Infertility: is there a role for the surgeon

Fifteen-year trend in the use of reproductive surgery in women in the United States

OBJECTIVE

To determine trends in female reproductive surgery volume.

DESIGN

Database analysis using the Healthcare Cost and Utilization Project databases from 1988, 1992, 1998, and 2002.

SETTING

Academic medical center.

PATIENT(S)

All patients who underwent reproductive surgeries using United States community hospital discharge data and inpatient and outpatient data for New Jersey (NJ) and Maryland (MD).

INTERVENTION(S)

SAS statistical software was used to estimate the number of reproductive surgeries per year; weighted least squares analysis was performed to estimate trends in surgeries.

MAIN OUTCOME MEASURE(S)

Number of reproductive surgeries.

RESULT(S)

Nationally, approximately 250,000 inpatient female reproductive surgeries are performed yearly. There was a modest decreasing trend (-17%) in total reproductive surgeries, and the number of procedures with an associated diagnosis of infertility declined 79%; neither change reached statistical significance. Alternatively, a significant decline occurred in surgeries of the fallopian tubes and ovaries. Likewise, inpatient surgeries were unchanged in NJ and actually increased in MD (+13%), although outpatient surgeries declined in both states (-12% and -37%, respectively).

CONCLUSION(S)

The increased use of assisted reproductive technology (ART) has coincided with a decrease in surgeries on the fallopian tubes and ovaries. With the exception of surgery for tubal infertility, reproductive surgery has largely been complementary to, rather than replaced by, ART.