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Proximal Fallopian Tubal Embolization by Interventional Radiology prior to Embryo Transfer in Infertile Patients with Hydrosalpinx: A Prospective Study of an Off-label Treatment.
J Minim Invasive Gynecol. 2020 01; 27(1):107-115.JM

Abstract

STUDY OBJECTIVE

To evaluate in vitro fertilization (IVF) outcomes of proximal fallopian tube embolization by interventional radiology compared with laparoscopic salpingectomy before embryo transfer (ET) in patients with hydrosalpinx.

DESIGN

A single-center, off-label, nonrandomized prospective study.

SETTING

Academic university hospital.

PATIENTS

One hundred fifty-five patients with hydrosalpinx were identified on ultrasound or hysterosalpingography desiring IVF between April 2016 and December 2017.

INTERVENTIONS

Radiologically guided tubal occlusion with embolization microcoils (RTO-EM) and laparoscopic salpingectomy.

MEASUREMENTS AND MAIN RESULTS

Of the 155 analyzed patients, 42 were treated with RTO-EM and 113 with laparoscopic salpingectomy. The subsequent IVF outcomes, including implantation, clinical pregnancy, miscarriage, ectopic pregnancy, and ongoing pregnancy (i.e., a fetal heartbeat on ultrasound beyond 10 weeks) were compared between the 2 groups. Implantation and clinical pregnancy per ET cycle in the RTO-EM group were similar to that of the salpingectomy group (26.7% vs 30.2% [p = .51] and 39.0% vs 45.3% [p = .40], respectively), with a similar miscarriage rate. There was no statistically significant difference in ectopic pregnancies between the 2 groups. Moreover, no difference was detected in ongoing pregnancy per cycle between the 2 groups (33.9% vs 41.2%; p = .32). The ongoing-pregnancy rate per patient following RTO-EM was 47.6% (20 of 42) compared with 61.9% (70 of 113) following salpingectomy (odds ratio, 0.56; 95% confidence interval, 0.27-1.14; p = .11).

CONCLUSION

Pregnancy in the RTO-EM group was comparable to the salpingectomy group in patients with hydrosalpinx before ET treatment. RTO-EMs may be an alternative to salpingectomy for patients with hydrosalpinx planning for IVF-ET.

Authors+Show Affiliations

Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China.Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China.Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China.Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China.Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China.Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China.Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China. Electronic address: zouyuzju@zju.edu.cn.Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China. Electronic address: jinfan@zju.edu.cn.

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31580926

Citation

Yang, Xinyun, et al. "Proximal Fallopian Tubal Embolization By Interventional Radiology Prior to Embryo Transfer in Infertile Patients With Hydrosalpinx: a Prospective Study of an Off-label Treatment." Journal of Minimally Invasive Gynecology, vol. 27, no. 1, 2020, pp. 107-115.
Yang X, Zhu L, Le F, et al. Proximal Fallopian Tubal Embolization by Interventional Radiology prior to Embryo Transfer in Infertile Patients with Hydrosalpinx: A Prospective Study of an Off-label Treatment. J Minim Invasive Gynecol. 2020;27(1):107-115.
Yang, X., Zhu, L., Le, F., Lou, H., Zhao, W., Pan, P., Zou, Y., & Jin, F. (2020). Proximal Fallopian Tubal Embolization by Interventional Radiology prior to Embryo Transfer in Infertile Patients with Hydrosalpinx: A Prospective Study of an Off-label Treatment. Journal of Minimally Invasive Gynecology, 27(1), 107-115. https://doi.org/10.1016/j.jmig.2019.02.026
Yang X, et al. Proximal Fallopian Tubal Embolization By Interventional Radiology Prior to Embryo Transfer in Infertile Patients With Hydrosalpinx: a Prospective Study of an Off-label Treatment. J Minim Invasive Gynecol. 2020;27(1):107-115. PubMed PMID: 31580926.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proximal Fallopian Tubal Embolization by Interventional Radiology prior to Embryo Transfer in Infertile Patients with Hydrosalpinx: A Prospective Study of an Off-label Treatment. AU - Yang,Xinyun, AU - Zhu,Linling, AU - Le,Fang, AU - Lou,Hangying, AU - Zhao,Wei, AU - Pan,Peipei, AU - Zou,Yu, AU - Jin,Fan, Y1 - 2019/09/30/ PY - 2018/11/12/received PY - 2019/02/23/revised PY - 2019/02/27/accepted PY - 2019/10/4/pubmed PY - 2020/9/26/medline PY - 2019/10/4/entrez KW - In vitro fertilization KW - Proximal tubal occlusion KW - Tubal infertility SP - 107 EP - 115 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 27 IS - 1 N2 - STUDY OBJECTIVE: To evaluate in vitro fertilization (IVF) outcomes of proximal fallopian tube embolization by interventional radiology compared with laparoscopic salpingectomy before embryo transfer (ET) in patients with hydrosalpinx. DESIGN: A single-center, off-label, nonrandomized prospective study. SETTING: Academic university hospital. PATIENTS: One hundred fifty-five patients with hydrosalpinx were identified on ultrasound or hysterosalpingography desiring IVF between April 2016 and December 2017. INTERVENTIONS: Radiologically guided tubal occlusion with embolization microcoils (RTO-EM) and laparoscopic salpingectomy. MEASUREMENTS AND MAIN RESULTS: Of the 155 analyzed patients, 42 were treated with RTO-EM and 113 with laparoscopic salpingectomy. The subsequent IVF outcomes, including implantation, clinical pregnancy, miscarriage, ectopic pregnancy, and ongoing pregnancy (i.e., a fetal heartbeat on ultrasound beyond 10 weeks) were compared between the 2 groups. Implantation and clinical pregnancy per ET cycle in the RTO-EM group were similar to that of the salpingectomy group (26.7% vs 30.2% [p = .51] and 39.0% vs 45.3% [p = .40], respectively), with a similar miscarriage rate. There was no statistically significant difference in ectopic pregnancies between the 2 groups. Moreover, no difference was detected in ongoing pregnancy per cycle between the 2 groups (33.9% vs 41.2%; p = .32). The ongoing-pregnancy rate per patient following RTO-EM was 47.6% (20 of 42) compared with 61.9% (70 of 113) following salpingectomy (odds ratio, 0.56; 95% confidence interval, 0.27-1.14; p = .11). CONCLUSION: Pregnancy in the RTO-EM group was comparable to the salpingectomy group in patients with hydrosalpinx before ET treatment. RTO-EMs may be an alternative to salpingectomy for patients with hydrosalpinx planning for IVF-ET. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/31580926/Proximal_Fallopian_Tubal_Embolization_by_Interventional_Radiology_prior_to_Embryo_Transfer_in_Infertile_Patients_with_Hydrosalpinx:_A_Prospective_Study_of_an_Off_label_Treatment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(19)31235-X DB - PRIME DP - Unbound Medicine ER -