Comparison Between Hysteroscopic Proximal Tubal Occlusion Versus Laparoscopic Salpingectomy on Pregnancy Rates Following Intracytoplasmic Sperm Injection in Infertile Cases of Hydrosalpinx: Controlled Clinical Trial

Document Type : Original Article

Authors

1 Department of Obstetrics and Gynecology, Faculty of Medicine ,Cairo University, Cairo, Egypt

2 Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt

3 Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Abstract

Introduction: Tubal Factor of infertility resulting from various forms of subperitoneal damage remains a widespread cause
of female infertility, accounting for more than 35% of all cases of female infertility. Probably the most severe form of tubal
pathology is hydrosalpinx.  Objective: To assess and compare pregnancy outcomes in hydrosalpinx patients treated by hysteroscopic tubal occlusion and laparoscopic salpingectomy before IVF.  Material and Methods: A controlled, clinical trial between January 2020 to December 2020 was conducted, including a total of 78 women, of whom 39 were assigned to hysteroscopic proximal occlusion, and 39 were assigned to laparoscopic salpingectomy. Results:27/39 (69.2%) of patients who were operated upon by laparoscopic salpingectomy (LS) showed positive qualitative blood HCG test, while only 16/39 (41%) of those who were operated upon by hysteroscopic tubal occlusion (HPTO) showed positive qualitative blood HCG test, the difference in percentages of positive primary outcome between patients operated
upon by LS and HPTO are statistically significant (X2=6.271, P<0.05, RR=1.688, CI (1.097-2.596)). So we rejected the Null hypothesis of our research question that suggested that HPTO is of no difference in the pregnancy outcomes compared with Laparoscopic Salpingectomy(LS). Besides, we found that 24/39 (61.25%) of patients who underwent LS showed positive fetal heart sounds at eight weeks, versus 15/39 (38.5%) of those who underwent HPTO. The difference in Fetal heart sounds in 8 weeks between patients underwent LS and HPTO is statistically significant (X2=4.154, P<0.05, RR=1.6, CI (1.002-2.56)).  Conclusion: Laparoscopic salpingectomy (LS) is superior to Hysteroscopic tubal occlusion (HTPO) in terms of fetal heart sounds at eight weeksand higher pregnancy rate following IVF/ICSI upon adjusting the age and infertility status as confounders.

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