Tubal patency testing in women with polycystic ovary syndrome - is it worth before ovarian induction: Cost-effectiveness analysis.

BACKGROUND

Polycystic ovarian syndrome (PCOS) is related to infertility due to anovulatory cycles. However, it is unknown whether women with PCOS are at higher risk of tubal factor of infertility.

OBJECTIVES

This study sought to investigate the diagnostic accuracy of hysterosalpingo-foam sonography (HyFoSy) in women with polycystic ovarian syndrome (PCOS) before initiation of ovarian induction (OI)?

STUDY

DESIGN

We studied 432 infertile women in two groups: 1) with PCOS (n = 216) and 2) without PCOS (n = 216) which served as the controls. Data analysis included basic clinical parameters, duration of infertility, history of previous abdominal surgeries, pelvic inflammatory disease (PID), ectopic pregnancy (EP) and smoking status. The primary outcome of this study was the evaluation of the tubal patency testing outcomes in women with PCOS and compare it to women without ovulatory disorders. Secondary outcome was a cost-effectiveness analysis focused on direct medical costs related to chosen therapeutic models: 1) primary 3 cycles of OI and 2) HyFoSy followed by 3 cycles of OI if at least one tube was patent.

RESULTS

Women with PCOS had higher number of previous abdominal surgeries (+23.1 %) compared to the controls, with no differences in previously diagnosed either PID or EP and smoking. Bilateral tubal blockage was observed in 5 % of women with PCOS which was comparable to women without ovulatory disorders (4.2 %, p > 0.05). Regarding risk factors for blockage, among PCOS women at least one risk factor such as previous abdominal surgery, history of PID, EP or smoking were observed in 81.8 % (n = 9) participants with bilateral blocked tubes, 63.2 % (n = 12) in unilateral blocked group and 23.1 % (n = 43) participants with both patent tubes. The mean total costs per women were lower in Model 1 compared to Model 2 ($61 vs. $364, respectively). Implementation of HyFoSy in women with PCOS without risk factors of tubal blockage is not worth the extra cost and prolong the time to pregnancy.

CONCLUSION

A treatment model starting with OI before HyFoSY is cost-effective compared to the model with HyFoSY performed before OI. Tubal factor is present in 5% of woman with PCOS which is comparable to infertile women without ovulatory disorders.