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Prospectus: Assessment of Pregnancy Outcomes Following Intrauterine Insemination: Influence of Provider Status on Success Rates

Resident: Blaire Scott, MD

Faculty Advisor: LaTasha Craig, MD

Contributing Authors: Elizabeth Wolfe, MD; Jennifer Peck, PhD; Utty Phuong Steward, MD; Lena Do, MS4; Rachel Goode; Lauren Oliver, MD; M. Blake Evans, DO

Background

Intrauterine insemination (IUI) is a common, office-based fertility procedure traditionally performed by attending Reproductive Endocrinologists and fellows. In many clinical settings, the provider pool has expanded to include advanced practice providers (APPs) and registered nurses (RNs), however the impact on cycle outcomes has not been well studied. Ensuring consistent, high-quality care across provider types is essential. Therefore, our objective was to evaluate clinical pregnancy rates (CPR) following IUI based on provider type.

Methods

This is a retrospective cohort study that included patients who underwent ultrasound-guided IUI from November 2017 - September 2022 at a single academic institution. Demographic, cycle information, and outcome data has been obtained via chart review and stored in a HIPAA-compliant REDCap database. Data regarding who performed the IUI, type of catheter used, and perceived level of difficulty (easy, average, difficult, or impossible) was obtained via chart review. Cycles included natural cycles, as well cycles stimulated with clomiphene citrate, letrozole, or gonadotropins. Ovulation was either triggered with an HCG trigger, or allowed for natural LH surge. Exclusion criteria includes canceled IUI cycles and cycles with missing provider or outcome data. The primary outcome is clinical pregnancy rate defined as the presence of an intrauterine gestational sac with cardiac activity on ultrasound. The secondary outcome is biochemical pregnancy rate defined as a serum hCG level ≥10 mIU/ml. Risk ratios (RR) and 95% confidence intervals (CI) will be estimated using modified Poisson regression models with a log link and robust standard errors. These will be fit using generalized estimating equations (GEE) to account for within cluster correlation, with weights to adjust for informative clustering. The overall association between provider type and pregnancy outcome will be tested using a GEE-based Type 3 Wald chi-square test (p-value < 0.12), accounting for correlation of repeated cycles within patients. 

Results / Conclusion

Data collection ongoing







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