Omurtag Kenan, Grindler Natalia M, Roehl Kimberly A, Bates G Wright, Beltsos Angeline N, Odem Randall R, Jungheim Emily S
Washington University School of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, United States.
Washington University School of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, United States.
Reprod Biomed Online. 2014 Jul;29(1):131-5. doi: 10.1016/j.rbmo.2014.03.007. Epub 2014 Mar 24.
The aim of this study was to determine whether practice in states with infertility insurance mandates is associated with physician-reported practice patterns regarding hydrosalpinx management in assisted reproduction clinics. A cross-sectional, internet-based survey of 442 members of Society for Reproductive Endocrinology and Infertility or Society of Reproductive Surgeons was performed. Physicians practising in states without infertility insurance mandates were more likely to report performing diagnostic surgery after an inconclusive hysterosalpingogram than physicians practising in states with mandates (RR 1.2, 95% CI 1.1-1.3, P < 0.01). Additionally, respondents in states without mandates were more likely to report that, due to lack of infertility insurance coverage, they did not perform salpingectomy (SPX) or proximal tubal occlusion (PTO) before assisted reproduction treatment (RR 1.4, 95% CI 1.1-1.8, P = 0.01). Finally, respondents in states without mandates were less likely to report that the presence of assisted reproduction treatment coverage determined the urgency with which they pursued SPX or PTO before treatment (RR 0.7, 95% CI 0.5-1.0, NS). These results persisted after controlling for physician years in practice, age and clinic volume. In conclusion, self-reported physician practice interventions for hydrosalpinges before assisted reproduction treatment may be associated with state-mandated infertility insurance. Fallopian tube dysfunction is a known cause of infertility and severe dysfunction is manifested by dilation and occlusion, known as hydrosalpinx. Outcomes with assisted reproductive techniques (ART) are lower when hydrosalpinges are present and while there are several theories for this, reproductive specialist recommend "neutralizing" the tube either by occlusion or removal in order to enhance pregnancy rates. In the United States, coverage for infertility services is not uniform with only 15 states having some legislation requiring infertility benefits. Some states where ART is covered liberally, physicians might have different practice patterns related to the neutralization of hydrosalpinges compared to those who are in non -mandated states. We utilized a survey of over 400 providers in the United States to examine their practice patterns as it relates to hydrosalpinges based on which state they practice in and whether or not that state has mandated coverage of not.
本研究的目的是确定在有不孕不育保险强制规定的州的执业情况是否与医生报告的辅助生殖诊所中关于输卵管积水管理的执业模式相关。对442名生殖内分泌与不孕学会或生殖外科学会成员进行了一项基于互联网的横断面调查。在没有不孕不育保险强制规定的州执业的医生比在有强制规定的州执业的医生更有可能报告在子宫输卵管造影结果不明确后进行诊断性手术（相对危险度1.2，95%可信区间1.1 - 1.3，P < 0.01）。此外，在没有强制规定的州的受访者更有可能报告，由于缺乏不孕不育保险覆盖，他们在辅助生殖治疗前不进行输卵管切除术（SPX）或近端输卵管阻塞术（PTO）（相对危险度1.4，95%可信区间1.1 - 1.8，P = 0.01）。最后，在没有强制规定的州的受访者不太可能报告辅助生殖治疗覆盖的存在决定了他们在治疗前进行SPX或PTO的紧迫性（相对危险度0.7，95%可信区间0.5 - 1.0，无统计学意义）。在控制了医生的执业年限、年龄和诊所工作量后，这些结果仍然存在。总之，辅助生殖治疗前医生对输卵管积水的自我报告的执业干预可能与州强制规定的不孕不育保险有关。输卵管功能障碍是已知的不孕原因，严重功能障碍表现为扩张和阻塞，即输卵管积水。当存在输卵管积水时，辅助生殖技术（ART）的成功率较低，虽然对此有几种理论，但生殖专家建议通过阻塞或切除来“中和”输卵管以提高妊娠率。在美国，不孕不育服务的覆盖并不统一，只有15个州有一些要求提供不孕不育福利的立法。在一些对ART覆盖宽松的州，与那些在没有强制规定的州的医生相比，医生在输卵管积水“中和”方面可能有不同的执业模式。我们对美国400多名提供者进行了一项调查，以根据他们所在的州以及该州是否有强制覆盖规定来检查他们与输卵管积水相关的执业模式。
