M.B. Henne

The Estimated Annual Cost of Uterine Leiomyomata in the United States

OBJECTIVE The purpose of this study was to estimate the total annual societal cost of uterine fibroid tumors in the United States, based on direct and indirect costs that include associated obstetric complications. STUDY DESIGN A systematic review of the literature was conducted to estimate the number of women who seek treatment for symptomatic fibroid tumors annually, the costs of medical and surgical treatment, the amount of work time lost, and obstetric complications that are attributable to fibroid tumors. Total annual costs were converted to 2010 US dollars. A sensitivity analysis was performed. RESULTS The estimated annual direct costs (surgery, hospital admissions, outpatient visits, and medications) were

A new approach to ovarian reserve testing

4.1-9.4 billion. Estimated lost work-hour costs ranged from

The effect of air bubble position after blastocyst transfer on pregnancy rates in IVF cycles

1.55-17.2 billion annually. Obstetric outcomes that were attributed to fibroid tumors resulted in a cost of

Cost analysis model of outpatient management of ovarian hyperstimulation syndrome with paracentesis: “Tap early and often” versus hospitalization

238 million to

Cost and efficacy comparison of in vitro fertilization and tubal anastomosis for women after tubal ligation

7.76 billion annually. Uterine fibroid tumors were estimated to cost the United States

Insurance mandates, embryo transfer, outcomes—the link is tenuous

5.9-34.4 billion annually. CONCLUSION Obstetric complications that are associated with fibroid tumors contributed significantly to their economic burden. Lost work-hour costs may account for the largest proportion of societal costs because of fibroid tumors.

The effects of competition on assisted reproductive technology outcomes

OBJECTIVE To critically examine ovarian reserve testing before assisted reproduction. DESIGN A PUBMED computer search to identify relevant literature. SETTING Multiple sites. PATIENT(S) Patients undergoing assisted reproduction. INTERVENTION(S) Testing for ovarian reserve. MAIN OUTCOME MEASURE(S) Assisted reproductive technology (ART) and pregnancy outcomes. RESULT(S) The prevalence of ovarian insufficiency varies significantly for women aged 30-45 years. Generalization or averaging of threshold values across different aged women leads to very poor sensitivity, specificity, and positive predictive value for all tests of ovarian reserve. Because of the changing prevalence of ovarian insufficiency, there is no single, suitable threshold value for any screening test of ovarian reserve. Our analysis supports dividing impaired ovarian reserve into two groups: age-dependent ovarian aging (physiologic) and premature (nonphysiologic) reductions in the oocyte pool. Interpretation of any screening test used requires that age is considered as a variable. To guide clinical interpretation of test results, we suggest using a nomogram of FSH values versus expected delivery rate-per-cycle-start with ART for a given age. CONCLUSION(S) Proper interpretation of screening tests for ovarian insufficiency in couples considering ART is important as the presence of impaired ovarian reserve is associated with a low likelihood of pregnancy. The condition of premature (nonphysiologic) ovarian insufficiency warrants additional research.

Is Magnetic Resonance Imaging Sufficient to Diagnose Rudimentary Uterine Horn? A Case Report and Review of the Literature

OBJECTIVE To investigate the relationship between air bubble position after blastocyst transfer (BT) and pregnancy rates (PRs). DESIGN Retrospective cohort study. SETTING University-based infertility center. PATIENT(S) Three hundred fifteen consecutive nondonor BTs by a single provider. INTERVENTION(S) Catheters were loaded with 25 μL of culture media, 20 μL of air, 25 μL of media containing the blastocysts, 20 μL of air, and a small amount of additional media. The distance from the air bubble to the fundus, as seen on abdominal ultrasound examination, was measured at the time of transfer. Air bubble location was categorized as <10 mm, 10-20 mm, and >20 mm from the fundus. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate. RESULT(S) After controlling for age, parity, FSH and frozen transfers, and accounting for repeated cycles per patient, the PRs for both the >20-mm (38.3%) and the 10-20-mm (42.0%) from the fundus group were significantly reduced compared with the group in which the bubble was <10 mm from the fundus (62.5%). CONCLUSION(S) This study is the first to suggest that BT closer to the fundus is associated with higher PR. Although no ectopic pregnancies occurred in the <10-mm group, this outcome should be monitored closely in larger studies.

Robotically assisted hysterectomy in patients with large uteri: outcomes in five community practices.

OBJECTIVE To compare the cost of two treatment regimens for moderate to severe ovarian hyperstimulation syndrome (OHSS): conservative inpatient versus outpatient management with paracentesis. DESIGN A decision-tree mathematical model comparing conservative inpatient versus outpatient management of moderate to severe OHSS was created. The common final pathway of either management was resolution of OHSS. Sensitivity analyses were performed over the range of variables. MAIN OUTCOME MEASURE(S) Total management cost of OHSS. RESULT(S) The cost of conservative therapy including first-tier complications was

Uterine position at real embryo transfer compared to mock embryo transfer

10,099 (range