Efficacy of intrauterine inseminations as a training modality for performing embryo transfer in reproductive endocrinology and infertility fellowship programs

Capsule:
Pregnancy rates for the first 100 ETs performed by reproductive endocrinology and infertility fellows were unchanged after an IUI training requirement. The substantial variation noted among fellows decreased as more ETs were completed.

Authors:
Divya K. Shah, M.D., Stacey A. Missmer, Sc.D., Katharine F.B. Correia, M.A., Catherine Racowsky, Ph.D., Elizabeth Ginsburg, M.D.

Volume 100, Issue 2, Pages 386-391, August 2013

Abstract:

Objective:
To assess pregnancy rates before and after a training intervention in which reproductive endocrinology and infertility fellows were required to perform 100 IUIs before performing ETs.

Design:
Retrospective cohort study.

Setting:
Large, academic training program.

Patient(s):
Not applicable.

Intervention(s):
Comparing pregnancy rates between two time periods: July 1998–June 2001 (before IUI intervention) and July 2001–June 2010 (after IUI intervention).

Main Outcome Measure(s):
Clinical pregnancy rate (PR) for the first 100 ETs performed by fellows before and after the IUI training; median attending physician PR during each time period served as the referent. Multivariate generalized estimating equations were used to calculate odds of pregnancy per ET for fellows as compared with attending physicians.

Result(s):
Multivariate analyses revealed no significant difference in PR for the first 100 ETs performed by fellows as compared with attending physicians, before or after the IUI training requirement (odds ratio 0.99, 95% confidence interval 0.82–1.20 and odds ratio 0.91, 95% confidence interval 0.81–1.30, respectively). The median attending physician PR in the preintervention group was exceeded by fellows after the first 70 ETs; fellows in the postintervention group exceeded the median attending physician PR after 100 ETs. The PR in both groups improved as fellows progressed from the first 20 to 100 ETs.

Conclusion(s):
The PR for the first 100 ETs performed by fellows was unchanged after implementing an IUI training requirement. The substantial variation noted among individual fellows decreased as more ETs were completed.

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