A Cochrane review [Abstract] 1 included 11 studies with a total of 1386 subjects. Laparoscopic salpingectomy increased clinical pregnancy rate (CPR) (RR 2.02, 95% CI 1.44 to 2.82; 4 RCTs; n = 455; I² = 42.5%). This suggests that in women with a CPR of approximately 19% without tubal surgery, the rate with salpingectomy lies between 27% and 52%. Tubal occlusion increased CPR compared to no tubal surgery (RR 3.21, 95% CI 1.72 to 5.99; 2 RCTs; n = 209). Laparoscopic occlusion of the fallopian tube versus no intervention increased CPR (RR 3.21, 95% CI 1.72 to 5.99; 2 RCTs; n = 209; I² = 0%). This suggests that with a CPR of approximately 12% without tubal surgery, the rate with tubal occlusion lies between 21% and 74%. Comparison of tubal occlusion to salpingectomy did not show a significant advantage of either surgical procedure in terms of CPR or live birth rate.
A seven-year real-world retrospective cohort study 2 included 160 women with primary or secondary infertility and laparoscopically confirmed hydrosalpinx, who underwent Palmer-type neosalpingostomy. Clinical pregnancy rate was 33.8%, intrauterine/live birth rate 25.6%, miscarriage rate 3.8%, and ectopic pregnancy rate 4.4%. Recurrence occurred in 21.2% of cases. Outcomes were strongly influenced by hydrosalpinx severity and pelvic adhesions: women with mild disease achieved the highest pregnancy rates. Neither age, AMH, nor laterality were independent predictors. Median time to pregnancy was 9 months.
A network meta-analysis 3 compared the safety and effectiveness of different methods, both ablative and non-ablative, to treat hydrosalpinx in infertile patients before in-vitro fertilization. 9 RCTs revealed no significant differences in live birth rate between hydrosalpinx treatment methods, with laparoscopic tuval occlusion achieving the highest SUCRA value (0.9). Salpingectomy and ultrasound-guided aspiration significantly increased the ongoing pregnancy rate compared with no treatment (OR 4.35 [95% CI 1.70 to 11.14] and 2.80 [95% CI 1.03 to 7.58], respectively), with salpingectomy having the highest SUCRA value (0.9). Clinical pregnancy rate was significantly higher following salpingectomy (OR 2.24 [95% CI 1.30 to3.86]) and laparoscopic tuval occlusion (OR 2.55 [95% CI 1.20 to 5.51]) compared with no treatment.
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