Evaluation Of Relapsed-hydrosalpinx Rate After Laparoscopic Proximal Tubal Ligation And Distal Salpingostomy And The IVF-ET Outcome Of Those Patients

Hydrosalpinx(HSP) is the most frequency infertility factor in the assistantreproductive technic clinical, for which decreases pregnancy rate and implantationrate in both spontaneous pregnancy and in vitro fertilization embryo transfer (IVF-ET)cycle. Studies suggest that pretreatment HSP before IVF-ET increases the successfulrate significantly, and doctors abroad that all women suffering this very infertilityfactor should receive salpingectomy under laparoscopy, while patients and doctors inChina prefer to choose laparoscopic proximal tubal occlusion. But the latter surgeryget a risk of recurrence because of not removing the pathologic fallopian tube. Atpresent there is no researches focus on the relapsed hydrosalpinx after laparoscopicproximal tubal occlusion and its influence on the outcome of IVF-ET. This studyconducted a retrospective analysis of this.Part Ⅰ hydrosalpinx recurrence after laparoscopic proximal tuballigation and distal salpingostomyObjectiveAnalysis the recurrence rate of hydrosalpinx after proximal tubal occlusionMaterials and methodsRetrospective analysis of document data from234patients hospitalized indepartment of Gynecology in the Third Affiliated Hospital of Guangzhou Medical University China for hydrosalpinx infertility between January2007and June2011,analysis the relapsed rate of hydrosalpinx, and the difference between groupsaccording to their age, abdominal surgery history, compound pelvic disease, surgeryand the year operated.Results234patients were conducted, including11patients had a unilateralsalpingectomy and the rest had no tubal surgery or congenital absence. The recurrencerate of hydrosalpinx is52.1%(122/234) per people, and the relapsed rate of bilateralhydrosalpinx patients was51.8%(117/226), which was significantly higher than thatof unilateral hydrosalpinx patients(33.3%(18/54))(P=0.002, Person Test). Interestingly,contralateral HSP was tested in5unilateral HSP patients during controlled ovarianstimulation(COH) and a bilateral HSP was supervised in1unilateral patient.The relapsed rate had no difference in groups according to patients’ age,abdominal surgery history, compound pelvic disease, surgery and the year operated.Conclusion1.>50%infertile patients suffering HSP has a risk of recurrence afterlaparoscopic tubal occlusion, and this risk has no relation to patients’ age, abdominalsurgery history, compound pelvic disease, surgery and the year operated.2. The relapsed rate of bilateral HSP patients is much higher than that ofunilateral HSP patients.Part Ⅱ the IVF-ET outcome of patients with hydrosalpinx afterlaparoscopic surgeryObjectiveCompare hydrosalpinges recurrece and without recurrence patients undergoingIVF-ET cycle general cycle characteristics, embryo development and IVF outcome,and to explore its mechanism.Materials and methodsCollect data of infertile patients underwent laparoscopic proximal tubal ligation and distal salpingostomy in gynecological department and then following the IVF-ETprocedure in our hospital between January2007ans June2011.234patients wereenrolled and307cycles were followed.Analysis the data of the IVF procedure and grouped them according to therecurrenc of the hydrosalpinx supervised by transvaginal sonography. Compare thecycle characteristics (age, duration of infertility, primary infertility rate, Gn amount,Gn days, hCG quantity, hCG day serum E2levels, endometrial thickness, endometrialtype and serum E2levels on hCG day), embryo culture indicators (number of oocytes,fertilization rate, cleavage rate, high-quality embryos, numbers of transferred embryos,days of embryo transferred, the number of high quality embryo transferred) and IVFoutcomes (pregnancy rate, implantation rate, multiple pregnancy rate, abortion rate,embryo loss rate, ectopic pregnancy, take-home baby rate).ResultsIn234included patients, there were173，50，10and1patients followed1,2,3and4cycles of IVF-ET, which is307cycles in all. The pregnancy rate is39.1%（120/307），implantation rate is27.1%（180/664），ectopic pregnancy rate is1.6%（2/120）, spontaneous abortion rate of25.8%(31/120), embryos loss rate of18.9%(34/180), hold the infant was30.3%(93/307).1． The whole outcome of IVF-ET cyclesThe outcome of recurrent group (116people,153cycles) and non-relapsed group(118people,154cycles) is followed:Relapsed hydrosalpinx group got a higher Gn and hCG quantity(P <0.05) whileother indictors of cycle characteristics compared had no significant difference;Oocytes,2Pn embryos, the number of good quality embryos, the number of goodquality embryos were transplanted in the relapsed group were significantly lower thanthat of non-relapsed group(P <0.05) and the remaining embryo culture measurementswere no difference.Both pregnancy rate and implantation rate in relapsed group were higher than theother group, but ovarian hyperstimulation syndrome rate in recurrent group was lower （P=0.072）and the rest of the indictors were similar..2． The IVF-ET outcome of the1stcycle after laparoscopic surgeryThe outcome of recurrent group (116people,116cycles) and non-relapsed group(118people,118cycles) is followed:Relapsed hydrosalpinx group got a higher Gn and hCG quantity(P <0.05) whileother indictors of cycle characteristics compared had no significant difference;Oocytes and2Pn embryos in the relapsed group were significantly lower thanthat of non-relapsed group(P <0.05) and the remaining embryo culture measurementswere no difference;Both pregnancy rate and implantation rate in relapsed group were higher than theother group, but ovarian hyperstimulation syndrome rate in recurrent group wassignificantly lower（P<0.05）and the rest of the indictors were similar.3． The IVF-ET outcome of the2ed cycle after laparoscopic surgeryThe outcome of recurrent group (29people,29cycles) and non-relapsed group(32people,32cycles) is followed:the number of good quality embryos, the number of good quality embryos weretransplanted in the relapsed group were significantly lower than that of non-relapsedgroup（the number of good quality embryos: P=0.091；the number of good qualityembryos were transplanted: P=0.072） and the remaining embryo culturemeasurements were no difference.Both pregnancy rate and implantation rate in relapsed group were lower than theother group with no difference（P<0.05）and the rest of the indictors were similar.Conclusions1. Patients after laparoscopic proximal tubal ligation and distal salpingostomyhave a satisfactory IVF-ET outcome.2. Compared with patients with non-relapsed hydrosalpinx after laparoscopicproximal tubal ligation and distal salpingostomy, the ones with relapsed hydrosalpinx need more Gn and hCG, gained less oocytes and good quality embryos, but attained asignificantly higher pregnancy rate and implantation rate.3. Weather mechanism of patients with relapsed hydrosalpinx have a betterIVF-ET outcome has relationship with increased receptivity of endometrium needsmore research.