title: A Focus on Maternal Health Before Assisted Reproduction: Results From a Pilot Survey of Canadian IVF Medical Directors.
abstract: OBJECTIVE
  To describe current physician practice patterns in Canada with regard to performing in vitro fertilization in high-risk patients.
  
  
  METHODS
  All medical directors of IVF clinics registered with the Canadian Fertility and Andrology Society (n=35) were invited to participate in an online survey between January and May 2014. We carried out descriptive analyses of participants' responses regarding implementation of local restrictive policies for access to IVF. Whether practice patterns differed in hospital versus community-based clinics was assessed using chi-square testing with significance set at alpha<0.05.
  
  
  RESULTS
  The response rate was 77.1%. More than one half of clinics (55.6%) were university-affiliated, and 29.6% were hospital-based. The majority of respondents (70.4%) used an upper age limit for permitting IVF (median 50 years, IQR 44 to 50), mostly because of lower pregnancy and live birth rates. Approximately one half of respondents limited treatment according to BMI (median upper permitted BMI 38 kg/m2, IQR 35 to 40 kg/m2) to minimize complications during pregnancy. Most respondents (77.8%) believed that routine pre-IVF medical assessment would be useful in their daily practice. There was a non-significant trend towards more restrictive policies in hospital-based clinics compared with community-based clinics.
  
  
  CONCLUSIONS
  Our findings confirm that Canadian reproductive medicine physicians are taking maternal health factors into consideration when assessing patients' suitability for IVF. Nevertheless, there is between-clinic variability in the parameters used to assess eligibility for treatment. In light of the changing maternal demographic, more research is needed on assisted reproductive technology and perinatal outcomes in women who are at risk for pregnancy complications.
authors.affiliation: Department of Medicine, Division of General Internal Medicine, McGill University Health Centre, Montreal QC; LifeQuest Centre for Reproductive Medicine, University of Toronto, Toronto ON; Departments of Medicine and Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON.
authors.forename: Natalie
authors.initials: N
authors.lastname: Dayan
authors.affiliation: LifeQuest Centre for Reproductive Medicine, University of Toronto, Toronto ON.
authors.forename: Karen
authors.initials: K
authors.lastname: Spitzer
authors.affiliation: LifeQuest Centre for Reproductive Medicine, University of Toronto, Toronto ON; Departments of Medicine and Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON.
authors.forename: Carl A
authors.initials: CA
authors.lastname: Laskin
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002170:Canada; D005307:Fertilization in Vitro; D019538:Health Care Surveys; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D018579:Patient Selection; D008486:Physician Executives; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D016742:Preconception Care; D018570:Risk Assessment
keywords: ART; IVF; assisted reproductive technology; in vitro fertilization; maternal health; physician practice patterns; survey; women’s health