Abstract
Background: Septate uterus is the most common anomaly in infertile women. Particularly, distinguishing between different anomalies in women for IVF is critical and should be conducted using a superior modality.
Design: A theoretical decision/threshold analysis to assess 3D-US utility after hysterosalpingography (HSG) initial diagnosis of arcuate uterus to identify misdiagnosed/subtle uterine septum. Our hypothesis is whether HSG is adequate to conclude arcuate diagnosis in the IVF population.
Patients and Methods: A threshold analysis model was constructed for a hypothetical cohort of 100 infertile women indicated for IVF with primary HSG diagnosis of arcuate uterus to compare two 3D-US screening strategies utilized in daily practice. The first strategy (3D strategy) offers 3D-US as the next confirmatory step for HSG uterine indentation concordant with arcuate uterus diagnosis. The second strategy (NO-3D strategy) is the reference standard that adopts proceeding to IVF without 3D-US. Baseline input probabilities were derived by review of the published literature. ASRM criteria for uterine septum were followed to categorize modeled women. Model endpoints were cumulative costs and LB after three successive IVF cycles.
Results: Base-case analysis revealed that the 3D-US strategy was more cost-effective than the NO-3D strategy. After 3 IVF cycles, 3D-US screening resulted in a cumulative LB of 73.2% with $ 2,203,250 total costs compared to 58.9 % cumulative LB and $ 2,255,000 total costs in the NO-3D strategy.
Conclusions: Women for IVF with suspected fundal depression on HSG should be examined in advance by 3D-US to minimize hypothetical financial loss from missed septum diagnosis