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Proximal tubal occlusion first or oocyte retrieval first for patients with hydrosalpinx?

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Our study aimed to investigate the best time to manage hydrosalpinx to improve pregnancy outcomes during in vitro fertilization–embryo transfer (IVF–ET).

Methods

Patients with hydrosalpinx who received IVF treatment were analyzed retrospectively. And two groups were included to compare the effects of different timing treatment of hydrosalpinx on IVF pregnancy outcomes, "Proximal Tubal Occlusion First Group” (Group Ligation-COH) and “Oocyte Retrieval First Group” (Group COH-Ligation). The main outcome measures included: ovarian response indexes, laboratory indexes and clinical pregnancy outcomes. Univariate and multivariate Logistic regression analysis was performed for outcome indicators, and the odds ratios (OR) and 95% confidence interval (CI) were used.

Results

A total of 1490 patients were included (n = 976 Ligation-COH and n = 514 COH-Ligation). The Gn starting dose and MII rate in group Ligation-COH were significantly higher than those in group COH-Ligation (203.33 ± 58.20 vs. 203.33 ± 58.20, 81.58% vs. 80.28%, P < 0.05). The number of oocytes obtained and the number of available D3 embryos in group COH-Ligation were higher than those in group Ligation-COH (15.10 ± 7.58 vs. 13.45 ± 6.42, 10.92 ± 5.81 vs. 9.94 ± 5.15, P < 0.05). Although the number of ET cycles per IVF cycle in group COH-Ligation was higher than that in group Ligation-COH (1.88 ± 1.00 vs. 1.48 ± 0.70, P < 0.05), the biochemical pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, live birth rate and cumulative live birth rate in group Ligation-COH were significantly higher than those in group COH-Ligation (60.83% vs. 46.27% for biochemical pregnancy, 55.69% vs. 38.5% for clinical pregnancy, 26.18% vs. 17.74% for multiple pregnancy, 47.08% vs. 25.26% for live birth, 69.47% vs. 47.47% for cumulative live birth, P < 0.05), and the miscarriage rate in group Ligation-COH was lower than that in group COH-Ligation (10.47% vs. 17.20 for early abortion, 4.49% vs. 15.86% for late abortion, P < 0.05). In logistic regression analysis, after adjustment for age and multiple factors, the above results were still statistically significant differences (P < 0.001). For elderly patients, the clinical pregnancy rate, multiple birth rate and live birth rate in group Ligation-COH were also higher than those in group COH-Ligation (P < 0.001). No significant differences were detected for patients with diminished ovarian reserve.

Conclusions

For the choice of ligation operation time, we recommend that patients choose tubal ligation first and then ovulation induction and oocyte retrieval treatment.

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Data availability

Data will be made available on request from Jie Li (lijie2012@126.com) and Qiuling Shi (qshi@cqmu.edu.cn).

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Acknowledgements

We thank all the clinicians, embryologists, research nurses and laboratory technicians as well as the patients in this study sincerely.

Funding

This study was funded by the Self-funded research projects by Guangxi Zhuang Autonomous Region Health Commission (grant numbers Z-A20220363).

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Author notes

  1. Jie Li, Sien Mo and Zhong Lin have contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China

    Jie Li & Qiuling Shi

  2. Reproductive Medicine Department, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China

    Jie Li, Sien Mo, Zhong Lin & Fuhua Mo

  3. School of Public Health, Chongqing Medical University, Chongqing, China

    Qiuling Shi

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Contributions

Topic selection and research designed: JL, SM, and QS; wrote the “Introduction” and “Discussion” sections: JL, FM; Wrote the “Materials and methods” and “Results” sections and participated in summarizing the manuscript: JL, ZL, and SM. All authors were responsible for writing and revising the draft.

Corresponding author

Correspondence to Qiuling Shi.

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Conflict of interest

The authors (J.L., SE. M., Z.L., FH.M., and QL.S.) declare that they have no competing interests.

Ethical approval

The research was approved by the medical ethics committee of the Reproductive Hospital of Guangxi Zhuang Autonomous Region (No.KY-LL-2022–13).

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Li, J., Mo, S., Lin, Z. et al. Proximal tubal occlusion first or oocyte retrieval first for patients with hydrosalpinx?. Arch Gynecol Obstet 309, 1597–1608 (2024). https://doi.org/10.1007/s00404-023-07359-0

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  • DOI: https://doi.org/10.1007/s00404-023-07359-0

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