Sharon E. Moayeri

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

OBJECTIVE To evaluate the cost effectiveness of laparoscopy for unexplained infertility. DESIGN We performed a cost-effectiveness analysis using a computer-generated decision analysis tree. Data used to construct the mathematical model were extracted from the literature or obtained from our practice. We compared outcomes following four treatment strategies: [1] no treatment, [2] standard infertility treatment algorithm (SITA), [3] laparoscopy with expectant management (LSC/EM), and [4] laparoscopy with infertility therapy (LSC/IT). The incremental cost-effectiveness ratio (ICER) was calculated, and one-way sensitivity analyses assessed the impact of varying base-case estimates. SETTING Academic in vitro fertilization practice. PATIENT(S) Computer-simulated patients assigned to one of four treatments. INTERVENTION(S) Fertility treatment or laparoscopy. MAIN OUTCOME MEASURE(S) Incremental cost-effectiveness ratios. RESULT(S) Using base-case assumptions, LSC/EM was preferred (ICER =

Testosterone concentrations in early pregnancy: relation to method of conception in an infertile population

128,400 per live-birth in U.S. dollars). Changing the following did not alter results: rates and costs of multiple gestations, penalty for high-order multiples, infertility treatment costs, and endometriosis prevalence. Outcomes were most affected by patient dropout from infertility treatments-SITA was preferred when dropout was less than 9% per cycle. Less important factors included surgical costs, acceptability of twins, and the effects of untreated endometriosis on fecundity. CONCLUSION(S) Laparoscopy is cost effective in the initial management of young women with infertility, particularly when infertility treatment dropout rates exceed 9% per cycle.

Fertility Issues for Newly Diagnosed Women Interested in Child Bearing: Strategies and Options

This prospective cohort study of infertility patients compared testosterone concentrations in early pregnancy in infertility patients who conceived naturally or after treatment. Although all groups demonstrated some increase in pregnancy testosterone from baseline concentrations, subjects who conceived following ovulation induction showed a significantly increased rise in testosterone as compared with controls (P<0.01).

Risk of monozygotic twinning with blastocyst transfer decreases over time: an 8-year experience

Breast cancer is the most common cancer among reproductive aged women, accounting for 30% of all cancers. In the United States during 2005, more than 210,000 new cases of breast cancer were reported and approximately 11,000 occurred in women younger than 40 years. Among the many concerns experienced by patients with breast cancer, fertility issues can be a particular concern. Identifying this need and offering specialized counseling at the earliest possible point in the patient’s care can potentially preserve options for future pregnancy in the young woman with breast cancer.