Proximal tubal occlusion first or oocyte retrieval first for patients with hydrosalpinx?

Abstract

Our study was aimed to investigate the best time to manage hydrosalpinx in order to improve pregnancy outcomes during in vitro fertilization-embryo transfer (IVF-ET). MethodsPatients with hydrosalpinx who received IVF-ET were selected. Two groups were divided to compare the effects of different timing treatment of hydrosalpinx on IVF pregnancy outcomes, "Proximal Tubal Occlusion First Group" (Group Ligation-COH) and "Oocyte Retrieval First Group" (Group COH-Ligation). The main outcome measures included: ovarian response indexes, laboratory indexes and clinical pregnancy outcomes. Univariate and multivariate Logistic regression analysis was performed for outcome indicators, and the odds ratios (OR) and 95% con dence interval (CI) were used. ResultsA total of 1490 patients were included. The Gn initiation dose and MII rate in group Ligation-COH were signi cantly higher than those in group COH-Ligation (P < 0.05). The number of oocytes obtained and the number of available D3 embryos in group COH-Ligation were higher than those in group Ligation-COH (P < 0.05). Although the number of ET cycles per IVF cycle in group COH-Ligation was higher than that in group Ligation-COH (P < 0.05), the biochemical pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, live birth rate and cumulative live birth rate in group Ligation-COH were signi cantly higher than those in group COH-Ligation (P < 0.05), and the miscarriage rate in group Ligation-COH was lower than that in group COH-Ligation (P < 0.05). In logistic regression analysis, after adjustment for age and multiple factors, the above results were still statistically signi cant differences (P < 0.001). For elderly patients, the clinical pregnancy rate, multiple birth rate and live birth rate in group Ligation-COH were also higher than those in group COH-Ligation (P < 0.001). No signi cant differences were detected for patients with diminished ovarian reserve. ConclusionsFor the choice of ligation operation time, we recommend that patients choose tubal ligation rst and then ovulation induction and oocyte retrieval treatment. Pregnancy follow-upBlood β-HCG was detected 14 days after embryo transfer. Vaginal ultrasound monitoring was performed 28 days after transplantation. If pregnancy sac was found in utero as clinical pregnancy, luteal support was performed until 10-12 weeks of pregnancy. Main outcome measures Ovarian response and laboratory indicatorsBlood samples were taken on the day of HCG administration, and transported to our clinical laboratory, centrifuged at 3000 rpm for 5 min, and stored at 2-8°C. Within 2-3 h, serum E2 level, LH level, and progesterone levels were assessed by Roche Elecsys electrochemiluminescence immunoassay (Elecsys ECLIA).The initiation dose of Gn, the total injection amount of Gn, the total injection days of Gn, endometrial thickness on the day of HCG administration, retrieved oocytes, oocyte maturation rate, normal fertilization rate, cleavage rate, number of D3 embryos, high-quality D3 embryo rate, available blastocyst rate, and hi...