Generalist providers are frequently the first point of care for women having problems conceiving and are in a “unique position” to advocate balanced infertility management, according to research recently published in the Journal of the American Board of Family Medicine.
Researchers noted that prevalence estimates of infertility range from 7.4% of married women of reproductive age to 15.5% who are trying to conceive.
“While the value of care before conception is well recognized, the role of a primary care provider in the diagnosis and treatment of infertility is not well studied,” Mandy W. Boltz, MD, MPH, of the department of family and preventive medicine, Office of Cooperative Reproductive Health, University of Utah, and colleagues wrote. “A better understanding of generalist providers’ role in the diagnosis and treatment of infertility may provide insight into opportunities for enhanced management of infertility in primary care settings.”
Boltz and colleagues analyzed mixed-mode questionnaire data from 867 women with primary infertility placed into a retrospective cohort through population- and fertility clinic-based sampling. The women were first asked if they saw a doctor or provider specifically for fertility-related issues. The researchers compared the likelihood of receiving in vitro fertilization (IVF) among women who first presented to a generalist provider with that of women who first presented to a fertility subspecialist, then compared time to pregnancy leading to a live birth by initial provider type.
Researchers found that 84% of the women first sought care from a generalist provider. Only 8% of women first sought care from a fertility subspecialist; these women were older and had been trying longer to conceive. In addition, women who first sought care from a general provider were less likely to receive IVF (AOR = 0.48; 95% CI, 0.28–0.82), but had similar times to pregnancy (AHR = 1.11; 95% CI, 0.8–1.53) and were equally likely to achieve pregnancy compared with women who first sought a subspecialist.
“These findings do not necessarily imply a causal relationship between first provider type and likelihood of receiving IVF. Women who seek infertility care from different types of providers likely differ beyond the factors we measured, such as cause of infertility,” Boltz and colleagues wrote.
Researchers wrote that using generalist providers as the first point of care may have several benefits for patients with infertility.
“Generalist providers who perform the initial workup and management of infertility may confer cost savings to their patients and to the health care system. They may also improve patient access to infertility care, especially for patients who, as a result of health care reform efforts, may now have increased access to primary care without increased access to subspecialty infertility care,” they wrote. “Generalist providers are uniquely positioned to promote the balanced management of infertility and may help some patients avoid unnecessary medical complications, costs, and stress associated with invasive fertility treatments.” – by Janel Miller
Disclosure: The researchers report no relevant financial disclosures.