Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF

• Published in: Human reproduction (Oxford) 1999-11, Vol.14 (11), p.2762-2769
• Main Authors: Strandell, A., Lindhard, A., Waldenström, U., Thorburn, J., Janson, P.O., Hamberger, L.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Birth control; Embryo Transfer; Fallopian Tube Diseases - complications; Fallopian Tube Diseases - surgery; Female; Fertilization in Vitro; Gynecology. Andrology. Obstetrics; Humans; hydrosalpinx; in-vitro fertilization; Laparoscopy; Medical sciences; Pregnancy; Pregnancy Outcome; pregnancy rates; Prospective Studies; randomized controlled trial; Retrospective Studies; salpingectomy; Scandinavian and Nordic Countries; Sterility. Assisted procreation; Treatment Failure
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/14.11.2762

Many retrospective studies have shown that hydrosalpinx is associated with poor in-vitro fertilization (IVF) outcome. The mechanism of the actual cause is not yet fully understood. A clinical practice of performing salpingectomy before IVF has developed, without any evidence from prospective trials. The aim of the present prospective randomized trial was to test if a salpingectomy prior to IVF was effective in terms of increased pregnancy rates. Patients with hydrosalpinx were randomized to either a laparoscopic salpingectomy or no intervention before IVF. A total of 204 patients was available for an intention-to-treat analysis and 192 actually started IVF. Clinical pregnancy rates per included patient were 36.6% in the salpingectomy group and 23.9% in the non-intervention group (not significant, P = 0.067) and the ensuing delivery rates were 28.6% and 16.3% (P = 0.045). The corresponding delivery rates per transfer cycle were 29.5% versus 17.5% (not significant, P = 0.083). A subgroup analysis revealed significant differences in favour of salpingectomy, in implantation rates in patients with bilateral hydrosalpinges (25.6% versus 12.3%, P = 0.038) and in clinical pregnancy rates (45.7% versus 22.5%, P = 0.029) and delivery rates (40.0% versus 17.5%, P = 0.038) in patients with ultrasound visible hydrosalpinges. The delivery rate was increased 3.5-fold in patients with bilateral hydrosalpinges visible on ultrasound (P = 0.019).