Survey of Australasian clinicians' prior beliefs concerning lipiodol flushing as a treatment for infertility: a Bayesian study.
OBJECTIVE
To evaluate clinicians' beliefs concerning the effectiveness of lipiodol flushing as a treatment for unexplained infertility, and to integrate these prior beliefs with evidence from randomised trials.


METHODS
Survey.


METHODS
Specialists in Australasian in vitro fertilisation (IVF) clinics in 2001.


METHODS
One of two types of structured survey was used to gather information from fertility specialists in Australasian IVF clinics. Prior beliefs were captured graphically and textually from responses.


RESULTS
Nineteen specialists returned questionnaires. Eighteen of the 19 specialists believed that lipiodol flushing was more likely to be beneficial than harmful. The most widely held prior belief, reflected in both textual and numerical responses, was that lipiodol was likely to produce a small beneficial response. The credible limits of this belief were compatible with a reasonable fertility benefit, as more than 50% believed that a 1.5-fold increase in pregnancy rate was plausible. The two surveys found that a 1.2-fold or 1.4-fold increase in pregnancy rate was the median expected level of benefit at which clinicians would have been inclined to recommend lipiodol flushing to their patients (combined range 1.1- to 2.3-fold) - new evidence suggests that for women with endometriosis but otherwise unexplained infertility, these levels of benefit are exceeded.


CONCLUSIONS
Among Australasian fertility specialists there is variation in prior beliefs concerning the effectiveness of lipiodol flushing as a treatment for unexplained infertility and in the expected level of benefit at which clinicians are inclined to recommend this treatment. Generalisability of these beliefs remains uncertain owing to a low study response rate.
Johnson
Neil P
NP
University of Auckland and Fertility Plus, Auckland, New Zealand. n.johnson@auckland.ac.nz
Fisher
Rosalie A
RA
Braunholtz
David A
DA
Gillett
Wayne R
WR
Lilford
Richard J
RJ
D001291:Attitude of Health Personnel; D001315:Australia; D001499:Bayes Theorem; D003287:Contrast Media / Q000008:administration & dosage*; D004715:Endometriosis / Q000188:drug therapy; D005184:Fallopian Tube Diseases / Q000188:drug therapy; D005187:Fallopian Tubes; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D007459:Iodized Oil / Q000008:administration & dosage*; D009520:New Zealand; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D007507:Therapeutic Irrigation
D003287:Contrast Media; D007459:Iodized Oil