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.