title: Physician recommendation for invasive prenatal testing: the case of the 'precious baby'.
abstract: OBJECTIVE
  Do clinicians manage pregnancies conceived by assisted reproductive technologies (ART) differently from spontaneous pregnancies?
  
  
  CONCLUSIONS
  Clinicians' decisions about prenatal testing during pregnancy depend, at least partially, on the method of conception.
  
  
  BACKGROUND
  Research thus far has shown that patients' decisions regarding prenatal screening are different in ART pregnancies compared with spontaneous ones, such that ART pregnancies may be considered more valuable or 'precious' than pregnancies conceived without treatment.
  
  
  METHODS
  In this cross-sectional study, preformed during the year 2011, 163 obstetricians and gynecologists in Israel completed an anonymous online questionnaire.
  
  
  METHODS
  Clinicians were randomly assigned to read one of two versions of a vignette describing the case of a pregnant woman. The two versions differed only with regard to the method of conception (ART; n = 78 versus spontaneous; n = 85). Clinicians were asked to provide their recommendations regarding amniocentesis.
  
  
  RESULTS
  The response rate among all clinicians invited to complete the questionnaire was 16.7%. Of the 85 clinicians presented with the spontaneous pregnancy scenario, 37 (43.5%) recommended amniocentesis. In contrast, of the 78 clinicians presented with the ART pregnancy scenario, only 15 (19.2%) recommended the test. Clinicians were 3.2 (95% confidence interval [CI]: 1.6-6.6) times more likely to recommend amniocentesis for a spontaneous pregnancy than for an ART pregnancy.
  
  
  CONCLUSIONS
  The study is limited by a low response rate, the relatively small sample and the hypothetical nature of the decision, as clinician recommendations may have differed in an actual clinical setting.
  
  
  CONCLUSIONS
  Our findings show that fertility history and use of ART may affect clinicians' recommendations regarding amniocentesis following receipt of screening test results. This raises the question of how subjective factors influence clinicians' decisions regarding other aspects of pregnancy management.
  There was no funding source to this study. The authors declare no conflicts of interest.
authors.affiliation: Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, the Hebrew University, Jerusalem 91031, Israel.
authors.forename: Naama
authors.initials: N
authors.lastname: Srebnik
authors.forename: Talya
authors.initials: T
authors.lastname: Miron-Shatz
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rolison
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Hanoch
authors.forename: Avi
authors.initials: A
authors.lastname: Tsafrir
mesh_terms: D000328:Adult; D000649:Amniocentesis / Q000523:psychology*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D010820:Physicians / Q000523:psychology; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted / Q000523:psychology*; D018570:Risk Assessment; D011795:Surveys and Questionnaires
keywords: ART; decision making; infertility; prenatal diagnosis; prenatal screening