NATIONAL HARBOR, MD. – More than two-thirds of 30 women with infertility related to uterine pathology achieved pregnancy after a single surgery that combined both hysteroscopy and laparoscopy, a study showed.
"After treatment, many of these patients can achieve pregnancy spontaneously without the use of assisted reproductive technology, and significant cost savings are achieved if the procedures are done at the same time," said Dr. Chris J. Allphin, a gynecologist at the Eastern Idaho Regional Medical Center, Idaho Falls.
The single procedure cost an average of $15,000 less than having sequential procedures.
Dr. Allphin reported a retrospective study of 30 patients treated since 2007 for infertility due to ultrasound-confirmed uterine pathology; 13 women had a uterine septum and 17 had leiomyomata.
Two surgeons simultaneously performed the procedures. Septae were diagnosed laparoscopically and treated with hysteroscopic metroplasty. Leiomyomata were diagnosed laparoscopically and treated with either a hysteroscopic or laparoscopic myomectomy.
Of the 30 patients, 21 women (70%) became pregnant and 5 women conceived twice. Fourteen pregnancies (66%) – including one set of twins – were conceived without assisted reproduction techniques. Four were the result of intrauterine insemination. There were seven in vitro fertilization pregnancies, Dr. Allphin reported at the meeting sponsored by AAGL.
Younger women achieved the best pregnancy rates, with 82% of those younger than 35 years conceiving. The rate was 62% among those aged 35-40 years and 60% in those older than 40 years.
The average cost of having the laparoscopy and hysteroscopy at different admissions is $38,256. The average cost of the dual procedure at a single admission was $23,185. "Thirty patients having the dual procedure saved the system $450,000," according to Dr. Allphin.
Of the nine patients who did not conceive, two had no antral follicles at return to the fertility specialist, two had attempted one in vitro fertilization cycle and then discontinued treatment, one had two intrauterine insemination cycles and then discontinued treatment, three continue to go through in vitro fertilization cycles, and one has postponed trying to conceive.
Dr. Allphin said he had no relevant financial disclosures.