Preinfertility Referral Patterns

Abstract

INTRODUCTION: To identify patient characteristics associated with complete infertility evaluation and pursuit of treatment before specialist referral. METHODS: A research registry of new infertility patients was examined. Age, live birth history, menstrual regularity, months of unprotected intercourse, and history of prior evaluation and treatment were abstracted. Complete evaluation included assessment of ovarian reserve, tubal patency or uterine anatomy, and male factor. Partial workup was defined as two of these parameters. Logistic regression identified patient characteristics associated with increased likelihood of having undergone complete evaluation, treatment with clomiphene citrate, or both. Differences were determined by Fisher's exact and χ2 tests. RESULTS: Of 163 women who were included, the majority were younger than 35 years old (33.6±4.9 years), nulliparous (83.4%), and had either partial or no evaluation (86.8%) before referral. The most common evaluation was semen analysis for male factor with semen analysis and ovarian reserve being the most common partial evaluation. Maternal age was the most significant predictor for complete evaluation (P=.03); with every year increase in age, the odds of a complete evaluation increased by 12%. Despite the small percent of women with complete evaluation, 31% of patients were treated with clomiphene citrate before referral (3.5±2.38, range 1–13). Months of unprotected intercourse was significantly higher in those treated than in those who were not (37.3 compared with 29.1 months, P=.02). CONCLUSION: This is the first study to provide insight into prereferral practice patterns and supports the need for institutionally based health care provider education.