Tubal occlusion in new infertility patients
Published Date: 19th July 2016
Publication Authors: Omar M, Langton J
Objective
100% of women with risk factors for tubal occlusion should be offered diagnostic laparoscopy.
Background
NICE CG 156 (February 2013) recommendation 62 suggests that if any woman has comorbities that would lean towards tubal occlusion, that diagnostic lap should be offered. A paper with regards to cost-effectiveness of tubal patency tests by Verhoeve et al., interestingly states that if under 39 (and no known pathology) that the most cost effective fertility management is delay treatment, perform no tubal patency tests, then commence IVF after 12 months. It also states that if investigating tubal patency- then it is more cost effective to perform HSG (or hysterosalpingo-contrast-sonography-HyCoSy) and then diagnostic lap if needed, then diagnostic lap alone.
Methods
Access to clinic patient lists was via electronic document management system (EDMS). EDMS was used to access the clinic letters, and scanned documentation to elicit the demographics of the couples, and the initial management of any assessment for tubal patency. This was over a chosen retrospective period of four months (Jan–April 2012) to allow for completion of initial investigations and management.
Results and conclusions
Only 6% of patients with risk factors for tubal occlusion went for diagnostic laparoscopy. 82% of the patients with a history suggestive of potential of tubal occlusion had a negative HyCoSy. If the ‘at risk of tubal occlusion’ patients (n = 35/60) in this group all had diagnostic laparoscopies, this would of cost in excess of £90,000 compared to ~£13,000 for HyCoSy for all patients, or £40,000 for HyCoSy and subsequent laparoscopy. In conclusion, women with a history suggestive of tubal occlusion should have HyCoSy performed rather than diagnostic laparoscopy.
Omar, M and Langton, J. (2013). Retrospective audit of investigation of tubal occlusion in new infertility patients . BJOG: An International Journal of Obstetrics & Gynaecology. 120 (Suppl S3), 53
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