How members of the Society for Reproductive Endocrinology and Infertility and Society of Reproductive Surgeons evaluate, define, and manage hydrosalpinges

Abstract

Objective To describe the management of hydrosalpinges among Society for Reproduction Endocrinology and Infertility (SREI)/Society of Reproductive Surgeons (SRS) members. Design Cross-sectional survey of SREI/SRS members. Setting Academic and private practice–based reproductive medicine physicians. Participant(s) A total of 442 SREI and/or SRS members. Intervention(s) Internet-based survey. Main Outcome Measure(s) To understand how respondents evaluate, define, and manage hydrosalpinges. Result(s) Of 1,070 SREI and SRS members surveyed, 442 responded to all items, for a 41% response rate. Respondents represented both academic and private practice settings, and differences existed in the evaluation and management of hydrosalpinges. More than one-half (57%) perform their own hysterosalpingograms (HSGs), and 54.5% involve radiologists in their interpretation of tubal disease. Most respondents thought that a clinically significant hydrosalpinx on HSG is one that is distally occluded (80.4%) or visible on ultrasound (60%). Approximately one in four respondents remove a unilateral hydrosalpinx before controlled ovarian hyperstimulation (COH)/intrauterine insemination (IUI) and clomiphene citrate (CC)/IUI (29.3% and 22.8%, respectively), and physicians in private practice were more likely to intervene (COH: risk ratio [RR] 1.81, 95% confidence interval [CI] 1.31–2.51; CC: RR 1.98, 95% CI 1.33–2.95). Although laparoscopic salpingectomy was the preferred method of surgical management, nearly one-half responded that hysteroscopic tubal occlusion should have a role as a primary method of intervention. Conclusion(s) SREI/SRS members define a “clinically significant hydrosalpinx” consistently, and actual practice among members reflects American Society for Reproductive Medicine/SRS recommendations, with variation attributed to individual patient needs. Additionally, one in four members intervene before other infertility treatments when there is a unilateral hydrosalpinx present.

State-mandated insurance coverage is associated with the approach to hydrosalpinges before IVF

“…Briefly, surveys were sent to 1078 SREI and SRS members between 25 October and 8 November 2011. Detailed methods and demographic information about the survey mailing and respondents, respectively, is described elsewhere (Omurtag et al , 2012). Respondents practising in AIM and CIM states both reported performing more IVF cycles per year than respondents practising in NoIM states.…”

“…Although it is widely accepted that clinically significant hydrosalpinges negatively affect IVF success rates, Omurtag et al (2012) previously demonstrated that physicians differ in their reported management practices. The current work provides three pieces of evidence suggesting that insurance coverage may be responsible for some of the variation in management.…”

“…201105156, approved 13 October 2011). The SREI member directory (www.socrei.org), which links to the ASRM member directory, was used to identify survey participants as previously described (Omurtag et al , 2012). Respondents were initially aggregated into three groups based on their primary practice location: (i) states with a comprehensive infertility insurance mandate (CIM): NJ, CT, IL, RI and MA; (ii) states with partial coverage: CA, TX, AR, MT, WV, OH, NY, HI, MD and LA; and (iii) states with no infertility insurance mandate (NoIM).…”

“…The current study group previously showed that Society for Reproductive Endocrinology and Infertility (SREI) and SRS members define a ‘clinically significant hydrosalpinx’ similarly and that practice reflects ASRM and SRS recommendations; however, variation in practice still exists and insurance coverage for assisted reproduction treatment may play a role (Omurtag et al , 2012). To better understand how particular health policies in a state may influence a physician's approach to hydrosalpinges, the current work surveyed practising SREI and SRS members regarding their evaluation and management of hydrosalpinges and stratified the responses on the basis of the presence or absence of mandated infertility insurance coverage in the state in which the respondents practice.…”

Ultrasound Assessment of the Essure Contraceptive Devices: Is Three-Dimensional Ultrasound Really Needed?

“…Use of Essure microinserts for therapeutic purposes (e.g., presence of hydrosalpinx or sactosalpinx) is largely supported by international literature and advocated by scientific societies as a safe, effective, and minimally invasive alternative to salpingectomy, whereas laparoscopic treatment is contraindicated [17][18][19][22][23][24][25].…”