Simultaneous vaginal oocyte retreival and laparascopic proximal occlusion of ultrasound visible hydrosalpinges improve the IVF outcome

Abstract

Objective: An increasing body of literature has reported that either unilateral or bilateral hydrosalpinges may exert a deletrious effect on IVF-ET cycle outcome. Also there is report that only large hydrosalpinges which were visible on ultrasound resulted in reduced clinical and pregnancy rate. To address this issue we compare the clinical and ongoing pregnancy rate attained after simultaneous vaginal oocyte retreival and laparascopic proximal occlusion of ultrasound visible hydrosalpinges with no proximal tubal occlusion in traditional IVF. Design: A group of 180 consenting unilateral or bilateral ultrasound visible hydrosalpinges IVF patients (IRB APPROVED) were randomly allocated for simultaneous vaginal oocyte retreival and laparascopic proximal occlusion of ultrasound visible hydrosalpinges versus no proximal tubal occlusion. Materials/Methods: 180 consenting normal responding IVF patients with maternal age less than 40 and unilateral or bilateral ultrasound visible hydrosalpinges were recruited for the study. The patients were randomly allocated into simultaneous vaginal oocyte retreival and laparascopic proximal occlusion of ultrasound visible hydrosalpinges (group 1, 92 patients) and no tubal occlusion (group 2, 88 patients). Results: The mean ages, number of oocytes and fertilization rates were not different in both groups. The mean number of embryos replaced were 2.3+0.8 and 3.1+0.6 in group 1 and 2 respectively (p <0.001). In the first group 6 out of 92 patients (6.5%) due to severe adhisions unilateral or bilateral laparascopic proximal occlusion of ultrasonic visible hydrosalpinges couldn‘t be done. Freezing of spare embryos was done in 50 cycles in group 1 and only in 12 cycles in group 2 (p = 0.006). The implantation rate in group 1 was 38.7% (106/274) and only 20.2% (40/198) in group 2 (p-value =0.002). The clinical pregnancy rates were 45.5% (40/88) and 18.6% (16/86)respectively (p-value=0.007). Conclusions: The pregnancy and implantation rates were significantly higher in simultaneous vaginal oocyte retreival and laparascopic proximal occlusion of ultrasound visible hydrosalpinges than in non-proximal tubal occlusion group and we believe that this is the best choice especially in patients with severe adhisions that prior removal of hydrosalpinges is not done. Supported by: Navid’s institute of infertility.