Salpingectomy and Proximal Tubal Occlusion for Hydrosalpinx Prior to In Vitro Fertilization: A Meta-analysis of Randomized Controlled Trials

Objective: The objective of this study was to conduct a systematic review of studies comparing the pregnancy outcomes in hydrosalpinx patients treated with salpingectomy versus those treated with proximal tubal occlusion prior to in vitro fertilization (IVF). Data Sources: An extensive PubMed literature search was performed for the period from 1980 to December 2013 using combinations of the following keywords: "hydrosalpinx," "salpingectomy," and "tubal occlusion." Methods of the Study Selection: Initially, 204 relevant studies were identified from MEDLINE and screened for retrieval. All of the randomized controlled trials comparing ovarian response and the pregnancy outcome of salpingectomy and proximal tubal occlusion for hydrosalpinx patients prior to IVF were considered eligible for analysis. Tabulation, Integration, and Results: Two investigators independently reviewed the studies. The data were pooled, and the mean standard difference (SD) was calculated. Eligible randomized controlled trials were selected for this meta-analysis. There were no differences in the response days to controlled ovarian hyperstimulation (SD = -1.112, SE = 0.973, Z = -1.14, P = 0.253), number of oocytes retrieved (SD = 0.404, SE = 0.311, Z= 1.300, P = 0.194), embryos transferred per cycle (SD = -0.757, SE = 0.568, Z = -1.332, P = 0.183), and fertilized oocytes (SD = -0.006, SE = 0.130, Z = -0.045, P = 0.964) between the patients receiving salpingectomy and proximal tubal occlusion. The pooled rates for clinical pregnancy (odds ratio, 0.864; 95% confidence interval, 0.534-1.398; Z = -0.596, P = 0.551) and implantation (odds ratio, 1.558; 95% confidence interval, 0.809-3.003; Z = 1.325, P = 0.185) were not significantly different between the hydrosalpinx patients with salpingectomy versus proximal tubal occlusion. Conclusions: Similar responses to controlled ovarian hyperstimulation and pregnancy outcome were observed in patients treated with salpingectomy or proximal tubal occlusion. Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this CME activity, physicians should be better able to evaluate the efficacy of salpingectomy versus proximal tubal occlusion treatment prior to IVF for hydrosalpinx patients.