Impact of the "physician factor" on pregnancy rates in a large assisted reproductive technology program: do too many cooks spoil the broth?
OBJECTIVE
To determine whether in one program with unified treatment protocols, patients can expect varying treatment outcomes with different physicians.


METHODS
Retrospective data analysis.


METHODS
University-affiliated infertility center with 14 physicians.


METHODS
One thousand eight hundred fifty IVF cycles performed consecutively between August 1995 and June 1997.


METHODS
The pregnancy rate and implantation rate per ET were evaluated for individual physicians between August 1995 and June 1996 (phase I). Physicians with lower success rates underwent strict supervision from July 1996 to June 1997 (phase II).


METHODS
Variations in success rates between physicians.


RESULTS
The pregnancy rate varied among the physicians from 13.2%-37.4%, and the implantation rate varied from 4.4%-14%. Some physicians' outcomes improved between phase I and phase II of the study, whereas others' did not. The pregnancy and implantation rates varied significantly for some physicians, depending on whether they were responsible for the choice of stimulation protocol, supervision of cycle monitoring, or ET in their own or other physicians' patients.


CONCLUSIONS
Outcomes of IVF vary depending on the treating physician. Lower than expected pregnancy and implantation rates usually are not caused by poor ET techniques alone, but appear to be disproportionately the consequences of poor cycle stimulation.
Karande
V C
VC
Center for Human Reproduction-Illinois, Hoffman Estates 60194, USA. vkarande@aol.com
Morris
R
R
Chapman
C
C
Rinehart
J
J
Gleicher
N
N
D010064:Embryo Implantation; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data; D006801:Humans; D018579:Patient Selection; D010820:Physicians; D011247:Pregnancy; D011272:Pregnancy, Multiple; D012099:Reproductive Techniques; D012189:Retrospective Studies; D016896:Treatment Outcome