Impact of laparoscopic salpingectomy on clinical pregnancy, live birth, and miscarriage rates in women with hydrosalpinx

INTRODUCTION: This study was planned to investigate the effect of L/S salpingectomy to be performed before IVF/ICSI on clinical pregnancy, live birth, and abortion rates in infertile patients diagnosed with hydrosalpinx.
METHODS: Forty patients who were found to have hydrosalpinx in routine evaluations before ART were included in the study. The diagnosis of Hydrosalpinx (HX) was made by transvaginal ultrasonography or hysterosalpingography (HSG). Based on HSG or sonography, a unilateral or bilateral hydrosalpinx was noted as being present or absent. A hydrosalpinx was defined as an echo-free cyst-like fluid accumulation or irregular cystic lesion located outside the ovary and uterus. Salpingectomy was recommended because it may adversely affect ART results. The patients were divided into two groups according to their salpingectomy decisions. Group 1 (n=23) consisted of patients with uni or bilateral HX and accepted salpingectomy. Group 2 (n=17) consisted of patients who were found to have uni or bilateral HX but did not accept salpingectomy. Fifteen patients who did not have HX and were planned for IVF/ICSI due to unexplained infertility were accepted as the control group. The primary outcome measures of the study were detection of serum beta hCG levels, clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate.
RESULTS: Positive beta-hCG was detected in 11 of 23 patients who underwent salpingectomy (47.8%), while hCG was positive in six of 17 patients who did not undergo salpingectomy (35.2%). In the salpingectomy group, clinical pregnancy was detected in 10 patients (43.4%), nine patients had a live birth (39.1%), and abortion was found in 1 patient (9.0%). In the group that did not undergo salpingectomy, clinical pregnancy was detected in 5 patients (29.4%), three patients gave live birth (17.6%), and abortion was found in 2 patients (33.3%). Positive beta-hCG (47.8% vs. 35.2%, p<0.01), CPR (43.4% vs. 29.4%, p<0.002), and LBR (39.1% vs. 17.6%, p<0.001) were found to be significantly higher in the salpingectomy group compared to the nonsalpingectomy group. Abortion rates were significantly higher in the group that did not undergo salpingectomy (33.3% vs. 9.0%, p<0.01). The hCG positivity, CPR, and LBR of the unexplained infertile patients were similar to the salpingectomy group. In this group, pregnancy test positivity was found in seven of 15 patients (46.6%), clinical pregnancy was found in 6 patients (40%), and five patients had a live birth (33.3%). Abortion was detected in one case in the control group (14.2%).
DISCUSSION AND CONCLUSION: Performing salpingectomy for HX improves clinical pregnancy and live birth rates and reduces miscarriage rates.