No Difference Between Female Physicians, Nonphysicians in Assisted Reproduction Outcomes
Key findings
- Female physicians tend to delay childbearing and have higher rates of infertility and pregnancy complications than nonphysicians
- In a study, Mass General Brigham researchers retrospectively evaluated data from fresh and frozen in vitro fertilization (IVF) cycles completed for patients seeking treatment of infertility
- They found that pregnancy outcomes for female physicians were as good as or better than those of female nonphysicians
Previous studies have documented that female physicians tend to delay childbearing longer than female nonphysicians do and have higher rates of infertility, use of assisted reproduction technology, and pregnancy complications.
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However, when female physicians undertake assisted reproduction, their pregnancy outcomes are similar to those of nonphysicians, as reported by Anna C. Vanderhoff, MD, formerly of the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital, and Erika Rangel, MD, a surgeon at Massachusetts General Hospital, and colleagues in Obstetrics & Gynecology.
Methods
The researchers retrospectively evaluated data from all fresh and frozen in vitro fertilization (IVF) cycles completed for patients seeking treatment of infertility at the Brigham center between January 1, 2015, and March 31, 2022. Information about occupation is routinely recorded in the center’s database, and for this study it was dichotomized as physician or nonphysician.
Demographic and Baseline Characteristics
The study included 248 female physicians (427 fresh or stimulated IVF cycles, 533 frozen or frozen embryo transfer cycles) and 3,470 female nonphysicians (5,534 IVF cycles, 7,253 embryo transfer cycles). The two groups were similar in mean age and had similar baseline ovarian reserve parameters.
Compared with nonphysicians, physicians had significantly lower body mass index, were significantly more likely to be Asian, and had a higher rate of unexplained infertility, but the two groups were similar in other infertility diagnoses.
Cycle Characteristics
Physicians and nonphysicians were equally likely to undergo good rather than poor responder protocols. Physicians were more likely to use assisted hatching, preimplantation genetic testing for aneuploidy, and donor eggs. The two groups were equally likely to use donor sperm and intracytoplasmic sperm injection.
Physicians and nonphysicians were similar with respect to:
- Number of oocytes retrieved
- Oocyte maturity rates
- Mean number of fertilized embryos and blastocysts per stimulation
- Embryo transfer rates
- Percentage of blastocyst-stage embryo transfers
- Mean number of blastocysts transferred per cycle
- Number of cleavage-stage embryos transferred per cycle
Pregnancy Outcomes
The primary outcome was live-birth rate (at or beyond 24 weeks of gestation) per embryo transfer cycle. Most laboratory and pregnancy outcomes did not differ significantly between groups:
- Live-birth rate per transfer cycle—Physicians 39% vs. nonphysicians 38.2% (adjusted RR, 1.01; 95% CI, 0.91–1.13)
- Cumulative live birth rate per cycle start—44.6% vs. 44.2% (aRR, 1.11; 95% CI, 1.00–1.24)
- Implantation rate—34.7% vs. 33.7% (RR, 1.03; 95% CI, 0.94–1.14)
- Rate of early pregnancy loss per transfer—21.9% vs. 19.8% (aRR, 1.18; 95% CI, 0.99–1.41)
- Number of stimulated cycles—1.73 vs. 1.59 (P=0.24)
- Number of transfer cycles—2.15 vs. 2.09 (P=0.99)
Perhaps because of better ability to navigate the medical system, physicians experienced a faster time to pregnancy (21.82 vs. 25.16 weeks for nonphysicians; aRR, 0.86; 95% CI, 0.83–0.89). After controlling for preterm birth, physicians also had a slightly faster time to first delivery (56 vs. 58 weeks; aRR 0.96; 95% CI, 0.94–0.98).
Helping Physicians Increase Family-building Opportunities
Despite their high medical literacy, physicians may have limited understanding of the natural decline in fertility with age. Additionally, physicians in their prime childbearing years often face limited insurance coverage for infertility treatment and have little protected time off to undergo assisted reproduction.
Medical school should include education about the natural decline in fertility with age, and financial and clinical-duty coverage should be provided for fertility workup and treatment at early career stages. Notably, Massachusetts (the state where patients in this study received care) has an insurance mandate for infertility coverage.
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