Human Reproduction, Vol. 16, No. 11, 2403-2410,
November 2001
© 2001 European Society of Human Reproduction and Embryology
Hydrosalpinx and IVF outcome: cumulative results after salpingectomy in a randomized controlled trial*
1 Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden, 2 The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark and 3 IVF Center Falun, Falu Hospital, S-791 82 Falun, Sweden
BACKGROUND: A randomized controlled trial of salpingectomy prior to IVF in patients with hydrosalpinges has been conducted in Scandinavia. The results from the first transfer cycle have been published and clearly demonstrated an improved pregnancy outcome after salpingectomy had been performed in patients with hydrosalpinges large enough to be visible on ultrasound. The present article is aimed at analysing the effect of salpingectomy on cumulative birth rate, including all individual transfer cycles. METHODS AND RESULTS: A total of 186 women underwent 452 cycles. Among the 77 women randomized to no surgical intervention, 24 underwent salpingectomy after one or two failed cycles. Cumulative results were analysed by Cox regression, taking into account the number of cycles per patient and the presence of a salpingectomy after a previous transfer. Salpingectomy implied a significant increase in birth rate (hazard ratio 2.1, 95% CI 1.6–3.6, P = 0.014). Within the subgroup of patients with ultrasound-visible hydrosalpinges, the birth rate was even higher (hazard ratio 3.8, 95% CI 1.5–9.2, P = 0.004). Implantation rate was significantly higher in patients who had undergone salpingectomy (27.2% versus 20.2, P = 0.03) and, in the subgroup of patients with ultrasound-visible hydrosalpinges, the difference was even larger (30.3% versus 17.1%, P = 0.003). CONCLUSIONS: The results of the cumulative cycles strengthen the recommendation for a laparoscopic salpingectomy prior to IVF in patients with ultrasound-visible hydrosalpinges.
Key words: cumulative pregnancy rates/hydrosalpinx/IVF/randomized controlled trial/salpingectomy
* The study group for the multicentre trial and responsible investigator at each site were as follows. Sweden: Annika Strandell, Dept Ob/Gyn, Sahlgrenska University Hospital, Göteborg; Urban Waldenström, IVF Center Falun, Falu Hospital, Falun; Niklas Simberg, Dept Ob/Gyn, Uppsala University Hospital, Uppsala; Leif Hägglund, International Fertility Center, Malmö; György Csemiczky, Dept Ob/Gyn, Karolinska Hospital, Stockholm. Denmark: Anette Lindhard, The Fertility Clinic, Rigshospitalet, University Hospital, Copenhagen. Norway: Vidar von Düring, Dept Ob/Gyn, Trondheim; Kari Flo, Dept Ob/Gyn, University of Tromsø. Iceland: GuPmundur Arason, Dept Ob/Gyn, National University Hospital, Reykjavik.
4 To whom correspondence should be addressed. E-mail: annika.strandell{at}medfak.gu.se
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