Economic Evaluation of In Vitro Fertilization with Embryo Transfer and Neosalpingostomy by Laparotomy or Laparoscopy

Three cohorts of infertile women were treated for bilateral tubal obstruction. From July 1990 to July 1994, 37 distal tubal obstruction were treated with laparoscopic bilateral neosalpingostomy using a Coherent ultrapulse carbon dioxide (CO2) laser. Before July 1990, 72 with distal obstruction had neosalpingostomy by laparotomy using the CO2 laser and microsurgical techniques. From July 1990 to December 1994, 127 women with all forms of bilateral tubal obstruction were treated with a first cycle of in vitro fertilization-embryo transfer (IVF-ET). The groups were comparable for age and length of infertility. The live birth rates were 19% (14/72) and 22% (8/37), and the ectopic pregnancy rates 7% (5) and 8% (3) in the laparotomy and laparoscopy groups, respectively. The corresponding rates for the IVF-ET group were 19% (24) and 3% (4). The estimated costs for a live birth were $8573 after laparoscopy and $27,773 and $28,100 after laparotomy and IVF-ET, respectively. The reproductive performance after bilateral laparoscopic neosalpingostomy in selected patients is at least equal to that after neosalpingostomy by laparotomy and a single IVF-ET cycle. The least expensive live birth is associated with laparoscopic neosalpingostomy.