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Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment.
J Obstet Gynaecol Can. 2020 06; 42(6):779-786.JO

Abstract

OBJECTIVE

This study sought to answer the following question: What are the complications and assisted reproductive technology outcomes among women with hydrosalpinges managed by hysteroscopic microinsert tubal occlusion compared with women with hydrosalpinges managed by laparoscopic proximal tubal occlusion or salpingectomy?

METHODS

This was a retrospective cohort study conducted from January 2009 to December 2014 at two academic, tertiary care, in vitro fertilization centres in Toronto, Ontario. All patients (n = 52) who underwent hysteroscopic tubal occlusion for hydrosalpinges were identified. Patients who proceeded with embryo transfer cycles after hysteroscopic microinsert (n = 33) were further age matched to a cohort of patients who underwent embryo transfer after laparoscopic proximal tubal occlusion or salpingectomy (n = 33). Main outcome measures were clinical pregnancy rate per patient and per embryo transfer cycle.

RESULTS

Among 33 patients, there were 39 fresh and 37 frozen embryo transfer cycles in the hysteroscopic group (group A); among 33 patients in the laparoscopic group (group B), there were 42 fresh and 29 frozen embryo transfer cycles. The cumulative clinical pregnancy rate in group A and group B was similar (66.7% vs. 69.7%, respectively; P = 0.8). The clinical pregnancy rate per embryo transfer cycle was also similar in both groups (28.9% in group A vs. 32.4% in group B; P = 0.6). There were two incidents of ectopic pregnancy in the laparoscopic group and no ectopic pregnancy in the hysteroscopic group. There were three major complications: tubo-ovarian abscess, distal migration of the coil after microinsert placement, and an acute abdomen following the hysteroscopic procedure.

CONCLUSION

Pregnancy outcomes after hysteroscopic placement of a microinsert for hydrosalpinx management before embryo transfer were comparable to those following laparoscopic proximal tubal occlusion or salpingectomy. However, caution is advised regarding microinsert placement for hydrosalpinges before proceeding with assisted reproductive technology.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON.Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON.Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON.Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON.Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON.Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; CReATe Fertility Centre, Toronto, ON.Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; CReATe Fertility Centre, Toronto, ON.Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; CReATe Fertility Centre, Toronto, ON.Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; CReATe Fertility Centre, Toronto, ON.Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON. Electronic address: egreenblatt@mtsinai.on.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32224160

Citation

Arora, Ritika, et al. "Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment." Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstetrique Et Gynecologie Du Canada : JOGC, vol. 42, no. 6, 2020, pp. 779-786.
Arora R, Shapiro H, Liu K, et al. Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment. J Obstet Gynaecol Can. 2020;42(6):779-786.
Arora, R., Shapiro, H., Liu, K., Arthur, R., Cruickshank, B., Sharma, P., Glass, K., Baratz, A., Librach, C., & Greenblatt, E. M. (2020). Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment. Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstetrique Et Gynecologie Du Canada : JOGC, 42(6), 779-786. https://doi.org/10.1016/j.jogc.2019.11.065
Arora R, et al. Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment. J Obstet Gynaecol Can. 2020;42(6):779-786. PubMed PMID: 32224160.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment. AU - Arora,Ritika, AU - Shapiro,Heather, AU - Liu,Kimberly, AU - Arthur,Rebecca, AU - Cruickshank,Barbara, AU - Sharma,Prati, AU - Glass,Karen, AU - Baratz,Ari, AU - Librach,Clifford, AU - Greenblatt,Ellen M, Y1 - 2020/03/26/ PY - 2019/08/07/received PY - 2019/11/11/revised PY - 2019/11/14/accepted PY - 2020/4/1/pubmed PY - 2020/4/1/medline PY - 2020/4/1/entrez KW - fallopian tube diseases KW - fertilization in vitro KW - hysteroscopes KW - reproductive techniques, assisted KW - salpingectomy KW - sterilization, reproductive SP - 779 EP - 786 JF - Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC JO - J Obstet Gynaecol Can VL - 42 IS - 6 N2 - OBJECTIVE: This study sought to answer the following question: What are the complications and assisted reproductive technology outcomes among women with hydrosalpinges managed by hysteroscopic microinsert tubal occlusion compared with women with hydrosalpinges managed by laparoscopic proximal tubal occlusion or salpingectomy? METHODS: This was a retrospective cohort study conducted from January 2009 to December 2014 at two academic, tertiary care, in vitro fertilization centres in Toronto, Ontario. All patients (n = 52) who underwent hysteroscopic tubal occlusion for hydrosalpinges were identified. Patients who proceeded with embryo transfer cycles after hysteroscopic microinsert (n = 33) were further age matched to a cohort of patients who underwent embryo transfer after laparoscopic proximal tubal occlusion or salpingectomy (n = 33). Main outcome measures were clinical pregnancy rate per patient and per embryo transfer cycle. RESULTS: Among 33 patients, there were 39 fresh and 37 frozen embryo transfer cycles in the hysteroscopic group (group A); among 33 patients in the laparoscopic group (group B), there were 42 fresh and 29 frozen embryo transfer cycles. The cumulative clinical pregnancy rate in group A and group B was similar (66.7% vs. 69.7%, respectively; P = 0.8). The clinical pregnancy rate per embryo transfer cycle was also similar in both groups (28.9% in group A vs. 32.4% in group B; P = 0.6). There were two incidents of ectopic pregnancy in the laparoscopic group and no ectopic pregnancy in the hysteroscopic group. There were three major complications: tubo-ovarian abscess, distal migration of the coil after microinsert placement, and an acute abdomen following the hysteroscopic procedure. CONCLUSION: Pregnancy outcomes after hysteroscopic placement of a microinsert for hydrosalpinx management before embryo transfer were comparable to those following laparoscopic proximal tubal occlusion or salpingectomy. However, caution is advised regarding microinsert placement for hydrosalpinges before proceeding with assisted reproductive technology. SN - 1701-2163 UR - https://www.unboundmedicine.com/medline/citation/32224160/Safety_and_Assisted_Reproductive_Technology_Outcomes_of_Hysteroscopic_Tubal_Microinserts_Versus_Laparoscopic_Proximal_Tubal_Occlusion_or_Salpingectomy_for_Hydrosalpinges_Treatment. L2 - https://linkinghub.elsevier.com/retrieve/pii/S1701-2163(19)31108-9 DB - PRIME DP - Unbound Medicine ER -
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