Abstract
The objective of this paper is to compare assisted reproductive technology (ART) cumulative live birth rates after hysteroscopic proximal tubal occlusion and laparoscopic salpingectomy in endometriosis patients, for management of hydrosalpinx. This is an observational cohort study at a university hospital, including all endometriosis patients with hydrosalpinges undergoing ART, between January 2013 and December 2018. The patients underwent either laparoscopic salpingectomy or hysteroscopic proximal tubal occlusion with Essure® when laparoscopy was not an option (extensive pelvic adhesions at exploratory laparoscopy or a history of multiple abdominal surgeries with frozen pelvis). The diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography (TVUS) and magnetic resonance imaging (MRI). Endometriosis patients with hydrosalpinges diagnosed by hysterosalpingography and/or TVUS and/or MRI were included. The primary outcome was the cumulative live birth rate. A total of 104 patients were included in the study; 74 underwent laparoscopic salpingectomy and 30 underwent proximal tubal occlusion with Essure®. The Essure® group had longer infertility durations (58.9 ± 30.0 months vs. 39.5 ± 19.1 months, p = 0.002) and a higher incidence of associated adenomyosis (76.7% vs. 39.1%, p < 0.001) than the salpingectomy group. The cumulative live birth rate was 56.6% after 44 ART cycles in the Essure® group and 40.5% after 99 ART cycles in the salpingectomy group (p = 0.13). In a population of endometriosis patients undergoing ART, women treated by Essure® for management of hydrosalpinx have similar cumulative live birth rates as women treated by laparoscopic salpingectomy.
Similar content being viewed by others
Data availability
NA
Code Availability
NA
References
Sampson JA. Metastatic or embolic endometriosis, due to the menstrual dissemination of endometrial tissue into the venous circulation. Am J Pathol. 1927;3(2):2.
Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666–82. https://doi.org/10.1038/s41574-019-0245-z.
Maignien C, et al. Prognostic factors for assisted reproductive technology in women with endometriosis-related infertility. Am J Obstet Gynecol. 2017;216(3, 3). https://doi.org/10.1016/j.ajog.2016.11.1042.
Zeyneloglu HB, Arici A, Olive DL. Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization-embryo transfer. Fertil Steril. 1998;70(3):492–9. https://doi.org/10.1016/s0015-0282(98)00200-3.
Strandell A, Thorburn J, Wallin A. The presence of cytokines and growth factors in hydrosalpingeal fluid. J Assist Reprod Genet. 2004;21(7):241–7. https://doi.org/10.1023/b:jarg.0000042009.93520.15.
Strandell A, Lindhard A. Why does hydrosalpinx reduce fertility? The importance of hydrosalpinx fluid. Hum Reprod Oxf Engl. 2002;17(5):1141–5. https://doi.org/10.1093/humrep/17.5.1141.
Seli E, et al. Removal of hydrosalpinges increases endometrial leukaemia inhibitory factor (LIF) expression at the time of the implantation window. Hum Reprod Oxf Engl. 2005;20(11):3012–7. https://doi.org/10.1093/humrep/dei188.
Copperman AB, Wells V, Luna M, Kalir T, Sandler B, Mukherjee T. Presence of hydrosalpinx correlated to endometrial inflammatory response in vivo. Fertil Steril. 2006;86(4):972–6. https://doi.org/10.1016/j.fertnstert.2006.02.113.
Melo P, et al. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev. 2020;10(22):CD002125. https://doi.org/10.1002/14651858.CD002125.pub4.
Arora P, Arora RS, Cahill D. Essure(®) for management of hydrosalpinx prior to in vitro fertilisation-a systematic review and pooled analysis. BJOG Int J Obstet Gynaecol. 2014;121(5):527–36. https://doi.org/10.1111/1471-0528.12533.
Xu B, Zhang Q, Zhao J, Wang Y, Xu D, Li Y. Pregnancy outcome of in vitro fertilization after Essure and laparoscopic management of hydrosalpinx: a systematic review and meta-analysis. Fertil Steril. 2017;108(1):84–95.e5. https://doi.org/10.1016/j.fertnstert.2017.05.005.
Dreyer K, et al. Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT. Hum Reprod Oxf Engl. 2016;31(9):2005–16. https://doi.org/10.1093/humrep/dew050.
Barbosa MW, Sotiriadis A, Papatheodorou SI, Mijatovic V, Nastri CO, Martins WP. High miscarriage rate in women treated with Essure® for hydrosalpinx before embryo transfer: a systematic review and meta-analysis. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2016;48(5):556–65. https://doi.org/10.1002/uog.15960.
Cohen SB, et al. In vitro fertilization outcomes after placement of Essure microinserts in patients with hydrosalpinges who previously failed in vitro fertilization treatment: a multicenter study. J Minim Invasive Gynecol. 2016;23(6):939–43. https://doi.org/10.1016/j.jmig.2016.05.010.
Zegers-Hochschild F, et al. The international glossary on infertility and fertility care, 2017. Hum Reprod Oxf Engl. 2017;32(9):1786–801. https://doi.org/10.1093/humrep/dex234.
Revzin MV, Moshiri M, Katz DS, Pellerito JS, Mankowski Gettle L, Menias CO. Imaging evaluation of fallopian tubes and related disease: a primer for radiologists. Radiogr Rev Publ Radiol Soc N Am Inc. 2020;40(5):1473–501. https://doi.org/10.1148/rg.2020200051.
Guerriero S, et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta-analysis. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2016;47(3):281–9. https://doi.org/10.1002/uog.15662.
Medeiros LR, et al. Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet. 2015;291(3):611–21. https://doi.org/10.1007/s00404-014-3470-7.
Marcellin L, et al. Focal adenomyosis of the outer myometrium and deep infiltrating endometriosis severity. Fertil Steril. 2020;114(4):818–27. https://doi.org/10.1016/j.fertnstert.2020.05.003.
Chapron C, et al. Questioning patients about their adolescent history can identify markers associated with deep infiltrating endometriosis. Fertil Steril. 2011;95(3):877–81. https://doi.org/10.1016/j.fertnstert.2010.10.027.
Chapron C, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020;26(3):392–411. https://doi.org/10.1093/humupd/dmz049.
null Bettocchi, New era of office hysteroscopy, J Am Assoc Gynecol Laparosc, 3, no. 4, Supplement, p. S4, 1996.
Franchini M, et al. Essure transcervical tubal sterilization: a 5-year x-ray follow up. Fertil Steril. 2011;95(6):2114–5. https://doi.org/10.1016/j.fertnstert.2011.02.022.
Dhruva SS, Ross JS, Gariepy AM. Revisiting Essure--toward safe and effective sterilization. N Engl J Med. 2015;373(15):e17. https://doi.org/10.1056/NEJMp1510514.
Bourdon M, et al. The deferred embryo transfer strategy seems not to be a good option after repeated IVF/ICSI cycle failures. Reprod Sci Thousand Oaks Calif. 2019;26(9):1210–7. https://doi.org/10.1177/1933719118811648.
Bourdon M, et al. The deferred embryo transfer strategy improves cumulative pregnancy rates in endometriosis-related infertility: a retrospective matched cohort study. PLoS One. 2018;13(4):e0194800. https://doi.org/10.1371/journal.pone.0194800.
Kolte AM, et al. Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group. Hum Reprod Oxf Engl. 2015;30(3):495–8. https://doi.org/10.1093/humrep/deu299.
Maheshwari A, McLernon D, Bhattacharya S. Cumulative live birth rate: time for a consensus? Hum Reprod Oxf Engl. 2015;30(12):2703–7. https://doi.org/10.1093/humrep/dev263.
T. E. G. G. O. Ovarian Stimulation et al., ESHRE guideline: ovarian stimulation for IVF/ICSI†, Hum Reprod Open, vol. 2020, no. 2, p. hoaa009, 2020. https://doi.org/10.1093/hropen/hoaa009.
De Vos A, et al. Cumulative live birth rates after fresh and vitrified cleavage-stage versus blastocyst-stage embryo transfer in the first treatment cycle. Hum Reprod Oxf Engl. 2016;31(11):2442–9. https://doi.org/10.1093/humrep/dew219.
Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev. 2016;6:CD002118. https://doi.org/10.1002/14651858.CD002118.pub5.
Kresowik JD, Stegmann BJ, Sparks AE, Ryan GL, van Voorhis BJ. Five-years of a mandatory single-embryo transfer (mSET) policy dramatically reduces twinning rate without lowering pregnancy rates. Fertil Steril. 2011;96(6):1367–9. https://doi.org/10.1016/j.fertnstert.2011.09.007.
Racca A, et al. Single and double embryo transfer provide similar live birth rates in frozen cycles. Gynecol Endocrinol Off J Int Soc Gynecol Endocrinol. 2020;36(9):824–8. https://doi.org/10.1080/09513590.2020.1712697.
Pabuccu R, Onalan G, Kaya C. GnRH agonist and antagonist protocols for stage I-II endometriosis and endometrioma in in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril. 2007;88(4):832–9. https://doi.org/10.1016/j.fertnstert.2006.12.046.
Rodriguez-Purata J, Coroleu B, Tur R, Carrasco B, Rodriguez I, Barri PN. Endometriosis and IVF: are agonists really better? Analysis of 1180 cycles with the propensity score matching. Gynecol Endocrinol Off J Int Soc Gynecol Endocrinol. 2013;29(9):859–62. https://doi.org/10.3109/09513590.2013.808327.
Câmara S, de Castro Coelho F, Freitas C, Remesso L. Essure® present controversies and 5 years’ learned lessons: a retrospective study with short- and long-term follow-up. Gynecol Surg. 2017;14(1):20. https://doi.org/10.1186/s10397-017-1023-3.
Santulli P, et al. Increased rate of spontaneous miscarriages in endometriosis-affected women. Hum Reprod Oxf Engl. 2016;31(5):1014–23. https://doi.org/10.1093/humrep/dew035.
Yang X, et al. Proximal fallopian tubal embolization by interventional radiology prior to embryo transfer in infertile patients with hydrosalpinx: a prospective study of an off-label treatment. J Minim Invasive Gynecol. 2020;27(1):107–15. https://doi.org/10.1016/j.jmig.2019.02.026.
Wu Y-C, et al. Fibered platinum coil: a novel option for the patients of hydrosalpinx with laparoscopic contradiction. Eur J Obstet Gynecol Reprod Biol. 2018;229:179–84. https://doi.org/10.1016/j.ejogrb.2018.08.579.
Chen H, Jiang W, Lin G, Lu G, Gong F. Hysteroscopic placement of platinum microinsert in patients with hydrosalpinx before in vitro fertilization and embryo transfer. J Minim Invasive Gynecol. 2019;26(6):1157–63. https://doi.org/10.1016/j.jmig.2018.08.033.
Acknowledgements
The authors thank the staff members of our department for their expert assistance with data collection, particularly Valerie Blanchet, Julia Gonnot, and Célie Cervantes of the ART unit, and we gratefully acknowledge Gaelle Gouet for unabatedly managing the patient database.
Author information
Authors and Affiliations
Contributions
PS and CC conceived of and designed the study. CM, MB, MC, JPS, AM, LM, and PS collected the data. CM, MB, JPS, AM, and PS developed the statistical analyses. CM, MC, JPS, AM, and PS authored the manuscript. All of the authors read and approved the final version of the manuscript.
Corresponding author
Ethics declarations
Ethics Approval
This study was approved for publication by the Ethics Review Committee of the Cochin University Hospital (CLEP) (n° AAA-2020-08043).
Consent to Participate
All the participants provided written informed consent.
Consent for Publication
All the participants provided written informed consent.
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Rights and permissions
About this article
Cite this article
Maignien, C., Bourdon, M., Scarano-Pereira, J.P. et al. ART Outcomes After Hysteroscopic Proximal Tubal Occlusion Versus Laparoscopic Salpingectomy for Hydrosalpinx Management in Endometriosis Patients. Reprod. Sci. 29, 427–435 (2022). https://doi.org/10.1007/s43032-021-00737-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43032-021-00737-6