Clinical implications
Our study is in favor of bilateral salpingectomy compared to neosalpingostomy in women with laparoscopic confirmed severe bilateral hydrosalpinges given the higher cumulative livebirth rates and shorter time to live birth and lower chance of EP. However, after this sterilizing surgery women can only become pregnant after IVF therapy. All women should be counseled concerning the alternatives, they need to know that they have approximately a 21% chance on a live birth by natural conception without any additional second surgery. This counseling is very important in particular in women who do not wish to undergo IVF or have a high risk on morbidity during IVF for example advanced age. This should be weighed against a longer period to achieve a live birth and a higher risk on EP. Sufficient surgical skills are obligatory to perform a proper neosalpingostomy. Therefore, every team should have specialized surgeons or should refer the patient in case of intended neosalpingostomy.