Initial Generalist Versus Subspecialist Provider for Fertility Treatment, Use of In Vitro Fertiliation, and Time to Pregnancy

Abstract

Background and Significance: Infertility is a common problem in the United States. Infertility is recognized as a disease by the World Health Organization (WHO) and is identified as an emerging public health priority by the Centers for Disease Control (CDC). It is also associated with numerous effects on women’s physical and emotional health, and involves treatment methods that are medically invasive and associated with health implications for the resulting children. A better understanding of the role of generalist providers in the management of infertility may lead to opportunities to promote a balanced approach to infertility. Research Questions: 1) With what types of providers do most women initiate infertility care? 2) How do women who enter care with a generalist provider differ from those who enter care with a fertility subspecialist? 3) Are different outcomes associated with presenting first to a generalist provider versus a fertility subspecialist? Methods: We analyzed mixed-mode questionnaire data from 279 Utah women with primary infertility enrolled through population-based sampling. We compared women presenting first to generalist providers with women presenting first to fertility subspecialists, with the main outcomes of receiving in vitro fertilization (IVF), time to pregnancy, and live birth. Results: The first point of contact for most women (84%) with infertility was a generalist provider. Only 5% of women sought care initially from a fertility subspecialist, and these women were more likely to have higher incomes, be older, and have been trying to conceive for longer periods of time before seeking care. Women who presented first to a generalist provider were less likely to receive IVF (aOR 0.17; 95% CI: 0.05, 0.57), were equally likely to achieve a pregnancy, and had similar times to pregnancy (aHR 0.80; 95% CI: 0.38, 1.69) as women who presented first to a subspecialist, after controlling for age, time attempting to conceive before seeking care, and income. Conclusion: In this population-based sample of women with primary infertility, presenting first to a generalist was associated with a decreased likelihood of receiving IVF and a similar time to pregnancy. Generalist providers are frequently the first point of care for women with difficulty conceiving and are uniquely positioned to promote a balanced management of infertility.