Delivery rates after in-vitro fertilization following bilateral salpingectomy due to hydrosalpinges: a case control study

Abstract

This retrospective case-control study assessed the impact of bilateral salpingectomy due to uni- or bilateral hydrosalpinges on the outcome of in-vitro fertilization (IVF) in a large consecutive series of patients. The effect of bilateral salpingectomy due to hydrosalpinges on pregnancy outcome was compared in 139 patients (263 cycles) and 139 age-matched controls with tubal infertility without hydrosalpinges (296 cycles). The delivery rates per initiated cycle as well as the implantation rates were equal in the two groups (21.7 versus 21.6% and 19 versus 21%). The number of embryos, the cleavage stage, and the embryo morphology score were equal in the two groups. Among 92 patients treated with 182 IVF cycles who underwent salpingectomy between 1.5 and 5 years prior to their first IVF cycle, the delivery and the implantation rates were 22.5 and 20.5% respectively. Of the patients with salpingectomy after an average of 1.7 failed IVF cycles and who re-entered the IVF programme 3 and 6 months subsequent to surgery, 47 were treated with 83 IVF cycles. The live birth and the implantation rates after surgery in this group were 20.5 and 20% respectively. It is concluded that bilateral salpingectomy due to hydrosalpinges restores a normal delivery as well as implantation rate after IVF treatment compared to controls. A favourable outcome is also found in patients operated on after repeated IVF failures. Furthermore, a normal live birth rate as well as a high implantation rate is maintained for at least three IVF cycles subsequent to surgical treatment.

Salpingectomy before assisted reproductive technologies: a systematic literature review

“…Obtained Embryos ± SD p No. transferred Embryos ± SD/range p Implantation Rate % (N) p Pregnancy Rate % (N) p Ongoing pregnancy rate % (N) p Lass et al [1]a) 29 SLP (ECP)Type: unilateralb) 73 no surgery(healthy subjects) pmol/L a) 6.087 ± 2.889b) 6.635 ± 2735 ns a) 12.3 ± 1.6b) 13.1 ± 2.0 ns - General a) 9.9 ± 5.3b) 9.9 ± 5.3c) Ipsilateral ovary3.8 ± 3.0Controlateral ovary6.0 ± 3.6a, b) nsc) .01 n.r -a) 2.4 ± 0.5b) 2.0 ± 0.7 ns n.r -a) 17.2 (5)b) 13.7 (10) ns n.r - Dechaud et al [2]a) 30 SLP (HY)Type: not specifiedb) 30 no surgery(TF, HY) pmol/L a) 2.699b) 1.903 ns n.r -a) 10.1 ± 5.0b) 10.5 ± 6.0 ns a) 5.2 ± 3.4b) 4.8 ± 3.7 ns n.r - - First attempts a) 10.4 (5/48)b) 4.6 (2/43) - All attempts a) 13.4 (21/156)b) 8.6 (10/116) ns - Per cycle a) 23.7 (14/59)b) 16.3 (8/49) - Per oocyte retrieval a) 31.8 (14/44)b) 23.5 (8/34) - Per transfer a) 36.8 (14/38)b) 25 (8/32) ns a) 34.2 (13/38)b) 18.7 (6/32) ns Bredkjaer et al [3]a) 139 SLP (HY)Type: 128 bilateral, 11 partialb) 139 no surgery(TF, no HY) n.r - n.r - a) 9.3b) 9.1 ns n.r - a) 2.1b) 2.1 ns a) 19b) 21 ns a) 40.3 (106)b) 40.5 (120) ns a) 21.7 (57)b) 21.6 (64) ns Strandell et al [4]a) 116 SLP (HY)Type: not specifiedb) 88 no surgery(TF, HY) n.r - a) 11.4 ± 2.2b) 11.6 ± 2.9 ns a) 10.6 ± 5.9b) 10.6 ± 6.1 ns a) 6.8 ± 4.8b) 7.0 ± 4.9 ns a) 2.0 ± 0.3b) 2.0 ± 0.4 ns - Per transfer cycle a) 22.8 (47/206)b) 18.8 (28/149) - Ultrasound visible HY a) 30 (21/70)b) 16.7 (13/78) ns .05 a) 36.6 (41)b) 23.9 (22) .05 a) 28.6 (32)b) 16.3 (15) .05 Dar et al [5]a) 26 SLP (ECP)...…”

“…All 11 [2, 4, 6, 7, 9–12, 20, 22, 28] and 14 [1, 3–5, 7–9, 11, 18, 22, 24, 25, 29, 30] studies which analyzed, respectively, the number of embryos obtained and of embryos transferred found no statistically significant difference between salpingectomy and non-salpingectomy patients.…”

“…One RCT and one retrospective study found no significant differences between treated and untreated women, even if surgically treated patients for hydrosalpinx showed a better implantation rate in terms of absolute value compared to untreated subjects [2, 10]. Two further retrospective studies found no significant improvement of implantation rate in patients after salpingectomy; however, in these cases, the control subjects were represented by patients with tubal factor infertility without hydrosalpinx [3, 24]. …”

“…The remaining RCT did not show a significant improvement in pregnancy rate, even if a better result in terms of absolute value for transfer cycle in the salpingectomy group was reported [2]. All other observational and retrospective studies, with the exception of that reported by Orvieto et al [18], did not report differences in terms of pregnancy rate in the salpingectomy compared to the control group; however, patients in the control group were generally affected by infertility for tubal factor without hydrosalpinx or were patients who underwent a surgical or medical procedure other than salpingectomy [1, 3, 8, 10, 17, 18, 21, 22, 24, 27, 30]. …”

“…The rapid development of IVF and embryo transfer (ET) has seen assisted reproduction proposed as a valid choice for women affected by different type of infertility ranging from aging related problems [1–3] to organic pathologies such as tubal factor [4–6]. …”