Pregnancy outcome of in vitro fertilization after Essure and laparoscopic management of hydrosalpinx: a systematic review and meta-analysis

The hysteroscopic placement of Essure devices to treat hydrosalpinx before in vitro fertilization produces inferior pregnancy outcomes compared with those after a laparoscopic approach.

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Volume 108, Issue 1, Pages 84–95.e5

Authors:

Bin Xu, M.D., Qiong Zhang, M.D., Jing Zhao, M.D., Yonggang Wang, M.D., Dabao Xu, M.D., Yanping Li, M.D.

Abstract:

Objective

To assess and compare pregnancy outcomes in hydrosalpinx (HX) patients treated by Essure, laparoscopic salpingectomy, and proximal tubal occlusion (LPTO) before IVF.

Design

Systematic review and meta-analysis.

Setting

University-affiliated teaching hospital.

Patient(s)

Women undergoing Essure, laparoscopic salpingectomy, and LPTO for HX before IVF.

Intervention(s)

The overall combined risk estimates were calculated by means of fixed- or random-effects models.

Main Outcome Measure(s)

Clinical pregnancy rate (CPR) and live birth rate (LBR).

Result(s)

In total, 3,065 patients were included in 33 studies. Thirteen of them were comparative studies among 3 surgical methods and no intervention. In the analysis of comparative studies, there were no significant differences in implantation rate (IR), CPR, and ongoing pregnancy rate/LBR between salpingectomy and LPTO groups. The CPR, IR, and LBR of Essure were significantly lower than those of the laparoscopic surgery (salpingectomy and LPTO) group, with a CPR of 34.1% vs. 44.0% (relative risk [RR] 0.71; 95% confidence interval [CI] [0.51, 0.98]), an IR of 17.3% vs. 38.0% (RR 0.45; 95% CI [0.27, 0.74]), and an LBR of 22.2% vs. 37.4% (RR 0.57; 95% CI [0.35, 0.91]).

Conclusion(s)

Management of HX by laparoscopic salpingectomy and LPTO yielded the same effect on the improvement of the pregnancy outcome after IVF. The hysteroscopic placement of Essure devices to treat HX before IVF produces inferior pregnancy outcomes compared with those following the laparoscopic approach. More multicenter randomized, controlled trials are warranted in future research to further examine the conclusion from this meta-analysis.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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