March 25, 2010 — Summary of "Perceptions of Women's Infertility: What Do Physicians See?" Ceballo et al., Fertility and Sterility, March 2010.
According to Rosario Ceballo of the University of Michigan and colleagues, research shows that African-American, less-educated and lower-income couples are more likely than other couples to experience infertility. However, attainment of medical treatment for infertility is most closely associated with age, being married, graduating from college, having a high income and being non-Hispanic white. Thus, there is a "startling mismatch" between women who most need care for infertility and those who most often receive it, the authors write.
Ceballo and colleagues designed a study to assess physicians' awareness of the infertility risks associated with race, age and education. It also sought to assess physicians' clinical management recommendations for a hypothetical patient. Researchers mailed a three-page, anonymous and confidential survey to 1,000 randomly selected physicians in Michigan, and 205 surveys were returned.
The surveyed included questions about the relative prevalence of infertility among women of various races, education levels and ages. It also asked what interventions a physician would recommend for one of four hypothetical female infertility patients: a European-American professional, a European-American Medicaid beneficiary, an African-American professional and an African-American Medicaid beneficiary.
Of the 155 participants who responded to a question about which racial group is most at risk for infertility, 16% correctly answered that African Americans have the highest prevalence. Similarly, only 13% of the 150 participants who responded to a question about infertility prevalence across various education levels correctly stated that women without a high school degree are the most at risk for infertility in that category. Thirty-one percent answered that women with college degrees are the most at risk for infertility, while 40% said women with professional degrees.
A larger percentage of physicians -- 43% -- correctly answered that people older than age 35 are the most at risk for infertility. According to the study, only two physicians answered all three questions correctly, while 44% of the 135 physicians who responded to all three questions did not correctly answer any questions.
On the portion of the survey that assessed interventions for a hypothetical patient, 16% of physicians said they would provide the full medical standard of care for the patient. Physicians were more likely to endorse other types of intervention, such as recommending educational reading or referring the patient to a specialist.
The extent to which physicians recommended the medical standard of care or non-medical interventions did not vary based on patients' race or socioeconomic status. Physicians' referrals to specialists did not vary by a patient's race, but physicians were more likely to refer the professional female patient to a specialist than to refer the Medicaid beneficiary to a specialist. Female physicians, ob-gyns and physicians with more infertility experience or more infertility patients were more likely to recommend medical standards of care.
The authors write, "It is not surprising that many physicians are unaware of the most common risk profile for infertility given societal portrayals of infertile women as hard-driving professionals in their 30s," typically of European American descent. They continue, "These findings demonstrate the importance of providing more information to physicians who are not infertility specialists about the characteristics of women with infertility and the unfortunate discontinuity between those who are most likely to seek treatment and those who are most likely to be experiencing a problem becoming pregnant."
The finding that "[p]hysicians were less likely to provide referrals to specialists when they were told that the hypothetical patient relied upon Medicaid ... is understandable given the great expense of specialized infertility services and the lack of Medicaid insurance coverage for such services," the authors state.
Noting that female physicians and ob-gyns "recommended more of the medical tests incorporated in the medical standard of care," the authors write that "[t]hese results highlight the importance of attending to the demographic characteristics among all people involved in medical exchanges." They add, "In the complex and dynamic encounters between patients and physicians, we cannot ignore the demographic characteristics of the physicians themselves."