title: Efficacy of intrauterine inseminations as a training modality for performing embryo transfer in reproductive endocrinology and infertility fellowship programs.
abstract: OBJECTIVE
  To assess pregnancy rates before and after a training intervention in which reproductive endocrinology and infertility fellows were required to perform 100 IUIs before performing ETs.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Large, academic training program.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Comparing pregnancy rates between two time periods: July 1998-June 2001 (before IUI intervention) and July 2001-June 2010 (after IUI intervention).
  
  
  METHODS
  Clinical pregnancy rate (PR) for the first 100 ETs performed by fellows before and after the IUI training; median attending physician PR during each time period served as the referent. Multivariate generalized estimating equations were used to calculate odds of pregnancy per ET for fellows as compared with attending physicians.
  
  
  RESULTS
  Multivariate analyses revealed no significant difference in PR for the first 100 ETs performed by fellows as compared with attending physicians, before or after the IUI training requirement (odds ratio 0.99, 95% confidence interval 0.82-1.20 and odds ratio 0.91, 95% confidence interval 0.81-1.30, respectively). The median attending physician PR in the preintervention group was exceeded by fellows after the first 70 ETs; fellows in the postintervention group exceeded the median attending physician PR after 100 ETs. The PR in both groups improved as fellows progressed from the first 20 to 100 ETs.
  
  
  CONCLUSIONS
  The PR for the first 100 ETs performed by fellows was unchanged after implementing an IUI training requirement. The substantial variation noted among individual fellows decreased as more ETs were completed.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. divya-shah@uiowa.edu
authors.forename: Divya K
authors.initials: DK
authors.lastname: Shah
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Missmer
authors.forename: Katharine F B
authors.initials: KF
authors.lastname: Correia
authors.forename: Catherine
authors.initials: C
authors.lastname: Racowsky
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ginsburg
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D015331:Cohort Studies; D004501:Education, Medical / Q000592:standards / Q000706:statistics & numerical data; D004521:Educational Measurement / Q000379:methods; D004624:Embryo Transfer / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D004704:Endocrinology / Q000193:education* / Q000592:standards; D005257:Fellowships and Scholarships / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007246:Infertility / Q000453:epidemiology / Q000628:therapy*; D007317:Insemination, Artificial, Homologous / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D007318:Inservice Training / Q000592:standards; D011247:Pregnancy; D018873:Pregnancy Rate; D018456:Reproductive Medicine / Q000193:education* / Q000592:standards; D012189:Retrospective Studies; D016896:Treatment Outcome; D014599:Uterus
keywords: Embryo transfer; education; fellows; intrauterine inseminations; training