Fertility Treatment, Use of in Vitro Fertilization, and Time to Live Birth Based on Initial Provider Type.
Fertility Treatment, Use of in Vitro Fertilization, and Time to Live Birth Based on Initial Provider Type.
复制标题
生育治疗，体外受精的使用以及根据初始提供者类型的生命时间。
DOI：
10.3122/jabfm.2017.02.160184
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发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Stanford JB
中科院分区：
文献类型：
--
作者：
Boltz MW;Sanders JN;Simonsen SE;Stanford JB
探讨不孕妇女的初始临床类型（全科医生与亚专科医生）、接受的治疗类型和妊娠时间之间的关系。在一项回顾性队列设计中，我们分析了867名原发性不孕症妇女的混合模式问卷数据，这些妇女是通过基于人口和生育诊所的抽样登记的。我们比较了首先向全科医生提供者就诊的妇女与首先向生育专科医生就诊的妇女，主要结局是接受体外受精（IVF）、妊娠时间和活产。大多数（84%）不孕症妇女的第一个接触点是一个多面手提供者。只有8%的女性首先从生育专科医生那里寻求护理，这些女性更有可能年龄较大，并且在寻求护理之前一直试图怀孕更长时间。与首次就诊于专科医生的女性相比，首次就诊于全科医生的女性接受IVF的可能性较小（aOR 0.48，95% CI 0.28，0.82），实现妊娠的可能性相同，妊娠时间相似（aHR 1.11，95% CI 0.80，1.53）。通才提供者通常是怀孕困难妇女的第一个护理点，并且在促进不孕症的平衡管理方面具有独特的优势。
To explore the relationship between initial clinician type (generalist versus subspecialist) seen by infertile women, type of treatment received, and time to pregnancy. In a retrospective cohort design, we analyzed mixed-mode questionnaire data from 867 women with primary infertility enrolled through population- and fertility clinic-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. The first point of contact for most (84%) women with infertility was a generalist provider. Only 8% of women sought care first from a fertility subspecialist, and these women were more likely to be older and have been trying to conceive longer before seeking care. Women who presented first to a generalist provider were less likely to receive IVF (aOR 0.48, 95% CI 0.28, 0.82), were equally likely to achieve pregnancy, and had similar times to pregnancy (aHR 1.11, 95% CI 0.80, 1.53) compared to women who presented first to a subspecialist. 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.
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