{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:49:08Z","timestamp":1789192148153,"version":"build-2803163510"},"reference-count":31,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP1147872"],"award-info":[{"award-number":["APP1147872"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001075","name":"Channel 7 Children\u2019s Research Foundation","doi-asserted-by":"crossref","award":["CRF-210323"],"award-info":[{"award-number":["CRF-210323"]}],"id":[{"id":"10.13039\/501100001075","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,12,18]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To examine longitudinal trends in infertility management in women attending general practice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Cohort study using the national general practice dataset, MedicineInsight.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Australian general practice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention(s)<\/jats:title>\n                  <jats:p>Not applicable.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>The cohort included 2 552 339\u2009women aged 18\u201349 years with one or more general practice clinical encounters between January 2011 and December 2021.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures(s)<\/jats:title>\n                  <jats:p>The primary outcome assessed was the proportion of women who had a clinical encounter related to infertility, stratified by year and age group. Second, the proportions of women receiving relevant clinical management actions, including selected pathology tests, imaging ordered and selected medications, were calculated. Univariable logistic regression analyses compared the likelihood of women having a documented clinical encounter related to infertility and receiving selected management actions based on individual characteristics. We also examined practice-level variation in the proportion receiving selected management for infertility by stratifying proportions based on practice site.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 2 552 339\u2009women had one or more clinical encounters with their general practitioner (GP) between January 2011 and December 2021, of which 27\u2009671 (1.1%) had a clinical encounter related to infertility management. The rate of infertility encounters increased from 3.4 per 1000 in 2011 to 5.7 per 1000 in 2021. Over episodes of care, half (50.9%) of women presenting for an infertility encounter had at least one specified pathology test, and almost a quarter (23.1%) had a specified imaging test. A relatively small proportion of infertility encounters (5.4%) resulted in prescribing of a selected infertility medication by the GP.<\/jats:p>\n                  <jats:p>Large variation in clinical management (pathology, imaging and medication prescribing) was evident according to both individual characteristics and also at the clinical-practice level. Factors associated with increased likelihood of being provided infertility medications included younger age, holding a Commonwealth concession card (indicating low income), lower socioeconomic status and living outside a major city.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Clinical encounters related to infertility are increasing in primary care, with large variation evident in corresponding clinical management. These findings support the development of clinical practice guidelines to enhance standardised and equitable approaches towards the management of infertility in primary care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-085149","type":"journal-article","created":{"date-parts":[[2025,2,2]],"date-time":"2025-02-02T09:05:22Z","timestamp":1738487122000},"page":"e085149","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Trends in clinical encounters and management for infertility among women attending Australian general practice: a national longitudinal study using MedicineInsight, 2011 to 2021"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2617-2989","authenticated-orcid":false,"given":"Renae C","family":"Fernandez","sequence":"first","affiliation":[{"name":"Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia"},{"name":"Discipline of Obstetrics and Gynaecology, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivienne","family":"Moore","sequence":"additional","affiliation":[{"name":"Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia"},{"name":"School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Boyle","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia"},{"name":"Department of General Practice, Monash University, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice R","family":"Rumbold","sequence":"additional","affiliation":[{"name":"Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia"},{"name":"South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Davies","sequence":"additional","affiliation":[{"name":"Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia"},{"name":"Discipline of Obstetrics and Gynaecology, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Mazza","sequence":"additional","affiliation":[{"name":"Department of General Practice, Monash University, Clayton, Victoria, Australia"},{"name":"SPHERE NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8554-4696","authenticated-orcid":false,"given":"Luke E","family":"Grzeskowiak","sequence":"additional","affiliation":[{"name":"South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"},{"name":"College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,2]]},"reference":[{"key":"2025101811581963000_15.2.e085149.1","doi-asserted-by":"crossref","DOI":"10.1093\/hropen\/hoac051","article-title":"Infertility prevalence and the methods of estimation from 1990 to 2021: a systematic review and meta-analysis","volume":"2022","author":"Cox","year":"2022","journal-title":"Hum Reprod Open"},{"key":"2025101811581963000_15.2.e085149.2","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dex234"},{"key":"2025101811581963000_15.2.e085149.3","doi-asserted-by":"publisher","DOI":"10.1001\/JAMA.2021.4788"},{"key":"2025101811581963000_15.2.e085149.4","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/"},{"key":"2025101811581963000_15.2.e085149.5","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.metabol.2018.09.005","article-title":"The epidemiology of obesity","volume":"92","author":"Chooi","year":"2019","journal-title":"Metab Clin Exp"},{"key":"2025101811581963000_15.2.e085149.6","unstructured":"Organisation for economic co- operation and development. sf2.3: age of mothers at childbirth and age- specific fertility. OECD family database; 2023. Available: https:\/\/www.oecd.org\/els\/soc\/SF_2_3_Age_mothers_childbirth.pdf"},{"key":"2025101811581963000_15.2.e085149.7","doi-asserted-by":"crossref","unstructured":"Thoma M , Fledderjohann J , Cox C , et al . Biological and social aspects of human infertility: a global perspective. In: Oxford Research Encyclopedia of Global Public Health. 2021. Available: https:\/\/oxfordre.com\/publichealth\/view\/10.1093\/acrefore\/9780190632366.001.0001\/acrefore-9780190632366-e-184 [accessed 18 Jul 2023].","DOI":"10.1093\/acrefore\/9780190632366.013.184"},{"key":"2025101811581963000_15.2.e085149.8","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dew123"},{"key":"2025101811581963000_15.2.e085149.9","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deq305"},{"key":"2025101811581963000_15.2.e085149.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.f650","article-title":"Fertility (update): summary of NICE guidance","volume":"346","author":"Fields","year":"2013","journal-title":"BMJ"},{"key":"2025101811581963000_15.2.e085149.11","doi-asserted-by":"crossref","first-page":"389","DOI":"10.5694\/mja2.52432","article-title":"Summary of the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome: an Australian perspective","volume":"221","author":"Teede","year":"2024","journal-title":"Med J Aust"},{"key":"2025101811581963000_15.2.e085149.12","unstructured":"Britt H MG , Bayram C , Henderson J , et al . A Decade of Australian General Practice Activity 2006\u201307 to 2015\u201316. Sydney: Sydney University Press, 2016. Available: http:\/\/purl.library.usyd.edu.au\/sup\/9781743325155"},{"key":"2025101811581963000_15.2.e085149.13","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1093\/humrep\/dez172","article-title":"Infertility management in women and men attending primary care-patient characteristics, management actions and referrals","volume":"34","author":"Chambers","year":"2019","journal-title":"Hum Reprod"},{"key":"2025101811581963000_15.2.e085149.14","first-page":"104","article-title":"Management of infertility in Australian general practice","volume":"34","author":"Charles","year":"2005","journal-title":"Aust Fam Physician"},{"key":"2025101811581963000_15.2.e085149.15","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz147"},{"key":"2025101811581963000_15.2.e085149.16","unstructured":"MedicineInsight . General practice insights report: july 2018\u2013 june 2019. Sydney NPS MedicineWise; 2020."},{"key":"2025101811581963000_15.2.e085149.17","unstructured":"Australian Bureau of Statistics . Socio-Economic Indexes for Areas (SEIFA): Technical Paper. Canberra: ABS; 2021. Available: https:\/\/www.abs.gov.au\/statistics\/people\/people-and-communities\/socio-economic-indexes-areas-seifa-australia\/latest-release [Accessed 18 Jul 2023]."},{"key":"2025101811581963000_15.2.e085149.18","unstructured":"Australian Commission on Safety and Quality in Health Care . MedicineInsight Sydney: ACSQHC. 2024. Available: https:\/\/www.safetyandquality.gov.au\/our-work\/indicators-measurement-and-reporting\/medicineinsight#practice-reconsent [Accessed 28 Nov 2024]."},{"key":"2025101811581963000_15.2.e085149.19","unstructured":"Australian Institute of Health and Welfare . Australia\u2019s mothers and babies. Canberra: AIHW; 2023. Available: https:\/\/www.aihw.gov.au\/reports\/mothers-babies\/australias-mothers-babies\/contents\/demographics-of-mothers-and-babies\/key-statistics-and-trends"},{"key":"2025101811581963000_15.2.e085149.20","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/des451"},{"key":"2025101811581963000_15.2.e085149.21","doi-asserted-by":"crossref","first-page":"113782","DOI":"10.1016\/j.socscimed.2021.113782","article-title":"Factors associated with medical help-seeking for infertility in developed countries: A narrative review of recent literature","volume":"277","author":"Passet-Wittig","year":"2021","journal-title":"Soc Sci Med"},{"key":"2025101811581963000_15.2.e085149.22","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1007\/s10995-018-2567-1","article-title":"Socioeconomic Position and Reproduction: Findings from the Australian Longitudinal Study on Women\u2019s Health","volume":"22","author":"Holowko","year":"2018","journal-title":"Matern Child Health J"},{"key":"2025101811581963000_15.2.e085149.23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0170170","article-title":"Life-Course Relationship between Socioeconomic Circumstances and Timing of First Birth in a Birth Cohort","volume":"12","author":"van Roode","year":"2017","journal-title":"PLoS One"},{"key":"2025101811581963000_15.2.e085149.24","article-title":"Infertility: management in Australian general practice","volume":"41","author":"Zhang","year":"2012","journal-title":"Aust Fam Physician"},{"key":"2025101811581963000_15.2.e085149.25","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1093\/humrep\/dex060","article-title":"General practitioners\u2019 adherence to work-up and referral recommendations in fertility care","volume":"32","author":"van der Pluijm-Schouten","year":"2017","journal-title":"Hum Reprod"},{"key":"2025101811581963000_15.2.e085149.26","doi-asserted-by":"crossref","DOI":"10.1093\/hropen\/hoaa065","article-title":"On estimating the prevalence of use of medically assisted reproduction in developed countries: a critical review of recent literature","volume":"2021","author":"Passet-Wittig","year":"2021","journal-title":"Hum Reprod Open"},{"key":"2025101811581963000_15.2.e085149.27","doi-asserted-by":"crossref","unstructured":"Wyns C , Bergh C , et al . The European IVF-monitoring Consortium for the European Society of Human Reproduction and Embryology. Hum Reprod Open 2020. doi:10.1093\/hropen\/hoaa032","DOI":"10.1093\/hropen\/hoaa032"},{"key":"2025101811581963000_15.2.e085149.28","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1046\/j.1464-410x.1999.00081.x","article-title":"Guideline Summary No. 2:the initial investigation and management of the infertile couple*","volume":"83","year":"1999","journal-title":"BJU Int"},{"key":"2025101811581963000_15.2.e085149.29","doi-asserted-by":"publisher","DOI":"10.1080\/14647270600939937"},{"key":"2025101811581963000_15.2.e085149.30","doi-asserted-by":"crossref","first-page":"289","DOI":"10.31128\/AJGP-11-17-4413","article-title":"How common is multiple general practice attendance in Australia?","volume":"47","author":"Wright","year":"2018","journal-title":"Aust J Gen Pract"},{"key":"2025101811581963000_15.2.e085149.31","unstructured":"Mina R , Thistlethwaite J , Belcher J , et al . MedicineInsight report: validation of the medicineinsight database: completeness, generalisability and plausibility. Sydney NPS MedicineWise; 2020."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-085149","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T18:58:29Z","timestamp":1760813909000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-085149"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,2]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bmjopen-2024-085149"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-085149","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}