Septal resection in women with uterine septum scheduled for in-vitro-fertilization (IVF); A decision analytic model.

Abstract

OBJECTIVE: Evidence is lacking to guide treatment decisions for uterine septum incision prior to IVF. The present work aimed to evaluate the cost effectiveness and live birth (LB) outcomes of septal resection in the setting of IVF women with septate uterus. DESIGN: A Decision analytic tree (model) MATERIALS AND METHODS: A decision-analysis model was constructed to compare four strategies for septal resection in women indicated for IVF. Strategy (1: Res-All) adopts resection for all internal fundal depressions (FD) >1cm, depicting the clinical relevance of defining uterine septum as >1cm FD. Strategy (2: Res-Long) resects FD R1.5cm coinciding with ASRM-2016 definition of septate uterus. The third strategy (3: Res-Afterfailure) resects all FD after 2 failed IVF cycles. The fourth strategy is the reference standard that does not provide any resection (4: No-Res). The 4 strategies were analyzed in 2 models. Model (1) assumed improving LB after resection of any FD more than 1 cm. However, in Model (2) only FD R1.5 cm would benefit from resection. Calculations were done for a hypothetical cohort of 100 women undergoing 3 consecutive IVF cycles. Input probabilities were derived from the best available evidence in literature. For cost estimates, we utilized Medicare 2019 national fee rates in US dollars. Analyses were done using TreeAge Pro Healthcare 2020.