Glatstein, I. Z., Harlow, B. L., & Hornstein, M. D. (1997). Practice patterns among reproductive endocrinologists: the infertility evaluation. Fertility and Sterility, 67(3), 443-451. https://doi.org/10.1016/s0015-0282(97)80067-2
Glatstein IZ, Harlow BL, Hornstein MD. Practice patterns among reproductive endocrinologists: the infertility evaluation. Fertil Steril. 1997;67(3):443-451. doi:10.1016/s0015-0282(97)80067-2
Glatstein, Isaac Z., et al. "Practice patterns among reproductive endocrinologists: the infertility evaluation." Fertility and Sterility, vol. 67, no. 3, 1997, pp. 443-451.
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Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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RRM Academy Synopsis
Most US IVF doctors routinely order five core infertility tests
A 1997 survey of 397 US IVF doctors (reproductive endocrinologists) found that most routinely order five core infertility tests and agree less on the rest. Physician age, sex, practice type and region were linked to the differences.
Key Findings
The response rate was 83.9%: 397 of 473 eligible physicians returned the questionnaire.
Routine ordering was reported for semen analysis (99.9%), any ovulation assessment (98.0%), hysterosalpingogram (96.0%), laparoscopy (89.1%) and postcoital test (79.0%).
Routine use was less uniform for pelvic ultrasound (54.5%), hysteroscopy (53.2%) and antisperm antibody testing (23.9%). Hormone tests ranged from LH (22.1%) to PRL (66.4%).
Each ovulation method was chosen by about 55% to 65% of physicians. The most frequently used method was midluteal phase serum P (31.7%), then BBT (21.9%).
Postcoital testing was ordered by 89.4% of private-practice physicians and 70.4% of university physicians (P < 0.001).
Interpretation
The study is a cross-sectional mail survey of what doctors report ordering. The survey collected no test results or pregnancy outcomes. The authors write that few rigorous trials have tested these tests against pregnancy outcomes. All respondents were board-certified specialists, and the questionnaire aimed at a typical snapshot of practice. The authors state that real couples rarely fit a routine workup.
RRM Context
Beyond the five core tests, the additional testing a couple receives varies with the doctor's sex, age, practice type and region. Restorative reproductive medicine puts evaluation first, to find the cause. The survey also shows ovulation assessment split among several methods, including BBT charting.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To determine how board-certified reproductive endocrinologists vary in their approach to the clinical tests performed on the infertile couple.
Design
A cross-sectional study to assess differences in the approach to evaluating the infertile couple.
Setting
A population-based national survey.
Participants
United States board-certified reproductive endocrinologists.
Main Outcome Measures
The frequency of clinical tests and evaluation procedures by physician age, sex, size and setting of practice, institutional affiliation, and geographic location.
Results
The overall response rate was 84%. Although the majority of practitioners routinely order a semen analysis (99.9%), an assessment of ovulation (98%), a hysterosalpingogram, (HSG; 96%), laparoscopy (89%), and a postcoital test (PCT, 79%), there was less agreement regarding hormonal testing (range, 22% [LH] to 66% [PRL]), use of pelvic ultrasounds (55%), hysteroscopy (53%), cervical cultures (range, 24% to 54%), and antisperm antibody testing (24%). Compared with male colleagues, female physicians order two to three times more cervical cultures and endometrial biopsies. Serum hormonal testing was two to three times more commonly ordered by younger (< 40 years) compared with older physicians, and physicians in private practice twice as frequently ordered hormonal testing, cervical cultures, PCTs, and antisperm antibody studies compared with their academic-affiliated colleagues. Western U.S. physicians order hormonal tests and cervical cultures 50% less often than their midwest and eastern counterparts.
Conclusions
Trained specialists rely heavily on five "traditional" infertility tests: semen analysis, an assessment of ovulation, HSG, laparoscopy, and PCT. With regard to additional modes of testing, there is marked variability by physician sex, age, type of practice, and geographic location.
