Comparison of the ongoing pregnancy rate of in vitro fertilisation following tubal occlusion by microcoil placement versus laparoscopic tubal ligation for hydrosalpinges.

To compare the pregnancy outcomes of in vitro fertilisation (IVF) following tubal occlusion by microcoil placement versus laparoscopic tubal ligation for hydrosalpinges. This was a single centre retrospective study of 127 infertile women aged <43 years with unilateral or bilateral hydrosalpinges on transvaginal ultrasound who underwent either tubal occlusion by the microcoil placement under X-ray control (the microcoil group (n = 60)) or laparoscopic tubal ligation (the ligation group (n = 67)) prior to IVF at the discretion of the attending physicians. In all women, laparoscopy was not considered to be contraindicated due to extensive pelvic adhesions. The pregnancy outcomes of the IVF cycle following the treatment for hydrosalpinges were compared. Both groups had comparable demographic and cycle stimulation characteristics. The positive pregnancy test (43.3% (26/60) vs 64.2% (43/67), p = 0.02, RR = 0.68 (0.48-0.95)), ongoing pregnancy (35.0% (21/60) vs 58.2% (39/67), p = 0.009, RR = 0.60 (0.40-0.89)) and implantation rates (33.3% (34/102) vs 49.5% (56/113), p = 0.016, RR 0.67 (0.48-0.94)) were significantly lower in the microcoil group than those in the ligation group. Both groups had similar miscarriage, multiple pregnancy and ectopic pregnancy rates. A multivariate logistic regression revealed that only the women's age and the treatment method of hydrosalpinx were significant factors in predicting the ongoing pregnancy. A lower ongoing pregnancy rate of IVF was found in women with hydrosalpinges following tubal occlusion by microcoil placement under X-ray when compared with laparoscopic tubal ligation.

Chlamydia trachomatis infection among Ghanaian women undergoing hysterosalpingography for suspected tubal factor infertility.

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis infection and the correlates of tubal pathology among Ghanaian women undergoing hysterosalpingography for suspected tubal factor infertility. METHODS: A cross-sectional study was conducted among 189 women with infertility who underwent hysterosalpingography at Korle Bu Teaching Hospital, Ghana, from September 1 to November 30, 2016. Demographic data; obstetric and gynecologic history; and hysterosalpingography findings were collected using a structured questionnaire. Endocervical swabs were tested for the presence of Chlamydia trachomatis using a rapid antigen-based diagnostic kit. Associations between the variables were assessed using bivariate analysis. RESULTS: Positive test results for Chlamydia trachomatis were recorded among 15 participants, giving an overall prevalence of 7.9% (95% confidence interval [CI] 4.1%-11.7%). In all, 67 (35.4%) participants had abnormal findings on hysterosalpingography, with 40 (21.2%) displaying bilateral tubal occlusion. The remaining 122 (64.6%) women had normal findings on hysterosalpingography. Eight participants with normal tubal appearance tested positive for Chlamydia trachomatis (prevalence 6.6%, 95% CI 2.2%-11.0%), whereas seven participants with abnormal tubal appearance tested positive (prevalence 10.4%, 95% CI 3.1%-17.7%; P=0.402). No associations were found between participant characteristics and tubal pathology. CONCLUSION: The prevalence of Chlamydia trachomatis did not differ by hysterosalpingography findings.

Hydrosalpinx: Tubal surgery or in vitro fertilisation? An everlasting dilemma nowadays; a narrative review.

The decision on how to treat tubal diseases, specifically hydrosalpinx, is a difficult one. Ιt involves surgical, medical, social, emotional and economic factors. This narrative review aims to increase awareness of tubal disease diagnosis and treatment, to compare between tubal surgery and in vitro fertilisation (IVF) for tubal factor infertility, and to investigate the effect of the combination of both. This way, we can be more effective, safe and provide our patients with better treatment results. The review analysed randomised studies, trials and meta-analysis, which give new aspects on the treatment methods for tubal pathology before IVF. Recent papers published in English have been studied, alongside guidelines and committee opinions from previous years. Tubal surgery and IVF aim to exploit a woman's reproductive potential. IVF and endoscopic tubal surgery must be thought of as complementary, rather than competing techniques in tubal disease cases, in order to improve fertility outcome. The first-line treatment for young women less than 35 years old with minor tubal pathology, is tubal surgery. IVF should be offered if there are other factors in a couple's subfertility, if the patient is >38 years old, if moderate to severe tubal disease is present, and if it has been more than 12 months post-surgery.

In Vitro Fertilization Outcomes After Placement of Essure Microinserts in Patients With Hydrosalpinges Who Previously Failed In Vitro Fertilization Treatment: A Multicenter Study.

STUDY OBJECTIVE: To investigate whether hysteroscopic proximal tubal occlusion with Essure microinserts (Conceptus Inc.; Bayer, AG, North Rhine-Westphalia, Germany) can improve pregnancy rates in patients with hydrosalpinges who had failed in vitro fertilization (IVF) treatment. DESIGN: A prospective cohort study. SETTING: University-affiliated tertiary centers. PATIENTS: Twenty-four consecutive women with hydrosalpinges who had failed IVF treatment were included. INTERVENTIONS: Hysteroscopic placement of Essure microinserts for hydrosalpinx blockage followed by IVF treatment. MEASUREMENTS AND MAIN RESULTS: Ongoing pregnancy and live birth rates were recorded. Of the 24 patients undergoing a total of 42 IVF cycles after Essure insertion, 18 (75% of patients and 42.8% of IVF cycle attempts) conceived and 16 delivered live births (66.6% of patients and 38.1% of IVF cycle attempts). CONCLUSION: Hysteroscopic proximal occlusion of hydrosalpinges with Essure microinserts is a valuable alternative to laparoscopic salpingectomy, resulting in reasonable pregnancy rates.

Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT.

STUDY QUESTION: Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy? SUMMARY ANSWER: Hysteroscopic proximal tubal occlusion by intratubal devices is inferior to laparoscopic salpingectomy in the treatment of hydrosalpinges in women undergoing IVF/ICSI with respect to ongoing pregnancy rates. WHAT IS KNOWN ALREADY: It is known that women with hydrosalpinges undergoing IVF have poorer pregnancy outcomes compared with women with other forms of tubal infertility. In these women, both laparoscopic salpingectomy and laparoscopic proximal tubal ligation are known to improve IVF outcomes. At present, it is unclear whether a less-invasive hysteroscopic treatment with intratubal devices leads to similar ongoing pregnancy rates following IVF when compared with laparoscopic salpingectomy. STUDY DESIGN, SIZE, DURATION: A two-centre, randomized, controlled, non-inferiority trial. Between October 2009 and December 2014 a total of 85 women were included in this study; of whom, 42 were randomized to hysteroscopic proximal occlusion by intratubal device placement and 43 were randomized to laparoscopic salpingectomy. Randomization was based on a computer-generated randomization list. The study was unblinded. The primary outcome was ongoing pregnancy rate, defined as a fetal heartbeat on ultrasound beyond 10-week gestation following one IVF/ICSI treatment (fresh and frozen-thawed embryo transfers). PARTICIPANTS/MATERIALS, SETTING, METHODS: We studied women aged 18-41 years, with uni- or bilateral ultrasound visible hydrosalpinges who were scheduled for an IVF/ICSI treatment. MAIN RESULTS AND THE ROLE OF CHANCE: The ongoing pregnancy rates per patient according to the intention-to-treat principle were 11/42 (26.2%) after hysteroscopic proximal occlusion by intratubal devices (intervention group) versus 24/43 (55.8%) after laparoscopic salpingectomy (control group) (P = 0.008) [absolute difference: 26.1%; 95% confidence interval (CI): 0.5-51.7, relative risk (RR): 0.56; 95% CI: 0.31-1.03, P = 0.01]. In the per protocol analysis, the ongoing pregnancy rate per patient following hysteroscopic proximal occlusion by intratubal devices was 9/27 (33.3%) compared with 19/32 (59.4%) following laparoscopic salpingectomy (P = 0.067) (absolute difference: 29.6%; 95% CI: 7.1 to 49.1, RR: 0.47; 95% CI: 0.27-0.83, P = 0.062). LIMITATIONS, REASONS FOR CAUTION: Masking participants and investigators would be difficult due to the nature of both interventions. Since we had objective outcome measurements, we withheld sham procedures, leaving the study unblinded. Furthermore, our low sample size resulted in wide CIs. A larger sample size would result in a more accurate treatment effect; however, this was non-feasible for recruitment and inclusion. WIDER IMPLICATIONS OF THE FINDINGS: In the treatment of hydrosalpinges prior to IVF/ICSI, hysteroscopic proximal occlusion by intratubal devices is inferior to laparoscopic salpingectomy. STUDY FUNDING/COMPETING INTERESTS: The intratubal devices were received from Conceptus, Inc., San Carlos, CA, USA, which was acquired by Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ, USA in 2013. Conceptus, Inc./Bayer HealthCare Pharmaceuticals, Inc. had no role in the study design, data collection and analyses, decision to publish or preparation of the manuscript. The study as a whole was funded by the SWOG (foundation for scientific investigation in obstetrics and gynaecology of the VU University Medical Centre, Amsterdam, the Netherlands). P.G.A.H. has received non-financial support from Conceptus, Inc. during the conduct of this study. He has received grants from Ferring B.V., Merck Serono and Abbott outside the submitted work. M.H.E. has received personal fees from Smith and Nephew and IQ Medical Ventures outside the submitted work. TRIAL REGISTRATION NUMBER: The Dutch Trial Register: NTR 2073. TRIAL REGISTRATION DATE: October 21, 2009. DATE OF FIRST PATIENT'S ENROLMENT: October 26, 2009.

Diagnostic accuracy of hysterosalpingo-foam-sonography to confirm tubal occlusion after Essure® placement as treatment for hydrosalpinges.

Consensus globally is that hydrosalpinges need to be treated before IVF owing to their negative influence on outcomes. The current standard treatment is laparoscopic salpingectomy. A potential less invasive treatment is proximal occlusion of a hydrosalpinx by hysteroscopic placement of an Essure® device. Tubal occlusion after Essure® placement needs to be verified by hysterosalpingography (HSG). However, this is a painful examination, that exposes patients to radiation. Hysterosalpingo-foam sonography (HyFoSy) is a less invasive alternative test to confirm proximal tubal occlusion. This prospective diagnostic accuracy study evaluated if HyFoSy is as accurate as HSG to confirm proximal tubal occlusion after placement of an Essure® device as treatment for a hydrosalpinx before IVF. Thirty-eight treated hydrosalpinges in 26 women were evaluated. Proximal occlusion was verified by HyFoSy (index test) and HSG (standard reference). The accuracy of HyFoSy was 97.4% (95% CI 92.3% to 100.0%). Sensitivity and specificity were 97.1% (95% CI.84.6% to 99.5%) and 100.0% (95% CI 40.2% to 100.0%), respectively. After an Essure® device is placed as treatment for a hydrosalpinx before IVF, HyFoSy is as able as HSG to confirm proximal tubal occlusion. If HyFoSy demonstrates tubal patency, a subsequent HSG needs to be carried out to validate this finding.

Outcomes of pregnancies in women with hysteroscopically placed micro-inserts in situ.

This was a retrospective review of all pregnancies reported after Essure in situ in the Netherlands. Pregnancies included those that were unintentional (resulting from lack of protocol adherence and/or misread confirmation tests) and those that were intentional (resulting from off-label use of Essure micro-inserts for hydrosalpinx closure before in vitro fertilization/intracytoplasmic sperm injection with embryo transfer or in vitro fertilization with embryo transfer after regret of sterilization). The outcomes of 50 pregnancies in women with 1 or 2 micro-inserts in situ were evaluated. Eight unintended pregnancies and 18 intended pregnancies resulted in birth of a full-term healthy baby. Seven infants were delivered via cesarean-section. Two women delivered prematurely by C-section, (singleton after 34 weeks 1 day, twins after 35 weeks 3 days). All babies are healthy and without any congenital anomalies. There were 2 stillbirths after 20 weeks; however, it is unlikely that this was related to the presence of the micro-inserts. In conclusion, it is unlikely that the presence of intratubal micro-inserts interferes with implantation and the developing amniotic sac and fetus.