Proximal Tubal Occlusion First or Oocyte Retrieval First for Patients with Hydrosalpinx?

Abstract Purpose Our study was aimed to investigate the best time to manage hydrosalpinx in order to improve pregnancy outcomes during in vitro fertilization-embryo transfer (IVF-ET). Methods Patients with hydrosalpinx who received IVF-ET were selected. Two groups were divided to compare the effects of different timing treatment of hydrosalpinx on IVF pregnancy outcomes, "Proximal Tubal Occlusion First Group” (Group Ligation-COH) and “Oocyte Retrieval First Group” (Group COH-Ligation). The main outcome measures included: ovarian response indexes, laboratory indexes and clinical pregnancy outcomes. Univariate and multivariate Logistic regression analysis was performed for outcome indicators, and the odds ratios (OR) and 95% confidence interval (CI) were used. Results A total of 1490 patients were included. The Gn initiation dose and MII rate in group Ligation-COH were significantly higher than those in group COH-Ligation (P < 0.05). The number of oocytes obtained and the number of available D3 embryos in group COH-Ligation were higher than those in group Ligation-COH (P < 0.05). Although the number of ET cycles per IVF cycle in group COH-Ligation was higher than that in group Ligation-COH (P < 0.05), the biochemical pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, live birth rate and cumulative live birth rate in group Ligation-COH were significantly higher than those in group COH-Ligation (P < 0.05), and the miscarriage rate in group Ligation-COH was lower than that in group COH-Ligation (P < 0.05). In logistic regression analysis, after adjustment for age and multiple factors, the above results were still statistically significant differences (P < 0.001). For elderly patients, the clinical pregnancy rate, multiple birth rate and live birth rate in group Ligation-COH were also higher than those in group COH-Ligation (P < 0.001). No significant differences were detected for patients with diminished ovarian reserve. Conclusions For the choice of ligation operation time, we recommend that patients choose tubal ligation first and then ovulation induction and oocyte retrieval treatment.