AHRQ Report: Comparative Effectiveness and Safety of Treatments for Common Causes of Infertility
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. State the goal of the AHRQ infertility systematic review 2. Discuss the key findings in the AHRQ infertility management review
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 7/1/2019 through 1/25/2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the test and evaluation. Upon registering and successfully completing the test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
The AHRQ released a systematic review with the goal of evaluating the comparative effectiveness and safety of treatments for common causes of infertility. Previous studies often did not separate outcomes based on diagnoses. This systematic review focuses on the following clinical scenarios
Women ages 18–44, with infertility due to
Tubal or peritoneal factors
Couples with male factor infertility
56 for PCOS | 7 for endometriosis | 50 for
infertility secondary to unknown causes | 8 for tubal/peritoneal factor | 23
for male factor | 5 for outcomes in male and female gamete donors
21 studies where findings were relevant across
all infertility diagnose
Letrozole vs clomiphene results in (moderate strength
Higher live birth rates
Reduced multiple births
No difference in ectopic pregnancies
Metformin vs clomiphene (moderate strength
No differences in outcomes when used as primary
Laparoscopic ovarian drilling vs oral agents
(moderate strength evidence)
No difference in live birth rates
Immediate IVF vs starting clomiphene and IUI or gonadotropins and IUI, followed by IVF as necessary (moderate strength evidence)
Shorter time to pregnancy
Likely no differences for other outcomes including
ICSI vs and intracytoplasmic morphological sperm injection (not used in the US)
No difference in live birth rate (moderate strength evidence)
No difference in miscarriage rate (low strength evidence)
GnRH agonist trigger vs hCG trigger (low strength
Lower incidence of ovarian hyperstimulation syndrome
Limited evidence regarding specific comparisons for tubal factor or endometriosis-related infertility
Lower live birth rates for African-Americans compared with other racial/ethnic groups (low strength evidence)
Single embryo transfer (low strength evidence)
Lower live birth rates
Significant reductions in multiple birth rates
Maternal cancers and ART (low strength evidence)
No increase in most maternal cancers after ART treatment after adjustment for infertility in general or specific causes
Children born after ART (low strength evidence)
Possible increased risk of neurodevelopmental disorders after ICSI compared with IVF alone
No difference in overall cancer incidence
The Evidence Summary states
In general, our current review’s findings are consistent with the NICE and ASRM guidelines— there is a general consensus that the overall body of evidence for many aspects of infertility treatment across all patient groups is limited. One consistent limitation is the relative paucity of studies utilizing live birth per couple as the primary outcome
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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