling (P=0.71). When patients asked about fertility problems, 56.0% of FM and 28.8% OG immediately referred to another physician (P<0.0001). Pooling both types of physicians, 36.2% of MA and 49.4% of KS physicians referred immediately (P<0.0001). The proportion reporting that they prescribe clomiphene citrate was 65.3% for FM and 98.7% for OG (P<0.0001). For all FM respondents, 26.3% in MA and 70.1% in KS (P<0.0001) and for all OG, 97.9% in MA and 100% in KS reported clomiphene use (P=0.30). Multiples had occurred in the last 2 years among clomiphene-treated patients for 43.2% of OG and 8.1% of FM.CONCLUSIONS: FM and generalist OG physicians provide a substantial amount of infertility care. Variations in practice patterns appear to be more pronounced in FM vs. OG when comparing insurance mandated and non-mandated states. Multiple births were common, suggesting a potential need for education on infertility treatment. OBJECTIVE: To describe infertility practice patterns of family medicine (FM) and generalist obstetrics and gynecology (OG) physicians in a state mandating insurance coverage for certain infertility treatments (Massachusetts, MA) and another without a mandate (Kansas, KS). DESIGN: Cross sectional survey. MATERIALS AND METHODS: An anonymous survey was sent to licensed OG and FM physicians in each state. To be eligible for analysis, respondents needed to report they were in active FM or OG practice in KS or MA. Data were analyzed using SPSS (Pearson Chi-Square or Fisher's Exact). RESULTS: Of 4699 surveys mailed, 1033 were returned (21.9% response rate) and 859 (83.2%) of respondents met eligibility criteria. During the past 5 years, 72.5% of FM and 98.0% of OG reported counseling patients about infertility (P<0.0001). Of the FM, 86.2% in MA and 70.7% in KS reported such counseling (P<0.02), whereas 97.9% of MA and 98.2% of KS OG reported counseling (P=1.0). In analyzing counseling by gender, 63.9% of male and 87.8% of female FM (P<0.0001), and 97.5% of male and 98.4% of female OG reported such counseling (P=0.71). When patients asked about fertility problems, 56.0% of FM and 28.8% OG immediately referred to another physician (P<0.0001). Pooling both types of physicians, 36.2% of MA and 49.4% of KS physicians referred immediately (P<0.0001). The proportion reporting that they prescribe clomiphene citrate was 65.3% for FM and 98.7% for OG (P<0.0001). For all FM respondents, 26.3% in MA and 70.1% in KS (P<0.0001) and for all OG, 97.9% in MA and 100% in KS reported clomiphene use (P=0.30). Multiples had occurred in the last 2 years among clomiphene-treated patients for 43.2% of OG and 8.1% of FM. CONCLUSIONS: FM and generalist OG physicians provide a substantial amount of infertility care. Variations in practice patterns appear to be more pronounced in FM vs. OG when comparing insurance mandated and non-mandated states. Multiple births were common, suggesting a potential need for education on infertility treatment.