Economic Evaluation of in vitro Fertilization-Embryo Transfer (IVF-ET) and Neosalpingostomy for Bilateral Tubal Obstruction |
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| Institution: | 1. Department of Obstetrics and Gynaecology, St. Joseph’s Health Centre and University Hospital, The University of Western Ontario;1. Universidad Peruana de Ciencias Aplicadas, Escuela de Medicina, Lima, Peru;2. Universidad de San Martin de Porres, Facultad de Medicina Humana, Centro de investigación del evejecimiento (CIEN), Lima, Peru;3. Universidad Científica del Sur, Lima, Peru;4. Bamboo Senior Health Services, Lima, Peru;1. Postgraduate Medical Education, University of Toronto, Toronto, ON, Canada;2. Department of Medicine, University of Toronto, Toronto, ON, Canada;3. Evaluative Clinical Sciences, Odette Cancer Research Program, Sunnybrook Research Institute, Toronto, ON, Canada;4. Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;5. Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada;6. Princess Margaret Cancer Centre, Toronto, ON, Canada;1. Vaccines Clinical Research and Development, Pfizer Inc, Collegeville, PA;2. Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY;3. Section of Infectious Diseases, Providence Hospital, Washington, DC;4. Department of Medicine, Pulmonary Diseases Division, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina;5. Division of Pulmonary, Critical Care, and Sleep Disorders, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY;1. Assisted Conception Unit, Guys Hospital, 11th Floor, Tower Wing, Great Maze Pond, London SE1 9RT, United Kingdom;2. Royal Derby Hospital, Derby & NURTURE, University of Nottingham, Nottingham NG7 2UH, United Kingdom;1. Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculty of Medicine Pierre and Marie Curie, Sorbonne University, Paris, France;2. Groupe de Recherche Clinique GRC6-UPMC: Centre Expert En Endométriose (C3E), France;3. Department of Obstetrics, Gynecology and Assisted Reproductive Technologies Centers, Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique-Hôpitaux de Paris, Bondy, France;4. Department of Gynaecology and Obstetrics, Centre Hospitalier René Dubos, Pontoise, France;5. Faculty Paris 13, UFR SMBH Leonard de Vinci, Sobonne Paris Cité, Bobigny, France;6. Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris Sud, Assistance Publique - Hôpitaux de Paris, Clamart 92140, France;7. Université Paris-Sud, Université Paris Saclay, Le Kremlin Bicêtre, 94276, France |
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| Abstract: | Objectives: to determine the reproductive outcome and estimate the cost for a Jive birth after a single IVF-ET cycle and neosalpingostomy via laparotomy or laparoscopy in patients with bilateral tubal obstruction.Design: retrospective review of medical records.Setting: tertiary reproductive medicine university institute.Patients: three cohorts of infertility patients, treated for bilateral tubal obstruction were compared. Thirty-seven patients with bilateral distal tubal obstruction were treated between July 1990 and July 1994 with laparoscopic bilateral neosalpingostomy using a Coherent ultra-pulse CO2 laser. Seventy-two patients with bilateral distal tubal obstruction had undergone neosalpingostomy prior to July 1990 by laparotomy, using the CO2 laser and microsurgical techniques. One hundred and twenty-seven patients with all forms of bilateral tubal obstruction were treated with a single cycle of IVF-ET in the same institute between July 1990 and December 1994. The three groups were comparable in female age and length of infertility.Results: the live birth rate was 19 percent (14 of 72), 22 percent (8 of 37) and 19 percent (24 of 127), and the ectopic pregnancy rate was seven percent (5 of 72), eight percent (3 of 37) and three percent (4 of 127) for the laparotomy, laparoscopy and IVF-ET cycle groups, respectively. The estimated cost for alive birth was $10,497 following laparoscopy, while it was $29,532 and $28,300 following laparotomy and IVF-ET, respectively.Conclusions: the reproductive performance following bilateral laparoscopic neosalpingostomy is at least equal to the pregnancy rate following neosalpingostomy via laparotomy and a single IVF-ET cycle. The least expensive live birth is associated with laparoscopic neosalpingostomy. |
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| Keywords: | Neosalpingostomy IVF-ET cost-effectiveness |
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