Effects Of Different Operation Management And Postoperative Recurrence Of Hydrosalpinx On IVF-ET Outcome And Ovarian Function

BackgroundIn vitro fertilization and embryo transfer(IVF-ET)was originally designed to treat infertility caused by tubal disease,but hydrosalpinx could significantly reduce the clinical outcome of IVF-ET.At present,the treatment of hydrosalpinx included the ultrasound guided water aspiration,salpingostomy,Hysteroscopic tubal occlusion,proximal tubal ligation and salpingectomy.At present,the main method of treatment is salpingectomy,but there is not much research on the proximal ligation of the fallopian tube.There is a risk of recurrence of hydrosalpinx after the tubal ligation.In this case,there are lack of research about the adverse effects of recurrence of hydrosalpinges.Objective:To evaluate and compare the clinical impact of different operation methods and postoperative recurrence of hydrosalpinges when performed before IVF-ET in patients with hydrosalpinges.Methods:The data of 939 infertile patients through tubal factors undergoing IVF-ET in the Center for Reproductive Medicine,Shandong University from 2012 to 2014 were analyzed retrospectively.All patients were divided into four groups according to the management of hydrosalpinx.311 patients with hydrosalpinx in group A had been treated with proximal tubal ligation,113 patients with hydrosalpinx in group B treated with salpingostomy,,109 patients with hydrosalpinx in group C were treated with salpingectomy.While311 patients with hydrosalpinx in group D were untreated.Group A were divided into two groups according to whether the hydrosalpinx were reappeared.87 patients of hydrosalpinx were recurred with 224 patients cycles no recurrence of hydrosalpinx.The clinical outcome of IVF-ET was evaluated.Results:1.The clinical pregnancy rate,live birth rate,of per patients in the proximal tube ligation of the fallopian tube group were significantly higher compared with the untreated group[(157/311)50.5%vs.(164/406)40.4%,(144/157,91.7%vs.127/164,77.4%(p value<0.05)respectively].2.Ectopic-pregnancy rate in the proximal tube ligation of the fallopian tube group were significantly lower compared with the untreated group[(3/157),1.9%vs.(21/164),12.8%(p value<0.05)].3.There were no significant differences between the salpingostomy group and the untreated group.4.AFC number of salpingectomy group was lower than the ligation group[(12.4±6.0)vs.(12.0±4.9)(p value>0.05)].The Gn amount of salpingectomy group was merely more than the ligation group[(2160.3±794.1)vs(2111.1 ±762.6).(p value>0.05)].5.There were no significant differences of clinical outcome between the salpingectomy group and the ligation group.6.The clinical pregnancy rate and ectopic pregnancy rate in the reccurent proximal tubal ligation group was slightly higher compared with the unreccurent group(49.8%vs 46.3%;4.8%vs 0.9%;P>0.05 respectively)without significant differences.But the Biochemical pregnancy rate and abortion rate in the reccurent proximal tubal ligation group was slightlylower compared with the unreccurent group(4.6%vs 4.9%;7.14%vs6.09%;P>0.05 respectively)without significant differencesConclusions:1.Ligation of the fallopian tube when performed in women with unilateral or bilateral hydrosalpinges before their IVF treatment,represents potential benefits---significantly increasing the clinical pregnancy rate and significantly decreasing abortion rate and ectopic rate.2.Salpingostomy can not significantly increasing the clinical pregnancy of IVF-ET.3.There is no significance influence on ovarian function between proximal tubal ligation and salpingectomy.4.There is no effect of the hydrosalpinges recurrence on the 1VF-ET outcome after tube ligation.