Sequential-contingent strategy for fallopian tube evaluation using hysterosalpingo foam sonography: a cost analysis

Area of Science:

• Reproductive Medicine
• Diagnostic Imaging
• Gynecology

Background:

• Tubal pathology is a significant cause of female infertility, accounting for 20% of cases.
• Hysterosalpingography (HSG) has been the traditional method for evaluating fallopian tube patency.
• Hysterosonosalpingography with EXEM® foam is a newer technique offering comparable effectiveness to HSG with improved patient tolerability.

Purpose of the Study:

• To evaluate the effectiveness and cost-benefit of a sequential diagnostic strategy for tubal patency assessment.
• To compare hysterosonosalpingography with EXEM® foam followed by HSG when necessary, against a systematic HSG approach.

Main Methods:

• A cohort of patients eligible for intrauterine insemination (IUI) between January 2020 and July 2021 underwent initial assessment with hysterosonosalpingography using EXEM® foam.
• If results were inconclusive or pathological, hysterosalpingography (HSG) was performed.
• Treatment recommendations (IUI or IVF) were based on the findings of tubal patency.

Main Results:

• Concordance between hysterosonosalpingography with EXEM® foam and HSG was observed in 45.5% for unilateral and 66.7% for bilateral obstruction.
• The sequential strategy resulted in a cost saving of €9,323.50 compared to systematic HSG.
• This approach demonstrated a cost benefit by reducing the need for more expensive procedures.

Conclusions:

• A contingent sequential strategy, starting with hysterosonosalpingography with EXEM® foam, is a cost-beneficial approach for diagnosing tubal pathology.
• This method optimizes medical procedures, reduces hospital visits, and accelerates the initiation of assisted reproductive technology (ART).
• Patients with specific diagnostic profiles can benefit from IUI instead of IVF, further enhancing efficiency.