Laparoscopy in women with unexplained infertility: a cost-effectiveness analysis

Area of Science:

• Reproductive Medicine
• Health Economics
• Surgical Innovation

Background:

• Unexplained infertility affects a significant number of couples seeking fertility treatment.
• The optimal management strategy balancing cost and effectiveness remains a key clinical question.
• Laparoscopy is a minimally invasive surgical option with potential diagnostic and therapeutic benefits.

Purpose of the Study:

• To evaluate the cost-effectiveness of laparoscopy as an initial management strategy for unexplained infertility.
• To compare laparoscopy with expectant management versus laparoscopy with infertility therapy against standard treatment algorithms and no treatment.
• To determine the economic viability of laparoscopic interventions in improving live-birth rates.

Main Methods:

• A cost-effectiveness analysis was conducted using a computer-generated decision analysis tree.
• Data were sourced from existing literature and clinical practice at an academic in vitro fertilization center.
• Four treatment strategies were modeled: no treatment, standard infertility treatment algorithm (SITA), laparoscopy with expectant management (LSC/EM), and laparoscopy with infertility therapy (LSC/IT).
• Incremental cost-effectiveness ratios (ICERs) were calculated, with sensitivity analyses performed.

Main Results:

• Laparoscopy with expectant management (LSC/EM) was the preferred strategy, with an ICER of $128,400 per live-birth under base-case assumptions.
• Sensitivity analyses indicated that LSC/EM remained cost-effective unless patient dropout from infertility treatments fell below 9% per cycle.
• Key factors influencing outcomes included patient dropout rates, surgical costs, and the impact of untreated endometriosis.

Conclusions:

• Laparoscopy represents a cost-effective approach for the initial management of unexplained infertility in young women.
• The economic benefit of laparoscopy is particularly pronounced when infertility treatment dropout rates are high (exceeding 9% per cycle).
• These findings support the integration of laparoscopy into the early stages of infertility management to improve patient outcomes and resource utilization.