Hysteroscopic polypectomy prior to infertility treatment: A cost analysis and systematic review

Abstract

The cost of fertility treatment is expensive and interventions that reduce cost can lead to greater efficiency and fewer embryos transferred. Endometrial polyps contribute to infertility and are frequently removed prior to infertility treatment. It is unclear whether polypectomy reduces fertility treatment cost and if so, the magnitude of cost reduction afforded by the procedure. The aim of this study was to determine whether performing office or operative hysteroscopic polypectomy prior to infertility treatment would be cost-effective. PubMed, Embase, and Cochrane libraries were used to identify publications reporting pregnancy rates after hysteroscopic polypectomy. Studies were required to have a polypectomy treatment group and control group of patients with polyps that were not resected. The charges of infertility treatments and polypectomy were obtained through infertility organizations and a private healthcare cost reporting website. These charges were applied to a decision tree model over the range of pregnancy rates observed in the representative studies to calculate an average cost per clinical or ongoing pregnancy. A sensitivity analysis was conducted to assess cost savings of polypectomy over a range of pregnancy rates and polypectomy costs. Pre-treatment office or operative hysteroscopic polypectomy ultimately saved €6,658 ($7,480) and €728 ($818), respectively, of the average cost per clinical pregnancy in women treated with four cycles of intrauterine insemination. Polypectomy prior to intrauterine insemination was cost-effective for clinical pregnancy rates greater than 30.2% for office polypectomy and 52.6% for operative polypectomy and for polypectomy price <€4,414 ($4,959). Office polypectomy or operative polypectomy saved €15,854 ($17,813) and €6,644 ($7,465), respectively, from the average cost per ongoing pregnancy for in vitro fertilization/intracytoplasmic sperm injection treated women and was cost-effective for ongoing pregnancy rates greater than 26.4% (office polypectomy) and 31.7% (operative polypectomy ) and polypectomy price <€6,376 ($7,164). These findings suggested that office or operative hysteroscopic polypectomy was cost-effective when performed prior to both intrauterine insemination and in vitro fertilization over a range of plausible pregnancy rates and procedural costs.

Effectiveness of different methods for polypectomy in the menopause: a retrospective study

“…Other causes of bleeding include atrophic vaginitis, cervicitis, endometritis, endometrial atrophy, uterine fibroids, endometrial hyperplasia, endometrial polyps, cervical polyps, and endometrial, vulvar, vaginal, and cervical cancers [11]. Furthermore, infertility is also a common symptom, due to the modified endometrial receptivity [12], blocking the pathway of sperms or other unknown reasons [13]. Polyps have been diagnosed hysteroscopically in 4% [14] of all women with unexplained infertility and 14.8% [15] of infertile women with eumenorrhea.…”

Feasibility of Basket Technique Compared to the Office Hysteroscopy to Treat Endometrial Polyps in Patients Undergoing in Vitro Fertilization

“…A study conducted by Mouhayar et al in 2017 concluded that office or operative hysteroscopy performed before an infertility treatment is a cost-effective means of increasing pregnancy rate. 19 In a randomized controlled study conducted by Elsetohy et al in 2015, the pregnancy rate was found to be significantly higher after routine office hysteroscopy but before ICSI in comparison to that without hysteroscopy. 20 Yang et al in 2017 compared the patients who underwent hysteroscopic polypectomy before IVF and the patients who were not evaluated for the cavity and reported that the embryo transfer rates were similar in polypectomy group, while clinical pregnancy rates were significantly higher.…”

Insights on Hysteroscopic Procedures and Their Place in Romanian Gynecologic Practice—The Experience of Two Medical Units

“…In Bucharest and Timisoara centres, simple transvaginal ultrasound (TV-US) was performed prior to hysteroscopic management. Sonohysterography is an alternative method for endometrial polyp and submucosal myoma diagnosis (specificity reaching almost 100%), mainly due to its ability to evaluate in detail the latter; it might also find its meaningful place in practice in the evaluation of perimenopausal women in whom, due to erratic ovarian oestrogen production, endometrium might be difficult to assess using TV-US alone [10][11][12][13]; however, it was not performed in any of the units included in our study…”