Reproductive outcomes
In total, 113 women were included in the ITT analysis, 42 out of 55
women in the salpingectomy group conceived successfully after IVF
treatment, and 21 out of 58 women had a live birth after the initial
intended neosalpingostomy without any additional surgery (12 conceived
naturally, and 9 through IVF). In the neosalpingostomy group, 15 women
had additional salpingectomy (7 unilateral, and 8 bilateral) for
recurrent hydrosalpinges (confirmed by HSG) or for ectopic pregnancy.
These 15 women had live births successfully (4 conceived naturally, and
11 through IVF).
According to the ITT analyses, the cumulative livebirth rate was
significantly higher in salpingectomy group than in the neosalpingostomy
group (85.3% vs 76.0%, hazard ratio of the whole survival curve =
2.18, 95% CI 1.37 - 3.45). Compared to neosalpingostomy, the mean time
to first live birth in salpingectomy group was shorter (19 [14,27]
vs 36 [17,76] months, P = 0.001) and the risk of an ectopic
pregnancy was lower (1.8% vs 20.7%, risk ratio = 0.07, 95% CI 0.01 -
0.57). All observed miscarriages were early clinical pregnancy losses
(before gestational age of 12 weeks). No statistically significant
differences regarding biochemical pregnancy and clinical miscarriage
between the two groups were found. Except that the biochemical pregnancy
rate and the overall livebirth rate were higher in the salpingectomy
group, similar results were obtained in both groups in PP analysis. This
can be explained by the fact that 8 women with additional bilateral
salpingectomy, excluded in PP analysis, all had live births successfully
after IVF treatment (Table 2, Table S3).
With the Kaplan-Meier analysis, the cumulative livebirth rate in
salpingectomy group reached a plateau at 85.30% from the
7th year onwards, while in the neosalpingostomy group,
five women had a live birth through IVF after 7 years of follow-up, of
which three received additional bilateral salpingectomy (Figure 2-A). In
neosalpingostomy group, 27.6% (16/58) of women had the first live birth
through natural conception (12/58 conceived naturally without additional
surgery), compared with 0% (0/55) in the salpingostomy group, and the
mean time to live birth in this group was 23 [15,44] months. The
trend of cumulative livebirth rate through natural conception in
neosalpingostomy group is shown in Figure 2-B.