Interventions
Preoperative hysterosalpingography (HSG) and an intraoperative tubal scoring system at laparoscopy were used to evaluate the severity of bilateral tubal lesions. Hydrosalpinx was diagnosed when a dilated, convoluted tubular structure was seen during HSG and a lack of diffusion of contrast medium into the abdomen (Figure S1).16, 17The H&R classification (2002) was used to assign subfertile women into three categories based on the severity of pelvic findings at laparoscopy or laparotomy.15 According to H&R classification, severe was rated in the cases of bilateral severe tubal damage, extensive tubal fibrosis, tubal distension > 1.5 cm, abnormal mucosal appearance, bilateral occlusion, and extensive dense adhesions (Table S1). All scores were evaluated by two experienced gynecologists during the operation independently. If there was any disagreement, another independent chief physician made an assessment based on the stored video after the surgery.
All women underwent surgery within 3 to 7 days after menstruation. Surgical procedures were performed using a 7mm hysteroscope (Shen Da) and 30-degree 10mm laparoscope (Stryker, American). In both groups, women received general endotracheal anesthesia in lithotomy and Trendelenburg position. Artificial pneumoperitoneum and surgery approaches of laparoscope and hysteroscope were established according to a routine protocol, followed by a detailed examination of the uterus, ovaries, pelvis and detailed evaluation of hydrosalpinges as described above.