title: Timing, characteristics and determinants of infertility diagnostic work up before admission to eleven second-level assisted reproductive techniques (ART) centres in Italy.
abstract: OBJECTIVE
  To describe the time-course of infertile couples not conceiving spontaneously or with medical or surgical therapies before assisted reproductive techniques (ART).
  
  
  METHODS
  Multicentre study of consecutive couples seen for the first time in eleven second-level infertility centres in Italy. A total of 464 couples entered the study and completed a structured questionnaire with the assistance of a clinician. Information was collected on general characteristics, reproductive and gynaecological history, and presumed causes of infertility. Further information was collected on: date of first trying for pregnancy and first consultation for infertility; doctor first consulted by the couple and who decided the diagnostic work-up; instrumental and laboratory tests performed during the diagnostic work-up.
  
  
  RESULTS
  The first medical consultation for infertility occurred after an average of 13 months of unprotected intercourse. This interval was statistically significantly longer for women with low educational level. The median interval between the first medical consultation and the consultation in a second-level infertility centre was 9.5 months. This interval was shorter when the first clinician consulted was a specialist in infertility working in a first-level public centre. Moreover, this interval was longer among women with low educational level. At the time of the consultation in a second-level infertility centre, most of the female patients had already been examined for ovarian, hypophyseal and thyroid function, but only 12% had undergone an anti-Mullerian hormone (AMH) determination: 56% had microbiological culture performed. Nearly 40% had been studied for tubal patency and karyotype. More than 50% of the male partners had not a complete semen evaluation, but 46.0% had second-level examinations.
  
  
  CONCLUSIONS
  Educational level is linked to a higher possibility of recognizing fertility problems. The referral process to a second-level centre is quicker in the public sector.
authors.affiliation: Dipartimento di Fisiopatologia preconcezionale e prenatale, Ospedale Galliera, Genoa, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Costa
authors.forename: Francesca
authors.initials: F
authors.lastname: Chiaffarino
authors.forename: Cristofaro
authors.initials: C
authors.lastname: De Stefano
authors.forename: Fabio
authors.initials: F
authors.lastname: Parazzini
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D054304:Anti-Mullerian Hormone / Q000097:blood; D004522:Educational Status; D005187:Fallopian Tubes / Q000473:pathology; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D007248:Infertility, Male / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D007558:Italy; D007621:Karyotyping; D010535:Laparoscopy; D008297:Male; D010050:Ovarian Function Tests; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017150:Public Sector / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D055101:Semen Analysis; D011795:Surveys and Questionnaires; D013960:Thyroid Function Tests; D013997:Time Factors
chemical_list: D054304:Anti-Mullerian Hormone