P-753 Preferences in subfertile women for hysterosalpingography or transvaginal hydrolaparoscopy in the fertility work-up: a labelled discrete choice experiment.
Authors: Paulussen M M V , Van Kessel M A , Tros R , Oosterhuis G J E , Bongers M Y , Mol B W J , Koks C A M , Essers B A B 
Published: June 2023

Abstract

Study question
What aspects do subfertile women prefer for hysterosalpingography (HSG) or transvaginal hydrolaparoscopy (THL) to assess their Fallopian tubes?

Summary answer
The chance of a false negative result, failure rate, and waiting time are attributes that impact women’s preference for tubal patency testing strategy.

What is known already
THL and HSG are commonly used diagnostic tests for tubal patency testing, both with different features. HSG is a radiological procedure whit contrast to evaluate tubal patency, whereas THL is a procedure where access to the pouch of Douglas is obtained with an endoscope and the tubes are tested with methylene blue. THL was found non-inferior to HSG as a first-line test in terms of conception leading to live birth.
Until now, limited research has been performed to study the values and preferences of subfertile women in the diagnostic work-up.

Study design, size, duration
We conducted a labelled discrete choice experiment (DCE), which is an attribute-based survey method for measuring preferences. This DCE consisted of 2 questionnaires with each 12 different choice sets. Women with an indication for tubal patency testing were included in the study between September 2021 and January 2023 in two Dutch hospitals. They were randomly assigned for questionnaire 1 or 2.

Participants/materials, setting, methods
Attributes were defined based on literature review, structured patient interviews and expert focus groups. This resulted in five final attributes: the chance of having a “false negative” result, complication rate, failure rate, subsequent management after a failed procedure and waiting time. Women were asked to choose between choice sets with hypothetical scenarios of two tubal patency tests with different levels of the attributes. Data were analysed by using multinomial logistic regression.

Main results and the role of chance
The questionnaire was returned by 75 out of 80 women. Mean age was 31.8 years and mean duration of subfertility was 23.5 months. 65 women experienced primary subfertility vs 10 who experienced secondary subfertility.
For THL women preferred a lower chance of a false negative result (p &lt; 0.001), a lower failure rate (p = 0.008) and a shorter waiting time (p = 0.003). Outcomes for chance of complications and management after a failed procedure were not significant. Only for the group of women with primary subfertility, if a THL is not conclusive or if there is a failure to reach the pouch of Douglas, women prefer to have a conventional laparoscopy over expectant management (p = 0.01).
Women choosing HSG preferred a lower chance of a false negative result (p &lt; 0.001), a shorter waiting time (p = 0.02) and a lower chance of complications (p = 0.001).
Because of the labelled design we performed, we saw that women chose for THL significantly more than for HSG; 83% vs 17% (P = 0.03). This may be caused by way of counselling and the fact that these medical centres are one of the few centres in the Netherlands that perform the THL.

Limitations, reasons for caution
Our analysis with 78 women, showed significant outcomes in terms of preference on specific attributes, but it is possible that we would have found stronger associations with a larger sample size.

Wider implications of the findings
These results provide more insight in the perspective of subfertile women about the aspects of tubal patency testing in the fertility work-up and they enable informed decision making. Further research is needed to compare our findings to the other forms of tubal patency testing in the fertility work-up.

Trial registration number
N20.009