Infertility treatment and informed consent: Current practices of reproductive endocrinologists

Objective: To determine current practice patterns of obtaining informed con sent for infertility treatment by reproductive endocrinologists and to asse ss changes in response to reports of an association between ovulation induc tion and ovarian cancer. Methods: Board-certified reproductive endocrinologists (n = 575) were surve yed by mail regarding how they informed patients and obtained consent for i nfertility treatments and how their practices had been influenced by studie s suggesting a link between ovulation induction and ovarian cancer. Data we re analyzed using chi(2) and logistic regression analyses. Results: The return rate was 62.1% (357 of 575 surveys). Most respondents ( 92%) used discussions with physicians to inform their patients of risks and benefits of all infertility treatments. Additional means, such as audiovis ual aids, were used significantly more often for assisted reproductive tech nologies (including intracytoplasmic sperm injection and use of donated egg s) than for less invasive therapies (31-43% versus 4-11%, P <.001). Most ph ysicians (46-66%) used verbal consent alone for hysterosalpingogram, intrau terine insemination, and ovulation induction. Formal written consent was us ed significantly more often for the various assisted reproductive technolog ies than for hysterosalpingogram, intrauterine insemination, or ovulation i nduction (94-95% versus 26-44%). Although most physicians (70%) did not bel ieve that ovulation induction increases the risk of ovarian cancer, 83% add ressed this risk when obtaining consent and 47% reported changing their pra ctices since an association was reported. Common changes included limiting length of treatment and addressing ovarian cancer risk. Conclusion: Current practice patterns of obtaining informed consent for var ious infertility treatments by board-certified reproductive endocrinologist s show, as expected, that informed consent is more rigorous for assisted re productive technologies. Although most surveyed did not believe that ovulat ion induction increases risk of ovarian cancer, the majority of physicians addressed that risk when obtaining consent and nearly half changed their pr actices on the basis of a possible association. (Obstet Gynecol 1999;93: 25 2-7. (C) 1999 by The American College of Obstetricians and Gynecologists.).