The role of tubal reconstructive surgery in the era of assisted reproductive technologies

doi:10.1016/j.fertnstert.2008.08.055

Cited by 9 publications

(4 citation statements)

References 29 publications

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“…First, evidence suggests that under an insurance plan that specifically excluded infertility treatment, nonnegligible fractions of claims paid for certain tubal and other surgeries were actually infertility related (Blackwell and Mercer 2000; Jones and Allen 2009). Second, as mentioned earlier, some evidence suggests that IVF and tubal surgeries could be seen as somewhat substitutable (Gocial 1995; Practice Committee of the American Society of Reproductive Medicine 2008). …”

Section: Resultsmentioning

confidence: 93%

“…But it also includes other medical procedures that are less expensive or might plausibly have been covered without mandates, including testing of the respondent or her partner, surgery for blocked tubes, and “other treatment” (which varies by year of the survey but includes treatment for endometriosis or fibroids, advice, and “other treatment not listed” categories). At least one of these other procedures, tubal surgery, is increasingly considered by the medical profession to be a less attractive substitute for IVF (Gocial 1995; Practice Committee of the American Society of Reproductive Medicine 2008). Other evidence suggests that even in the absence of insurance coverage for infertility treatment, some treatments may be paid for by insurers under alternate billing codes (Blackwell and Mercer 2000; Jones and Allen 2009).…”

Section: Methodology and Datamentioning

confidence: 99%

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Utilization of Infertility Treatments: The Effects of Insurance Mandates

2011

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Over the last several decades, both delay of childbearing and fertility problems have become increasingly common among women in developed countries. At the same time, technological changes have made many more options available to individuals experiencing fertility problems. However, these technologies are expensive, and only 25% of health insurance plans in the United States cover infertility treatment. As a result of these high costs, legislation has been passed in 15 states that mandates insurance coverage of infertility treatment in private insurance plans. In this article, we examine whether mandated insurance coverage for infertility treatment affects utilization. We allow utilization effects to differ by age and education, since previous research suggests that older, more-educated women should be more likely to be directly affected by the mandates than younger women and less-educated women, both because they are at higher risk of fertility problems and because they are more likely to have private health insurance, which is subject to the mandate. We find robust evidence that the mandates do have a significant effect on utilization for older, more-educated women that is larger than the effects found for other groups. These effects are largest for the use of ovulation-inducing drugs and artificial insemination.

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Section: Resultsmentioning

confidence: 93%

Section: Methodology and Datamentioning

confidence: 99%

Utilization of Infertility Treatments: The Effects of Insurance Mandates

2011

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“…Despite its interobserver variability and sensitivity/specificity regarding interpretation and screening, HSG remains a staple of the initial infertility workup (22–27). Detection of hydrosalpinx by HSG was first described in 1931 and refers to two classifications of hydrosalpinx: “hydrops tubae fallopii occlusae (distal and proximal occlusion)” and “hydrops tubae fallopii apertae (only distal occlusion)” (28).…”

mentioning

confidence: 99%

How members of the Society for Reproductive Endocrinology and Infertility and Society of Reproductive Surgeons evaluate, define, and manage hydrosalpinges

Omurtag

Grindler

Roehl

et al. 2012

Fertility and Sterility

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Objective To describe the management of hydrosalpinges among Society for Reproduction Endocrinology and Infertility (SREI)/Society of Reproductive Surgeons (SRS) members. Design Cross-sectional survey of SREI/SRS members. Setting Academic and private practice–based reproductive medicine physicians. Participant(s) A total of 442 SREI and/or SRS members. Intervention(s) Internet-based survey. Main Outcome Measure(s) To understand how respondents evaluate, define, and manage hydrosalpinges. Result(s) Of 1,070 SREI and SRS members surveyed, 442 responded to all items, for a 41% response rate. Respondents represented both academic and private practice settings, and differences existed in the evaluation and management of hydrosalpinges. More than one-half (57%) perform their own hysterosalpingograms (HSGs), and 54.5% involve radiologists in their interpretation of tubal disease. Most respondents thought that a clinically significant hydrosalpinx on HSG is one that is distally occluded (80.4%) or visible on ultrasound (60%). Approximately one in four respondents remove a unilateral hydrosalpinx before controlled ovarian hyperstimulation (COH)/intrauterine insemination (IUI) and clomiphene citrate (CC)/IUI (29.3% and 22.8%, respectively), and physicians in private practice were more likely to intervene (COH: risk ratio [RR] 1.81, 95% confidence interval [CI] 1.31–2.51; CC: RR 1.98, 95% CI 1.33–2.95). Although laparoscopic salpingectomy was the preferred method of surgical management, nearly one-half responded that hysteroscopic tubal occlusion should have a role as a primary method of intervention. Conclusion(s) SREI/SRS members define a “clinically significant hydrosalpinx” consistently, and actual practice among members reflects American Society for Reproductive Medicine/SRS recommendations, with variation attributed to individual patient needs. Additionally, one in four members intervene before other infertility treatments when there is a unilateral hydrosalpinx present.

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“…Surgical tubal reconstruction still plays an important role in infertility treatment, with pregnancy rates of up to 80% following reversal of sterilization and rates of from 65%-70% after salpingostomy or adhesiolysis (16)(17)(18). In a study of 1118 cases of microsurgical resterilization, the overall pregnancy rate was 54.8%, with a delivery rate of 72.5% of all pregnant women.…”

Section: Ep Still Plays An Important Role In First Trimester Pathologmentioning

confidence: 99%

The Effect of Therapy for Tubal Ectopic Pregnancy on Subsequent Reproductive Capacity and the Frequency of Recurrence

Schippert¹,

Gentemann²,

Soergel³

et al. 2017

International Journal of Women’s Health and Reproduction Scienc

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Introduction Ectopic pregnancy (EP), defined as the implantation of an embryo outside the uterine cavity, is a notable complication in the first trimester (especially between the sixth and ninth weeks of gestation) and can cause severe intra-abdominal bleeding and death. In the United States, from 2013-2017, there were 0.36 EP deaths per 100 000 live births. In addition, from 1998-2007, excessive haemorrhage, shock or renal failure accompanied 67.4% of the EP deaths of hospitalized women (1). Clinical symptoms of EP are pain in the lower abdomen and vaginal bleeding in combination with a positive pregnancy test. In the case of rupture of a fallopian tube, patients may show signs of haemorrhagic shock, including dyspnoea, hypotonia and tachycardia (2). A prior EP may also negatively affect female fertility due to damage or loss of the fallopian tube. More than 95% of all EPs are tubal pregnancies, 1%-2% are located in the intramural part of the uterus and a small number are ovarian, cervical or abdominal pregnancies. The very rare case of a combination intrauterine and EP, called a heterotopic pregnancy, occurs in 1 of every 3000 EPs (3). The aetiology of EP is multifactorial, including anatomic obstruction of the fallopian tube, malfunction of the tubal mobility and molecular factors (4). The main risk factors for the occurrence of EP are pelvic inflammatory diseases (chlamydia trachomatis, and gonorrhoea), previous sterilisation, application of an intrauterine device (IUD), previous tubal or intrauterine surgeries, previous EP, endometriosis, smoking and assisted reproductive techniques (ART) such as in vitro fertilisation (IVF) when performed in women with tubal pathologies (5-8). The prevalence of EP has increased worldwide due to improved diagnostic capabilities, increasing use of ART and tubal surgery and increased maternal age (2). The rate of EP following natural conception is approximately 2%, whereas the rates following ART are from 2.1%-11% (9). In Germany, following IVF, the highest EP rate is 4.5%, which is in smokers under age 30 who have tubal pathology (8). Tubal surgeries also can cause EP, with an incidence rate of up to 40%, depending on the location, type and severity of the tubal pathology and the surgical procedure performed (10). Often, verifying an EP is difficult. The diagnosis is made using a combination of the clinical symptoms, vaginal ultrasound and serum biochemistry, although there is no existing human chorionic gonadotropin (hCG) value

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The role of tubal reconstructive surgery in the era of assisted reproductive technologies

Abstract: Tubal reconstructive surgery has fewer indications in the era of assisted reproductive technologies than in the past, but is still appropriate and effective treatment for properly selected individuals.

Cited by 9 publications

References 29 publications

Utilization of Infertility Treatments: The Effects of Insurance Mandates

Utilization of Infertility Treatments: The Effects of Insurance Mandates

How members of the Society for Reproductive Endocrinology and Infertility and Society of Reproductive Surgeons evaluate, define, and manage hydrosalpinges

The Effect of Therapy for Tubal Ectopic Pregnancy on Subsequent Reproductive Capacity and the Frequency of Recurrence

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