title: Outcomes after intrauterine insemination are independent of provider type.
abstract: OBJECTIVE
  We sought to determine whether the success of intrauterine insemination (IUI) varies based on the type of health care provider performing the procedure.
  
  
  METHODS
  This was a retrospective cohort study set at an infertility clinic at an academic institution. The patients who comprised this study were 1575 women who underwent 3475 IUI cycles from late 2003 through early 2012. Cycles were stratified into 3 groups according to the type of provider who performed the procedure: attending physician, fellow physician, or registered nurse (RN). The primary outcome was live birth. Additional outcomes of interest included positive pregnancy test and clinical pregnancy. Repeated measures log binomial regression was used to estimate the risk ratios (RR) and 95% confidence intervals (CI) for the outcomes and to evaluate the effect of potential confounders. All tests were 2-sided, and P values < .05 were considered statistically significant.
  
  
  RESULTS
  Of the 3475 IUI cycles, 2030 (58.4%) were gonadotropin stimulated, 929 (26.7%) were clomiphene citrate stimulated, and 516 (14.9%) were natural. The incidences of clinical pregnancy and live birth among all cycles were 11.8% and 8.8%, respectively. After adjusting for female age, male partner age, and cycle type, the incidence of live birth was similar for RNs compared with attending physicians (RR, 0.80; 95% CI, 0.58-1.1) and fellow physicians compared with attending physicians (RR, 0.84; 95% CI, 0.58-1.2). Similar results were seen for positive pregnancy test and clinical pregnancy.
  
  
  CONCLUSIONS
  There was no significant difference in live birth following IUI cycles in which the procedure was performed by a fellow physician or RN compared with an attending physician.
authors.affiliation: Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, MA. Electronic address: randihgoldman@gmail.com.
authors.forename: Randi H
authors.initials: RH
authors.lastname: Goldman
authors.affiliation: Massachusetts General Hospital Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: Maria
authors.initials: M
authors.lastname: Batsis
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Hacker
authors.affiliation: Massachusetts General Hospital Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, MA; Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: Irene
authors.initials: I
authors.lastname: Souter
authors.affiliation: Massachusetts General Hospital Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, MA; Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: John C
authors.initials: JC
authors.lastname: Petrozza
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use*; D015331:Cohort Studies; D005180:Faculty, Medical; D005257:Fellowships and Scholarships; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D006062:Gonadotropins / Q000627:therapeutic use*; D006801:Humans; D007246:Infertility / Q000628:therapy*; D007315:Insemination, Artificial / Q000379:methods*; D050498:Live Birth; D016015:Logistic Models; D008503:Medical Staff; D009726:Nurses; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins; D002996:Clomiphene
keywords: infertility; intrauterine insemination; pregnancy rate; provider type