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.