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Awareness of the effects of postponing motherhood among hospital gynecologists: is their knowledge sufficient to offer appropriate help to patients?

  • Assisted Reproduction Technologies
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Abstract

Purpose

The aim of this study is to ascertain the awareness of hospital gynecologists about the effects of woman’s age on spontaneous fecundity and on the efficacy of assisted reproduction techniques (ARTs).

Methods

One hundred fifty-six gynecologists working in public or private Italian hospitals, without specific experience in reproductive medicine and ART, were administered a multiple-choice answer questionnaire addressing (a) the effect of age on woman’s spontaneous fecundity, (b) the tools to estimate the ovarian follicular reserve, and (c) the outcome of ART in women above 40 years.

Results

Approximately half of the interviewed gynecologists indicated the woman’s age limit for successful reproduction between 44 and 50 years; fertility lifespan was believed to be prolonged by oral contraception, pro-fertility medical treatments, or ART. The correct meaning of serum FSH measurement was known by approximately one third of the interviewed doctors. The effectiveness of ART for women of advanced age was overestimated by half of the gynecologists, especially in case of patients having regular cycles and/or small follicles at ultrasound.

Conclusions

Overall, the survey clearly showed that the knowledge of hospital gynecologists about the effects of age on woman’s fertility and ART effectiveness is largely insufficient to offer scientifically correct, helpful information to patients. Properly targeted corrections to academic and periodical educational programs for Ob/Gyn specialists are warranted.

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Author information

Authors and Affiliations

  1. Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Gynecological and Obstetrical Sciences, Sant’Anna Hospital, University of Torino, Turin, Italy

    Alberto Revelli, Alessandra Razzano, Luisa Delle Piane, Simona Casano & Chiara Benedetto

Authors
  1. Alberto Revelli
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  2. Alessandra Razzano
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  3. Luisa Delle Piane
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  4. Simona Casano
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  5. Chiara Benedetto
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Corresponding author

Correspondence to Alberto Revelli.

Additional information

Capsule

A relevant proportion of hospital gynecologists have poorer knowledge on fertility than required to properly advise patients

Appendix

Appendix

Questionnaire

Question 1

Until which age it is not rare to conceive, skip spontaneous miscarriage, and give birth for Caucasian white women?

 

Percentage of interviewed subjects giving the answer

44 years*

44

46 years

26

48 years

13

50 years

17

Question 2

Can the age threshold until which it is not rare to conceive, skip spontaneous miscarriage, and give birth be postponed by 3–4 years using one of the following medical treatments?

 

Percentage of interviewed subjects giving the answer

Use of hormones to stimulate ovulation

14

Use of in vitro fertilization (IVF)

23

Use of oral contraceptives (OCs) for at least 8 years

12

There is no treatment able to postpone the age threshold*

51

Question 3

In order to estimate the ovarian reserve of follicles and oocytes, which of the following measurements on the blood are needed?

 

Percentage of interviewed subjects giving the answer

Follicle-stimulating hormone (FSH) alone

40

FSH and luteinising hormone (LH)

7

FSH and estradiol*

44

FSH and progesterone

9

Question 4

To be a reliable indicator of the ovarian reserve of follicles and oocytes, must circulating FSH be measured at a specific time of the menstrual cycle?

 

Percentage of interviewed subjects giving the answer

Between days 8 and 14

15

Between days 14 and 21

2

Between days 2 and 5*

80

Any day of the menstrual cycle is appropriate

3

Question 5

Which is the circulating FSH threshold above which it is rare to conceive, skip spontaneous miscarriage, and give birth?

 

Percentage of interviewed subjects giving the answer

20 IU/l*

35

30 IU/l

20

40 IU/l

19

50 IU/l

26

Question 6

When circulating FSH is above the threshold (see question 5), are there situations in which the chance to conceive, skip spontaneous miscarriage, and give birth significantly improves?

 

Percentage of interviewed subjects giving the answer

When menstrual cycles are regular (26–33 days)

18

When ovulation is regularly maintained

20

When ovarian follicles may be observed at transvaginal ultrasound

13

None of the abovementioned situations significantly improve the chance to conceive*

49

Question 7

When circulating FSH is above the threshold (see question 5), does ART still offer good outcome if one of the following conditions is present?

 

Percentage of interviewed subjects giving the answer

If circulating FSH decreases after oral contraceptive administration

9

If FSH spontaneously decreases within 2 months

15

If menstrual cycles are regular (26–33 days) and follicles are seen at transvaginal ultrasound

22

None of the abovementioned situations offer the chance of a good ART outcome*

54

The correct answer is marked with an asterisk.

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Revelli, A., Razzano, A., Delle Piane, L. et al. Awareness of the effects of postponing motherhood among hospital gynecologists: is their knowledge sufficient to offer appropriate help to patients?. J Assist Reprod Genet 33, 215–220 (2016). https://doi.org/10.1007/s10815-015-0640-x

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  • DOI: https://doi.org/10.1007/s10815-015-0640-x

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