Effect Of Different Surgical Methods For Hydrosalpinx On The Outcome Of Assisted Pregnancy In ART Patients

ObjectiveTo compare the laboratory indicators of IVF-ET in patients with hydrosalpinx under different surgical methods,and to preliminarily explore the effect of hydrosalpinx on the laboratory outcomes of IVF-ET patients;To compare the pregnancy outcome indicators of the first frozen-thawed embryo transfer after IVF-ET in patients with hydrosalpinx,and to preliminarily explore the effect of different surgical methods on the outcome of F-ET assisted pregnancy.MethodsFrom January 2017 to December 2020,couples received IVF-ET post-operative whole embryo freezing and first frozen-thawed embryo transfer due to hydrosalpinx in the Reproductive Medicine Center of the First Affiliated Hospital of Hainan Medical College were selected as the research subjects.Their clinical and laboratory data were retrospectively analyzed.The subjects were divided into unilateral hydrosalpinx group and bilateral hydrosalpinx group.According to different surgical methods,the bilateral hydrosalpinx group was split into ultrasound-guided puncture and aspiration group（group A,36 patients）,bilateral salpingectomy group（group B,24 patients）,and bilateral salpingostomy group（group C,22 patients）.The basic clinical data,controlled ovarian hyperstimulation,embryonic development,and clinical outcomes were compared between groups A,B,and C.The lateral hydrosalpinx group（group D）included patients who only underwent ultrasound-guided puncture and aspiration,and were divided into mild（group D1,32patients）,moderate（group D2,28 patients）,and severe（group D3,18 patients）according to preoperative ultrasound findings.The primary clinical data,embryonic development,and clinical outcomes of the three groups were compared between the unilateral hydrosalpinx group and the bilateral salpingectomy group（group B）.Results1.There was no significant difference in the number of Gn days,the total amount of Gn,the number of follicles≥14 mm on HCG day,the level of E₂on HCG day,and the number of oocytes retrieved between groups A,B,and C（P>0.05）.There was no significant difference in 2PN rate,transferable embryo rate,high-quality embryo rate,blastocyst transfer rate and ectopic pregnancy rate among groups A,B,and C（P>0.05）.2.The implantation rate of group B（74.20%）was significantly higher than that of group A（34.54%）,and the implantation rate of group C（45.50%）was also higher than that of group A（34.54%）,with statistical significance（P<0.05）.In terms of clinical pregnancy rate,group B（79.16%）was significantly higher than group A（47.22%）,and the difference was statistically significant（P<0.05）;in terms of live birth rate,group B（70.83%）was significantly higher than group A（33.33%）,the difference was statistically significant（P<0.05）.3.There was no significant difference in the 2PN rate,transferable embryo rate,high-quality embryo rate,and ectopic pregnancy rate among the four groups（D1,D2,D3,and C）（P>0.05）.The embryo implantation rate（25.80%）of group D3 was significantly lower than that of group B（74.20%）,and the difference was statistically significant（P<0.05）.The clinical pregnancy rate of group D3（38.88%）was significantly lower than group B（79.16%）.The clinical pregnancy rate of group D2（35.55%）was lower than group B（79.16%）,and the difference was statistically significant（P<0.05）.The live birth rate of group D3（27.77%）was lower than group B（70.83%）,the difference was statistically significant（P<0.05）.Conclusions1.Hydrosalpinx has no significant adverse effect on embryonic developmental outcomes during in vitro fertilization embryo culture.2.Resection of bilateral fallopian tubes by core-pulling method has no significant adverse effect on ovarian reactivity in patients undergoing ART.3.Bilateral salpingectomy in patients with bilateral hydrosalpinx can help improve the embryo implantation rate,clinical pregnancy rate and live birth rate in the F-ET cycle.From the safety and efficacy,bilateral salpingectomy before F-ET is recommended for patients with bilateral hydrosalpinx.4.Severe unilateral hydrosalpinx significantly reduces the implantation rate,clinical pregnancy rate and live birth rate of F-ET assisted pregnancy.It is recommended to actively perform salpingectomy on the affected side.