Abstract
BackgroundThe aim of this study was to determine whether the treatment with doxycycline before and after oocyte retrieval is as effective as salpingectomy in minimizing the detrimental effect of hydrosalpinx on the outcomes of IVF-ET.MethodsA retrospective analysis was done for the outcomes of the IVF-ET cycles of patients with hydrosalpinx who underwent laparoscopic salpingectomy prior to IVF cycle (n = 260) or were treated with extended doxycycline treatment during the IVF cycle (n = 45). In doxycycline group, doxycycline (100 mg twice daily) was started 1 week before anticipated oocyte retrieval and was continued for 1 week after oocyte retrieval. In salpingectomy group, the mesosalpinx was coagulated as close as possible to the fallopian tube.ResultsThe implantation, clinical pregnancy, ongoing pregnancy and live birth rates were significantly higher in the salpingectomy group (20.87% Vs. 9.91%, P value =0.007, 44.62% Vs. 20%, P value = 0.002, 39.62% Vs. 17.78%, P value = 0.005 and 37.31% Vs. 15.56%, P value = 0.005 respectively).ConclusionSalpingectomy is more effective than extended doxycycline treatment in improving the outcomes of IVF-ET in patients with hydrosalpinx undergoing IVF-ET. Further, larger well designed randomized controlled trials should be conducted to confirm the findings of this study.
Highlights
The negative consequences of hydrosalpinx on the outcomes of In vitro fertilization embryo transfer (IVF-ET) are confirmed by an overwhelming scientific evidence [1, 2]
The stimulation period, total dose of highly purified urinary FSH (HP-uFSH), number of follicles ≥17 mm on the day of Human chorionic gonadotropin (HCG) administration, oocytes retrieved, metaphase II oocyte, 2 pro-nucleate (2PN) embryos and number of embryos transferred were comparable between both groups
The implantation, clinical pregnancy, ongoing pregnancy and live birth rates were significantly higher in the salpingectomy group (20.87% Vs. 9.91%, P value =0.007, 44.62% Vs.20%, P value = 0.002, 39.62% Vs. 17.78%, P value = 0.005 and 37.31%Vs. 15.56%, P value = 0.005 respectively)
Summary
The negative consequences of hydrosalpinx on the outcomes of IVF-ET are confirmed by an overwhelming scientific evidence [1, 2]. Since 1994, there is almost agreement between studies that salpingectomy or proximal tubal occlusion significantly improve the reproductive outcomes of IVF-ET [1, 4, 5]. A Cochrane review revealed that salpingectomy or proximal tubal occlusion prior to IVF-ET significantly increased the clinical pregnancy, ongoing pregnancy and live birth rates [6]. Salpingectomy or proximal tubal occlusion are invasive procedures that may be associated with peri-operative complications especially in patients with dense pelvic adhesions. The aim of this study was to determine whether the treatment with doxycycline before and after oocyte retrieval is as effective as salpingectomy in minimizing the detrimental effect of hydrosalpinx on the outcomes of IVF-ET
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