Introduction
Hydrosalpinges is a severe form of tubal disease, referred to as a
fluid-filled distention of the fallopian tube in the presence of a
distal tubal occlusion. It accounts for 10-30% of tubal diseases, which
forms 25-35% of female subfertility.1-3
Hydrosalpinges may be diagnosed with hysterosalpingography, laparoscopy
or ultrasonography.4, 5 The presence of a
hydrosalpinges has a negative effect on pregnancy rate in women who
undergo In Vitro Fertilization (IVF),6 however, the
exact mechanism has not been fully confirmed. It is hypothesized that
the leakage of fluid into the uterine cavity may disturb the receptivity
of the endometrium, alternatively the fluid may also be embryotoxicy,
for example lipophilic factors are reported to be detrimental to embryo
development.7, 8
In the last decades, IVF has become more and more implemented in women
with bilateral hydrosalpinges. Salpingectomy before IVF is assumed to
increase clinical pregnancy rates.3, 9, 10 However, in
the cases of bilateral disease, a bilateral salpingectomy results in
permanent sterility while a neosalpingostomy is a tuba-sparing surgery
that provides the option of future natural conception for more than one
cycle. As for women who would like to preserve their fallopian tubes and
the ability for natural conception, a salpingostomy could be performed
to restore the anatomy.
Previous studies reported a pooled livebirth rate of 25% (95% CI: 22 -
28%) through natural conception after neosalpingostomy and ongoing
pregnancy rate of 55.8% (24/43) via one IVF/ICSI
(Intra-Cytoplasmic
Sperm Injection) treatment cycle (including embryo-transfer of
cryopreserved embryos) after salpingectomy.11, 12Intrauterine pregnancy rates after neosalpingostomy for mild
hydrosalpinges range from 58% to 77% and for severe disease from 0%
to 22%.13 The variation can be explained by
variations in the indicators for severity of hydrosalpinges, variations
in outcomes’ definition and variations in the follow-up.
None of the previous studies compared the cumulative livebirth rate
between salpingectomy and
neosalpingostomy, also prognostic factors to select women who will
benefit from salpingectomy or neosalpingostomy are lacking. To compare
long term reproductive outcomes between salpingectomy and
neosalpingostomy, we performed a prospective cohort study in women with
subfertility with bilateral severe hydrosalpinges.