title: Practice patterns among board-certified reproductive endocrinologists regarding high-order multiple gestations: a united states national survey.
abstract: OBJECTIVE
  To assess current practice management, attitudes, and strategies of reproductive endocrinologists in the United States regarding high-order (at least three) multiple gestations.
  
  
  METHODS
  Questionnaires were mailed to 768 board-certified reproductive endocrinologists of whom 722 were eligible for the study. The questionnaires addressed topics such as practitioner demographics, management strategies, and attitudes regarding high-order multiple gestations.
  
  
  RESULTS
  The survey response rate was 52%. Most physicians performed 100-300 cycles of each ovulation induction with intrauterine insemination and in vitro fertilization in 1998 and 1999. The most commonly reported incidence of high-order multiple gestations resulting from each ovulation induction with intrauterine insemination and in vitro fertilization was 2-5% in 1998 and 1999. Strategies used to decrease the rate of high-order multiple gestations varied among practitioners. Informed consent regarding high-order multiple gestations was provided by 99.5% of practitioners. Information regarding selective reduction was provided by 98.3% of respondents. Over 90% of practitioners believed it is worthwhile to attempt to decrease the risk of high-order pregnancies at the risk of decreasing their group's overall pregnancy rates.
  
  
  CONCLUSIONS
  Most reproductive endocrinologists reported concern over the rising risk of high-order multiple gestations resulting from therapies such as superovulation with intrauterine insemination or in vitro fertilization. However, the ways in which patients are counseled regarding such events, their sequelae, and methods to avoid them greatly differ among respondents. Given the inconsistent practice patterns, a multifaceted educational approach may provide an opportunity to reduce the incidence of high-order multiple gestations and their sequelae.
authors.affiliation: Reproductive Medicine Associates of New Jersey, Somerset, USA.
authors.forename: Doreen L
authors.initials: DL
authors.lastname: Hock
authors.forename: David B
authors.initials: DB
authors.lastname: Seifer
authors.forename: Eftichia
authors.initials: E
authors.lastname: Kontopoulos
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.forename: Efthica
authors.initials: E
authors.lastname: Kontopoulos
mesh_terms: D003376:Counseling; D004704:Endocrinology; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D007258:Informed Consent; D007315:Insemination, Artificial / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006080:Ovarian Follicle / Q000502:physiology; D010062:Ovulation Induction / Q000009:adverse effects / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal; D018566:Pregnancy, High-Risk; D011272:Pregnancy, Multiple; D018456:Reproductive Medicine; D012307:Risk Factors; D013480:Superovulation; D011795:Surveys and Questionnaires; D014481:United States