Knowledge, attitudes, and practices regarding the use of ovulation induction and ovarian stimulation without in vitro fertilization (IVF): healthcare provider survey

Abstract

To assess provider practices of recommending non-IVF fertility treatments to patients, their knowledge about treatment safety, and their attitudes about using non-IVF fertility treatments. Cross-sectional, web-based survey of U.S. healthcare providers. We used data from the 2017 DocStyles survey of a random sample of providers with respondents’ distribution of age, sex, and region matching the American Medical Association's master file (39.5% response rate). We assessed responses of family practitioners, internists, nurse practitioners, and obstetrician-gynecologists who provided care for infertility patients in the past year. Non-IVF fertility treatments were defined as ovulation induction or ovarian stimulation with timed intercourse or insemination with no intention of performing IVF. Of 1,510 respondents, 603 (40%) reported providing care for infertility patients in the past year, including 182 family practitioners, 118 internists, 72 nurse practitioners, and 231 obstetrician-gynecologists. The most common non-IVF fertility treatments recommended by providers were natural cycle insemination (66%), clomiphene citrate (57%), and Metformin (57%). Primary reasons for recommending non-IVF fertility treatments were patient or couple’s prior success in conceiving a pregnancy (41%), duration of infertility (39%), and infertility diagnosis (38%). Most providers (53%) recommended non-IVF fertility treatments before IVF because they considered them less risky. While 44% of providers believe non-IVF fertility treatments were not associated with more adverse infant outcomes than IVF, 18% considered IVF to be safer. Only 35% of providers considered oral fertility drugs to be safer than injectable drugs, while 18% disagreed; 47% had no opinion. Nearly one-third (29%) of obstetrician-gynecologists and the majority of family practitioners (68%), internists (55%), and nurse practitioners (74%) reported not using any specific strategy to limit the risk of multiple births when using non-IVF fertility treatments. The most common strategies of preventing multiple births were beginning treatment with clomiphene citrate (29%), monitoring hormone levels and adjusting treatment protocols (16%), and monitoring follicular size using ultrasound and aspirating excess follicles if needed (14%). While study generalizability may be limited, many providers involved in infertility care may not be aware of the risk of adverse infant outcomes for non-IVF versus IVF fertility treatments, and do not attempt to limit the risk of multiple births while using these treatments. These results can inform provider education efforts.