Surgical treatment for tubal disease in women due to undergo in vitro fertilisation
Abstract
Background
Tubal disease, and particularly hydrosalpinx, has a detrimental effect on the outcome of in‐vitro fertilisation (IVF). It has been less clear whether surgical intervention for tubal disease prior to IVF is effective in improving the likelihood of successful outcome. Most data are retrospective or poorly controlled. To date no single prospective randomised trial has shown a significant benefit from such surgical treatment prior to IVF.
Objectives
To assess the value of surgical treatment for tubal disease prior to IVF.
Search methods
The search strategy of the Menstrual Disorders and Subfertility Group was used for the identification of relevant randomised controlled trials.
Selection criteria
All trials where a surgical treatment for tubal disease was compared with a control group generated by randomisation were considered for inclusion in the review.
Data collection and analysis
Three randomised controlled trials were identified and included in this review, after an attempt to obtain further information from the authors of all three trials. All trials were assessed for quality criteria. The studied outcomes were live birth (and ongoing pregnancy), pregnancy, ectopic pregnancy, miscarriage, multiple pregnancy, complications, implantation rate and the proportion of IVF cycles resulting in embryo transfer.
Main results
The odds of pregnancy (OR 1.75, 95%CI 1.07, 2.86) and of ongoing pregnancy and live birth (OR 2.13, 95%CI 1.24, 3.65) were increased with laparoscopic salpingectomy for hydrosalpinges prior to IVF. There was no significant difference in the odds of ectopic pregnancy (OR 0.42, 95%CI 0.08, 2.14), miscarriage (OR 0.49, 95%CI 0.16, 1.52), treatment complications (OR 5.80, 95%CI 0.35, 96.79) or implantation rate (OR 1.34, 95%CI 0.87, 2.05). No data were available concerning the odds of multiple pregnancy or the proportion of IVF cycles resulting in embryo transfer.
Authors' conclusions
Laparoscopic salpingectomy should be considered for all women with hydrosalpinges prior to IVF treatment. Currently unilateral salpingectomy for a unilateral hydrosalpinx (bilateral salpingectomy for bilateral hydrosalpinges) should be recommended, although this requires further evaluation. Further randomised trials are required to assess other surgical treatments for hydrosalpinx, such as salpingostomy, tubal occlusion or needle drainage of a hydrosalpinx at oocyte retrieval. The role of surgery for tubal disease in the absence of a hydrosalpinx is unclear and merits further evaluation.
PICOs
Plain language summary
Removing blocked or diseased fallopian tubes before IVF can increase pregnancy rates for women on the IVF program. Diseases such as hydrosalpinx (watery substances in blocked fallopian tubes) can severely reduce the chances of pregnancy while on the IVF program because of damage to the fallopian tubes. A salpingectomy (removing the damaged fallopian tube) can be done to remove the blocked part of the tube. The review of trials found laparoscopic salpingectomy prior to IVF treatment increases the odds of pregnancy and live birth. However, the procedure is very delicate. More research is needed to examine this and other treatments.
