| BackgroundTubal infertility accounts for about 30%-40%of female infertility.Hydrosalpinx is a common cause of tubal infertility,accounting for about 10%-30%of tubal infertility.Both one side and two sides hydrosalpinx have adverse effects on the outcome of embryo transfer.Previous studies have focused more on the surgical type of treating hydrosalpinx and its influence of pregnancy outcome,rather than the proper treatment time.There are two strategies for eliminating hydrosalpinx,one is to operate first and then undergo the controlled ovarian hyperstimulation(COH),the other is to perform COH and freeze all embryos first before operation.To date,evidence is not enough to provide clinical decision-making consultation.On the other hand,cumulative live birth rate(CLBR)has become an important index to evaluate pregnancy outcome.CLBR can not only directly reflect the level of reproductive center cycle treatment,but also answer the question whether patients can get live birth in one cycle.ObjectiveThis study is to compare the CLBR between adjacent in vitro fertilization(I F)or intracytoplasmic sperm injection(ICSI)at different operation time before or after hydrosalpinx treatment and to explore the best treatment strategy.MethodsThe data of 452 of infertile patients with hydrosalpinx undergoing IVF/ICSI from the Center for Reproductive Medicine,Shandong University from November 2014 to December 2017 were analyzed retrospectively.According to the time of operation,two strategies were adopted to deal with hydrosalpinx:hydrosalpinx treatment first and then IVF-ET,or frozen all embryos first and then underwent surgeries and thereafter undertook a deferred frozen embryo transfer.Based on these two strategies,the patients were divided into two groups:Oocyte retrieval first(group O)and surgery first(group S).The observation endings were either delivering a live birth baby or the whole embryos were used up in this cycle.The CLBR,the total number of follicles size>14 mm on hCG trigger day,the total required Gn dose,the total number of oocytes retrieved and good-quality embryos were assessed and compared between the two groups.The proportion of embryo transfer in the three different time zones of?0.5 years,?1 year and?1.5 years was compared.The two groups were divided into two subgroups according to the age<35 years or>35 years,and the cumulative live birth rate was further compared.ResultsThere was no significant difference in the cumulative live birth rate of adjacent COH cycles despite before or after surgical treatment of hydrosalpinx(P=0.17).There were significant differences in the?0.05 year and?1 year intervals(P<0.001 and P=0.009),there was no significant difference within 1.5 years interval(P=0.29).The CLBR under 35 years old were significantly higher than those over 35 years old(P<0.001).In the subgroup with age more than 35 years,the CLBR of collecting eggs first was higher than those who underwent operation first(P=0.02).ConclusionFor patients less than 35 years old with hydrosalpinx who also need IVF/ICSI methods to achieve pregnancy,the time of hydrosalpinx operation does not affect the CLBR,but surgery first could shorten the waiting time for pregnancy.For those aged>35 years,patients are suggested to retrieve oocytes first,and perform operations after obtaining available embryos. |
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