Practice patterns among reproductive endocrinologists: the infertility evaluation.
OBJECTIVE
To determine how board-certified reproductive endocrinologists vary in their approach to the clinical tests performed on the infertile couple.


METHODS
A cross-sectional study to assess differences in the approach to evaluating the infertile couple.


METHODS
A population-based national survey.


METHODS
United States board-certified reproductive endocrinologists.


METHODS
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.
Glatstein
I Z
IZ
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Harlow
B L
BL
Hornstein
M D
MD
D000328:Adult; D002568:Certification; D003430:Cross-Sectional Studies; D004704:Endocrinology; D005260:Female; D006801:Humans; D007247:Infertility, Female; D007248:Infertility, Male; D008297:Male; D008875:Middle Aged; D010820:Physicians; D010822:Physicians, Women; D011795:Surveys and Questionnaires; D014481:United States