Outcomes from a trainee-run ovulation induction program at a large urban safety net hospital

To improve access to fertility care at the largest safety net hospital in New York City, fellows and residents run a reproductive endocrinology and infertility clinic that supports an ovulation induction (OI) program under attending physician supervision. Our objective was to evaluate OI pregnancy outcomes to describe the program's efficacy and guide quality improvement.

We performed a descriptive study of patients who completed at least one OI cycle from 6/1/2019 to 4/1/2023. Fellows and residents managed patient care, including the prescription of an OI agent (clomiphene citrate or letrozole), ultrasound monitoring, and trigger (human chorionic gonadotropin) followed by timed intercourse (TIC) or intrauterine insemination (IUI). Primary outcomes included the overall pregnancy rate (PR) and live birth rate (LBR).

Two hundred twenty-eight patients were prescribed OI agents during the study period. Of these, 161 patients (70.6%) completed at least one OI cycle and were not lost to follow up. The PR and LBR per patient were 21.1% (34/161) and 11.2% (18/161). The PR and LBR per cycle were 9.0% (34/379) and 4.7% (18/379). Patients who achieved a pregnancy were younger (median 32.5 years vs. 36 years, p < 0.002), had a higher AMH (median 3.2 vs. 2.1 ng/mL, p < 0.03), and were more likely to have PCOS (35.3% vs. 18.9%, p < 0.04). Among the 228 patients ever-prescribed an OI agent, there were 22 (9.6%) patients with pregnancies that occurred without OI treatment.

PRs from this low-resource OI program are comparable to published data, demonstrating that fellow and resident-run initiatives can be successful in bridging the gap in fertility care.