Outcomes of Different Treatments for Hydrosalpinx Undergoing in Vitro Fertilization and Embryo Transfer: A Retrospective Study with a Follow-Up of 5 Years

Background: Except for laparoscopic surgery (salpingectomy or proximal tubal occlusion/ligation), there are also some other common treatments used for hydrosalpinx before IVF such as ultrasonic-guided hydrosalpinx aspiration, hysteroscopic tubal occlusion etc. More evidence is needed to give advice for clinicians on the most effective treatment for hydrosalpinx undergoing IVF-ET.Methods: We reviewed 936 women with hydrosalpinx and 6715 tubal infertile women without hydrosalpinx who underwent IVF/ICSI between January 2014 and August 2019 in our center. Hydrosalpinx patients received different treatments including laparoscopic surgery (only salpingectomy and proximal tubal occlusion/ligation were included), ultrasonic-guided aspiration and hysteroscopic tubal occlusion. Patients received laparoscopic surgery (salpingectomy or proximal tubal occlusion/ligation) before fresh cycles or freeze-thaw embryo transfer cycles. Ultrasonic-guided aspiration was conducted during oocyte retrieval procedure in fresh cycles. Hysteroscopic tubal occlusion was conducted before freeze-thaw embryo transfer cycles. Outcomes were analyzed by One-way ANOVA, Chi-Square test and logistic regression.Results: The live birth rate (LBR) of laparoscopic surgery (salpingectomy or proximal tubal occlusion/ligation) was significantly higher compared with hydrosalpinx aspiration (48.3% vs 39.6%, P=0.024). The cumulative live birth rate (CLBR) of subsequent laparoscopic surgery was significantly higher compared with subsequent hysteroscopic occlusion (65.1% vs 34.1%, P=0.001) and no subsequent treatment (65.1% vs 44.9%, P＜0.005). Subsequent laparoscopic surgery (salpingectomy or proximal tubal occlusion/ligation) significantly improved the CLBR of hydrosalpinx patients who received ultrasonic-guided aspiration and didn't get clinical pregnancy in fresh cycles (Oddis Ratio (OR) =1.875; 95%CI=1.041-3.378, P=0.036).Conclusions: Laparoscopic surgery (salpingectomy or proximal tubal occlusion/ligation) leads to significantly higher LBR than ultrasonic-guided aspiration and significantly higher CLBR than hysteroscopic occlusion and no treatment.

Comparing options for females seeking permanent contraception in high resource countries: a systematic review

Background Multiple options for permanent or long-acting contraception are available, each with adverse effects and benefits. People seeking to end their fertility, and their healthcare providers, need a comprehensive comparison of methods to support their decision-making. Permanent contraceptive methods should be compared with long-acting methods that have similar effectiveness and lower anticipated adverse effects, such as the levonorgestrel-releasing intrauterine contraception (LNG-IUC). We aimed to understand the comparability of options for people seeking to end their fertility, using high-quality studies. We sought studies comparing laparoscopic tubal ligation, hysteroscopic tubal occlusion, bilateral salpingectomy, and insertion of the LNG-IUC, for effectiveness, adverse events, tolerability, patient recovery, non-contraceptive benefits, and healthcare system costs among females in high resource countries seeking to permanently avoid conception. Methods We followed PRISMA guidelines, searched EMBASE, Pubmed (Medline), Web of Science, and screened retrieved articles to identify additional studies. We extracted data on population, interventions, outcomes, follow-up, health system costs, and study funding source. We used the Newcastle–Ottawa Scale to assess risk of bias and excluded studies with medium–high risk of bias (NOS < 7). Due to considerable heterogeneity, we performed a narrative synthesis. Results Our search identified 6,612 articles. RG, BV, BC independently reviewed titles and abstracts for relevance. We reviewed the full text of 154 studies, yielding 34 studies which met inclusion criteria. We excluded 10 studies with medium–high risk of bias, retaining 24 in our synthesis. Most studies compared hysteroscopic tubal occlusion and/or laparoscopic tubal ligation. Most comparisons reported on effectiveness and adverse events; fewer reported tolerability, patient recovery, non-contraceptive benefits, and/or healthcare system costs. No comparisons reported accessibility, eligibility, or follow-up required. We found inconclusive evidence comparing the effectiveness of hysteroscopic tubal occlusion to laparoscopic tubal ligation. All studies reported adverse events. All forms of tubal interruption reported a protective effect against cancers. Tolerability appeared greater among tubal ligation patients compared to hysteroscopic tubal occlusion patients. No high-quality studies included the LNG-IUC. Conclusions Studies are needed to directly compare surgical forms of permanent contraception, such as tubal ligation or removal, with alternative options, such as intrauterine contraception to support decision-making. Systematic review registration PROSPERO [CRD42016038254].