P-305 Tuesday, October 18, 2016
However, the fact that a visual
PREVALENCE OF PRIOR REPRODUCTIVE SURGERY AMONG
WOMEN SCHEDULED FOR IVF. A. M. Abdelmagied, M. K. Ali,
D. M. Habib, A. A. Abdelaleem, T. A. Farghaly, E. Badran,
A. A. Nassr, O. S. Abdalmageed, I. Elnashar, A. Abbas. Obstetrics and Gy-
necology, Women Health Hospital, Assiut University, Assiut, Egypt.
OBJECTIVE: Optimization of the function and anatomy of reproductive
organs either by medications or surgery is the main target of many clinicians
prior to IVF in order to get favorable cycle outcomes. Our objective was to
evaluate the prevalence of reproductive surgery in women scheduled for
IVF, and to correlate the baseline characteristics of these women to the prob-
ability of undergoing a reproductive surgery.
DESIGN: Prospective cross-sectional cohort.
MATERIALS AND METHODS: Through one-year cross sectional sur-
vey, infertile women scheduled for IVF were categorized into 3 groups based
on their history of prior reproductive surgery. Group 1 comprised women
who did not undergo any reproductive surgery before; group 2 included
women with history of one reproductive surgery; while group 3 included sub-
jects with history of 2 or more surgeries. The 3 groups were compared as re-
gards their baseline demographic and clinical characteristics. Statistical
methods used for comparisons included t-test, Chi-square test, Wilcoxon
rank sum test and logistic regression.
RESULTS: 244 women accepted to participate in the study; 76% of them
(n185) reported prior reproductive surgery. Women in group 3 (n59) were
more likely to have a longer duration of infertility (MeanSD; 5.83 vs.
5.23.2 vs. 4.53; p0.009), and comprised more women with endometri-
osis (50.8% vs. 21.45% vs. 1%; p0.000) and tubal block (22% vs. 11.1% vs.
3.4%; p0.000), when compared to groups 2 and 1 respectively. The total
number of surgical procedures in the whole cohort was 238 surgical proce-
dures. Out of them; 29.4%, 18.9%, and 16.4% were procedures for endome-
triosis, uterine procedures, and diagnostic laparoscopies, respectively. In
stepwise multivariate regression analysis, after adjustment of other variables;
longer duration of infertility (aOR 1.2, 95% CI1.04-1.3, P0.007), hav-
ing moderate endometriosis (aOR 12.1, 95% CI5.6-26.4, P0.000), and
having tubal disease (aOR 6.7, 95% CI2.7-16.6, P0.000) were signif-
icantly associated with likelihood of an IVF woman to have 2 surgical repro-
ductive procedures through her infertility treatment.
CONCLUSIONS: Reproductive surgeries are common among IVF
women presenting a sort of financial burden. Women with endometriosis
have substantial probability of undergoing a high order reproductive surgery.
P-306 Tuesday, October 18, 2016
DEVELOPMENT OFA NEW TUBAL RECANALIZATION METHOD
USING THE COMBINATION OF HYSTEROSCOPE AND LAPARO-
SCOPE IN THE TREATMENT OF OBSTRUCTED FALLOPIAN
TUBES. A. Tanaka, M. Nagayoshi, I. Tanaka, T. Miki, T. Yamaguchi.
Saint Mother Hospital, Kitakyusyu, Japan.
OBJECTIVE: The Falloposcopic tuboplasty (FT) catheter system for the
reconstructive surgery was developed to treat the obstruction of the fallopian
tubes. Using this treatment the fallopian tubes can be recanalized and many
Cost-Effectiveness of Robotic Salpingostomy (RS-ost)
IVF Possible
RS-ost Success RS-ost Success
Rate: Not Rate: Cost
Age Cost Effective Effective
MTX Not Possible, Under 35 0.760-0.783 0.783-0.789
Surgery Required 35-37 0.760-0.784 0.784-0.794
38-40 0.760-0.783 0.783-0.796
41-42 0.760-0.782 0.782-0.808
Over 42 0.760-0.777 0.777-0.810
MTX Possible Under 35 0.898-0.972 0.972-0.990
35-37 0.898-0.992 >0.992
38-40 0.898-0.992 >0.992
41-42 0.898-0.986 >0.986
Over 42 0.897-0.954 >0.954
FERTILITY & STERILITY
natural pregnancies have been achieved.
confirmation that the catheter has been properly inserted in the fallopian
tube is not so easy and the short durability of the catheter are the weak points
of this method. In order to overcome these problems we developed a new
strategy to conduct reconstructive surgery of the tubes using a combination
of hysteroscope and laparoscope.
DESIGN: Retrospective cohort study.
MATERIALS AND METHODS: The equipment used was a laparoscope
(VISERAELITE Olympus), a hysteroscope (EHY-110s Pentax) and a TER-
UMO catheter (RF-GY35183). 67 Childless couples with unilateral or bilat-
eral fallopian tubal obstructions without other infertility factors were selected
from January 2012 to December 2015. The catheter (0.89mm diameter dou-
ble lumen Kitazato Co.) was inserted into the opening of fallopian tubal and
moved it forward slowly under the laparoscopic observation. When the tip of
catheter hit the wall of the fallopian tube especially at the bend, it became
almost impossible to move forward any further so it was useful to hold the
fimbriated end with forceps laparoscopically and stretch it to make the
bend straight for further progression.
RESULTS: From Jan. 2012 to Dec. 2015, 37 cases of both fallopian tubes
blockage and 30 cases of obstruction in one of the tubes, making a total of 67
cases, were treated using this method. Four weeks after treatment a fallopian
tubes and HSG (hysterosalpingography) was conducted after four times of
additional hydrotubations. The recanalization of the fallopian tubes was
confirmed in 25 out of 37 cases of bilateral tubal blockage, and in 24 of 30
cases of a single tubal blockage. Up to this date spontaneous pregnancy rates
and miscarriage rates obtained were 28.6% (14/49), 21.4% (3/14) and 8
healthy babies have been born, remaining 3 cases are ongoing.
CONCLUSIONS: This method is useful as a treatment for fallopian tubes
obstruction and opens the possibility of achieving a natural pregnancy in
cases of blockage of both fallopian tubes that until now only have had
ART as a treatment method.
P-307 Tuesday, October 18, 2016
COST-EFFECTIVENESS OF ROBOTIC SALPINGOSTOMY FOR
MANAGEMENT OF ECTOPIC PREGNANCY. S. A. Singer
J. P. Shepherd. Department of Obstetrics, Gynecology, & Reproductive Sci-
ences, UPMC-Magee Womens Hospital, Pittsburgh, PA.
OBJECTIVE: To determine cost-effectiveness (CE) of robotic salpingos-
tomy (RS-ost) in women with ectopic pregnancy in a single remaining tube
and desiring future pregnancy compared to laparoscopic salpinogstomy (LS-
ost), salpingectomy (LS-ect), and methotrexate (MTX).
DESIGN: Cost-effectiveness analysis (CEA).
MATERIALS AND METHODS: We created multiple CEA models ac-
counting for appropriateness of MTX, availability of vitro fertilization
(IVF), and impact of 5 age groups on subsequent spontaneous and assisted
fertility. Surgical costs were based on Medicare physician fee schedules. Ro-
botic costs were 160.7% of laparoscopy from published gynecologic studies.
Successful completion of RS-ost was varied from 50-100% to compare dif-
ferential success versus LS-ost (baseline success 76%). CE of RS-ost was
calculated in cost per subsequent intrauterine pregnancy. Willingness-to-
pay (WTP) was based on age-specific IVF success.
IVF Not An Option
RS-ost Success RS-ost Success RS-Ost Success Rate:
Rate: Dominant Rate: Not Cost Effective Cost Effective
>0.789 0.760-0.785 >0.785
>0.794 0.760-0.786 >0.786
>0.796 0.760-0.784 >0.784
>0.808 0.760-0.783 >0.783
>0.810 0.760-0.776 >0.776
>0.990 0.898-0.950 >0.950
0.898-0.951 >0.951
0.897-0.948 >0.948
0.897-0.943 >0.943
0.897-0.930 >0.930
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