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The Endometriosis Fertility Index Accurately Predicts Fertility Outcomes in Women Having Surgery for Severe Endometriosis
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 respectively. The proportion with Medicaid insurance was 2.6% (n = 15), 5.0% (n = 33) and 8.4% (n = 86) for 2013, 2014, and 2015 respectively (trend statistically significant, chi square = 34.1, p < .001). Using Kaplan-Meier estimation, the 12-month LARC continuation rates were 85.4%, 75.3% and 64.3% for 2013, 2014 and 2015, respectively. The three survivor curves were significantly different (log rank test p-value = .009).
S181
Association between year of insertion, age and insurance status, respectively and the uptake of the etonogestrel implant. Model strata Odds of LARC being implant versus IUD Age>/=30 Age<30 OR(95% CI) OR(95% CI) Model terms Age(continuous) Private Insurance(vs. Medicaid/self-pay) Year of insertion 2013(reference) 2014 2015 2016
0.93(0.89–0.98) 1.06(0.52–2.15)
0.81(0.78–0.83) 2.48(1.73–3.54)
2.29(1.04–5.04) 1.57(0.72–3.45) 3.40(1.64–7.04)
0.88(0.58–1.33) 0.97(0.68–1.40) 1.60(1.12–2.27)
LARC = Long acting reversible contraception. IUD = Intrauterine device. Conclusion: In this large private practice setting the implant was significantly more popular among women under 30. However, among women 30 years and older, we observed a 3-fold increase in the uptake of the subdermal implant from 2013–2016. Further studies of implant uptake in the private practice setting are needed.
Conclusion: This study makes a suggestion that 12-month LARC continuation rates in this large private practice setting has decreased over time. Considering the high cost of LARCs, further studies are needed to determine the source of this trend.
554
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 12:51 PM – STATION H
Temporal Trends in the Uptake of the Etonogestrel Implant in a Large Private Practice Setting Howard D, Ford A, Ceballos S, Volker K. Las Vegas Minimally Invasive Surgery and Women’s Pelvic Health Center, Las Vegas, Nevada Study Objective: To assess temporal trends in the uptake of the etonogestrel subdermal implant in a large private practice setting. Design: This was a retrospective cohort study based on billing records. Setting: A large multi-specialty private practice in Las Vegas, Nevada. Patients: We looked at women of all ages seeking long-acting reversible contraception between January 1, 2013 and December 31, 2016. Intervention: None. Measurements and Main Results: The main outcome measure was uptake of the etonogestrel subdermal implant, expressed as a fraction of all insertions of long acting reversible contraceptives(LARCs), across four calendar years (2013–2016). There were 3477 total LARC insertions across the 4 year study period. In 2013, 51.6% of LARC insertions were in women under 30 years compared to 47.7% in 2016(p = .04). In 2013, 5.1% of LARC insertions occurred in women with Medicaid compared to 19.6% in 2016(p < .001). In unadjusted analyses, the uptake of the etonogestrel implant increased from 3.0% of LARC insertions in 2013 to 4.5% in 2015 to 9% in 2016 among women 30 years and older. For women under 30 years old, the uptake of the implant stayed stable from 2013–2015(22.8%, 21.7%, 22.4%) but increased to 30.9% in 2016. We modeled the uptake of the implant as a function of year of insertion adjusted for age (continuous) and insurance status (Private vs. Medicaid) and we stratified the models by age(less than 30 and 30 years and older). The positive association between year of insertion and uptake of the implant was significantly stronger for women 30 and older compared to women under 30 years old.
555
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 12:57 PM – STATION A
The Endometriosis Fertility Index Accurately Predicts Fertility Outcomes in Women Having Surgery for Severe Endometriosis Maheux-Lacroix S, Nesbitt-Hawes E, Deans R, Won H, Budden A, Abbott J. Royal Hospital for Women, University of New South Wales, Sydney, NSW, Australia Study Objective: To determine fertility outcomes and predictors of live births following resection of stage III-IV endometriosis. Design: We performed a retrospective cohort study and assessed fertility outcomes after a minimum of six months of follow-up. Setting: Two tertiary hospitals in Sydney, Australia: Prince of Wales Private Hospital and Royal Hospital for Women. Patients: A total of 279 women with stage III-IV endometriosis who attempted to conceive post-operatively were included in the study (participation rate = 84%) with a mean follow-up of four years. Intervention: Laparoscopic resection of stage III-IV endometriosis. Measurements and Main Results: The endometriosis fertility index (EFI) was calculated based on detailed operative reports and surgical images. Fertility outcomes were obtained by direct patient contact. Kaplan-Meier model, log rank test and Cox regression were used for analyses. A total of 147 women (63%) obtained a live birth following surgery, 94 of them (64%) without assisted reproductive technology (ART). The EFI was highly associated with non-ART live births (p < .001), the estimated cumulative rate at 5 years being 0% for women with an EFI of 0–2 and steadily increasing up to 91% for women with an EFI of 9–10 (Fig. 1). A low least function score (taking into account the impact of lesions on the function of the adnexa) was the most significant predictors of failure (p = .003), followed by having had a previous resection (p = .019) or incomplete resection (p = .028) of endometriosis, being older (p = .027), and having leiomyomas (p = .037). Conclusion: Women with a high EFI have excellent fertility prognosis and may be advised to try to conceive naturally compared to women with a low score for which prompt referral to ART seems more reasonable. Other prognostic factors can be used to guide the management of women with intermediate EFI score. Localization and impact of lesions on the function of the adnexa seems crucial for the fertility prognosis.
S181
Association between year of insertion, age and insurance status, respectively and the uptake of the etonogestrel implant. Model strata Odds of LARC being implant versus IUD Age>/=30 Age<30 OR(95% CI) OR(95% CI) Model terms Age(continuous) Private Insurance(vs. Medicaid/self-pay) Year of insertion 2013(reference) 2014 2015 2016
0.93(0.89–0.98) 1.06(0.52–2.15)
0.81(0.78–0.83) 2.48(1.73–3.54)
2.29(1.04–5.04) 1.57(0.72–3.45) 3.40(1.64–7.04)
0.88(0.58–1.33) 0.97(0.68–1.40) 1.60(1.12–2.27)
LARC = Long acting reversible contraception. IUD = Intrauterine device. Conclusion: In this large private practice setting the implant was significantly more popular among women under 30. However, among women 30 years and older, we observed a 3-fold increase in the uptake of the subdermal implant from 2013–2016. Further studies of implant uptake in the private practice setting are needed.
Conclusion: This study makes a suggestion that 12-month LARC continuation rates in this large private practice setting has decreased over time. Considering the high cost of LARCs, further studies are needed to determine the source of this trend.
554
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 12:51 PM – STATION H
Temporal Trends in the Uptake of the Etonogestrel Implant in a Large Private Practice Setting Howard D, Ford A, Ceballos S, Volker K. Las Vegas Minimally Invasive Surgery and Women’s Pelvic Health Center, Las Vegas, Nevada Study Objective: To assess temporal trends in the uptake of the etonogestrel subdermal implant in a large private practice setting. Design: This was a retrospective cohort study based on billing records. Setting: A large multi-specialty private practice in Las Vegas, Nevada. Patients: We looked at women of all ages seeking long-acting reversible contraception between January 1, 2013 and December 31, 2016. Intervention: None. Measurements and Main Results: The main outcome measure was uptake of the etonogestrel subdermal implant, expressed as a fraction of all insertions of long acting reversible contraceptives(LARCs), across four calendar years (2013–2016). There were 3477 total LARC insertions across the 4 year study period. In 2013, 51.6% of LARC insertions were in women under 30 years compared to 47.7% in 2016(p = .04). In 2013, 5.1% of LARC insertions occurred in women with Medicaid compared to 19.6% in 2016(p < .001). In unadjusted analyses, the uptake of the etonogestrel implant increased from 3.0% of LARC insertions in 2013 to 4.5% in 2015 to 9% in 2016 among women 30 years and older. For women under 30 years old, the uptake of the implant stayed stable from 2013–2015(22.8%, 21.7%, 22.4%) but increased to 30.9% in 2016. We modeled the uptake of the implant as a function of year of insertion adjusted for age (continuous) and insurance status (Private vs. Medicaid) and we stratified the models by age(less than 30 and 30 years and older). The positive association between year of insertion and uptake of the implant was significantly stronger for women 30 and older compared to women under 30 years old.
555
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 12:57 PM – STATION A
The Endometriosis Fertility Index Accurately Predicts Fertility Outcomes in Women Having Surgery for Severe Endometriosis Maheux-Lacroix S, Nesbitt-Hawes E, Deans R, Won H, Budden A, Abbott J. Royal Hospital for Women, University of New South Wales, Sydney, NSW, Australia Study Objective: To determine fertility outcomes and predictors of live births following resection of stage III-IV endometriosis. Design: We performed a retrospective cohort study and assessed fertility outcomes after a minimum of six months of follow-up. Setting: Two tertiary hospitals in Sydney, Australia: Prince of Wales Private Hospital and Royal Hospital for Women. Patients: A total of 279 women with stage III-IV endometriosis who attempted to conceive post-operatively were included in the study (participation rate = 84%) with a mean follow-up of four years. Intervention: Laparoscopic resection of stage III-IV endometriosis. Measurements and Main Results: The endometriosis fertility index (EFI) was calculated based on detailed operative reports and surgical images. Fertility outcomes were obtained by direct patient contact. Kaplan-Meier model, log rank test and Cox regression were used for analyses. A total of 147 women (63%) obtained a live birth following surgery, 94 of them (64%) without assisted reproductive technology (ART). The EFI was highly associated with non-ART live births (p < .001), the estimated cumulative rate at 5 years being 0% for women with an EFI of 0–2 and steadily increasing up to 91% for women with an EFI of 9–10 (Fig. 1). A low least function score (taking into account the impact of lesions on the function of the adnexa) was the most significant predictors of failure (p = .003), followed by having had a previous resection (p = .019) or incomplete resection (p = .028) of endometriosis, being older (p = .027), and having leiomyomas (p = .037). Conclusion: Women with a high EFI have excellent fertility prognosis and may be advised to try to conceive naturally compared to women with a low score for which prompt referral to ART seems more reasonable. Other prognostic factors can be used to guide the management of women with intermediate EFI score. Localization and impact of lesions on the function of the adnexa seems crucial for the fertility prognosis.