Perspectives on the Management of Infertility in Primary Care: A Survey of Healthcare Providers in a Regional Health Care System in Southwest Virginia

Purpose: The objective of this study is to identify current practice patterns of the primary care providers in the Carilion Clinic system for the evaluation, management, and referral of patients with infertility. Methods: A 15 question survey was emailed to primary care physicians, physician assistants, and nurse practitioners in the Carilion Clinic system. The survey included a demographic analysis of the practice, and provided questions in regards to practice patterns in the evaluation, treatment, and referral of an infertile couple. The inclusion criteria were all PCPs (family medicine, internal medicine). Exclusion criteria included any other field of medicine Results: Twenty-five percent of PCPs in the Carilion network answered the survey. Majority of responders were family medicine (80%), and physicians (80%). Fifty-five percent were female and thirty percent have been practicing medicine for more than 20 years. Half of PCPs were comfortable initiating the diagnostic evaluation of the infertile couple and of these, seventy three percent order diagnostic testing. Less than half (42%) of providers refer patients greater than age 35 that present with infertility for more than 6 months. Conclusion: This survey provides insight into the variation of practice patterns of infertility by primary care providers (PCPs). Although half of PCPs that answered our survey are comfortable initiating the evaluation of the infertile couple, they are not following the current referral guidelines. This can lead to delayed diagnosis, and decreased time to achieve pregnancy. Based on these results, an educational model may be beneficial for PCPs that are interested in the evaluation of the infertile couple.