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.