Hysteroscopic Tubal Electrocoagulation versus Laparoscopic Tubal Disconnection for Management of Hydrosalpinx and Subsequent Pregnancy Outcomes: A Randomized Clinical Trial

Background: Hydrosalpinx impairs the success of in-vitro fertilization (IVF) embryo transfer. Various surgical approaches, such as fluid aspiration or isolation of the affected Fallopian tubes, have been utilized to enhance the outcome. This study was conducted to evaluate and compare the efficacy of Laparoscopic Tubal Disconnection (LTD) versus Hydroscopic Tubal Electrocoagulation (HTE) for hydrosalpinx prior to IVF.
Methods: After obtaining ethical committee approval, we assessed 112 subfertile women due to hydrosalpinx to check their adherence to our selection criteria. Eligible patients were allocated into 2 groups (LTD vs. HTE). Both groups underwent extensive assessment prior to the operative procedure. IVF and subsequent embryo transfers were done in both groups. Live birth and pregnancy rates were evaluated.
Results: Patients who underwent LTD prior to IVF embryo transfer have significantly higher live birth (41%), clinical pregnancy (57%), and chemical pregnancy (61%) rates in the LTD group compared to the HTE group (12%, 35%, 41%, respectively). However, we could not find a significant difference between the 2 groups regarding the miscarriage (17% vs. 28%, p= 0.33) and multiple pregnancy (14% vs. 12%, p= 0.79) rates. No major complications with HTE except for a case of uterine perforation, while 2 cases of surgical complications occurred in the LTD group. Additionally, we found a significantly shorter operative time and hospital stay (0.5±0.7 days, p= 0.012) in the HTE group.
Conclusion: Laparoscopic tubal disconnection may be a more effective approach compared to hysteroscopic tubal electrocoagulation for improving birth and pregnancy rates in IVF patients with hydrosalpinx.
Keywords: hydrosalpinx, tubal infertility, IVF, embryo transfer, laparoscopy.