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.