Pregnancy rates after in-vitro fertilization in cases of tubal infertility with  and without hydrosalpinx: a meta-analysis of published comparative studies

Camus E; Poncelet C; Goffinet F; Wainer B; Merlet F; Nisand I; Philippe HJ

doi:10.1093/humrep/14.5.1243

Assisted Reproduction · Outcomes and Effectiveness

Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies

Camus E, Poncelet C, Goffinet F, Wainer B, Merlet F, Nisand I, Philippe HJ

Published May 15, 1999 Human Reproduction (Oxford, England), 14(5), 1243-1249

DOI 10.1093/humrep/14.5.1243 PMID 10325271

RRM Academy Synopsis

IVF pregnancy and delivery rates were lower with hydrosalpinx

IVF pregnancy rates were about 20 out of 100 with hydrosalpinx and about 31 without, a pooled analysis of 14 retrospective series found. The series covered 5592 patients with tubal infertility. Live deliveries per transfer ran about 13 out of 100 with hydrosalpinx and about 23 out of 100 without.

Key Findings

The pregnancy rate was 19.7% in the hydrosalpinx group and 31.2% in the group without (odds ratio 0.64; 95% confidence interval 0.56 to 0.74).
The implantation rate was 8.5% with hydrosalpinx and 13.7% without (odds ratio 0.63; 95% confidence interval 0.55 to 0.72).
The live delivery rate per transfer was 13.4% with hydrosalpinx and 23.4% without (odds ratio 0.58; 95% confidence interval 0.49 to 0.69).
The incidence of early pregnancy loss was 43.7% in the hydrosalpinx group and 31.1% in the control group.
Nine published retrospective comparisons and five abstract-only series, with extra data from their authors, covered 5592 patients: 1004 with hydrosalpinx and 4588 with tubal infertility lacking it.

Interpretation

The analysis pools 14 retrospective series. It shows an association between hydrosalpinx and lower IVF results. The series used ultrasound, dye X-ray of the tubes or laparoscopy to diagnose hydrosalpinx. None gave information on other conditions, such as endometriosis or infection. Results differed significantly between series for pregnancy and delivery rates. The authors say it is premature to conclude that every woman with hydrosalpinx should have the tube removed. They point to randomized studies for that answer.

RRM Context

Restorative reproductive medicine starts by asking why conception has not occurred. Hydrosalpinx is a specific tubal diagnosis that answers part of that question. IVF bypasses the tubes and leaves the tubal disease in place. The pooled series found lower pregnancy and delivery rates in the presence of that disease. The authors offer hypotheses: tubal fluid reaching the uterus might hinder implantation, and components of the fluid might harm the embryo or the endometrium.

Our editorial summary of this paper, not the article's abstract.

Abstract

This meta-analysis was intended to evaluate differences in pregnancy rates after in-vitro fertilization (IVF) in tubal fertility with and without hydrosalpinx. It examined nine published retrospective comparative series and five series published as abstracts for which additional information was obtained. In all, these studies involved 5592 patients (1004 with hydrosalpinx and 4588 with tubal infertility without hydrosalpinx). The main outcome measures were rates of pregnancy, implantation, live delivery, and early pregnancy loss. Pregnancy rates were significantly lower in the presence of hydrosalpinx: 31.2% for the tubal sterility group without hydrosalpinx and 19.7% for the group with hydrosalpinx (odds ratio: 0.64; 95% confidence interval: 0.56, 0.74). Similarly, the implantation rate and the delivery rate per transfer in the hydrosalpinx group were only slightly more than half those of the non-hydrosalpinx group (implantation: 8.5 and 13.7%, respectively; delivery: 13.4 and 23.4%). The incidence of early pregnancy loss was also higher in the hydrosalpinx group (43.7%) than in the control group (31.1%). This meta-analysis makes it clear that hydrosalpinx present during IVF-embryo transfer has negative consequences on the rates of pregnancy, implantation, live delivery, and early pregnancy loss. It would be premature, nonetheless, to conclude that routine salpingectomy should be performed on all patients with hydrosalpinx.

Topics

Assisted Reproduction › Outcomes and Effectiveness › Outcomes by Diagnosis · Infertility › Tubal Factor › Distal Tubal Disease

Francois Goffinet

F Goffinet

PMID 10325271 10325271 DOI 10.1093/humrep/14.5.1243 10.1093/humrep/14.5.1243 Camus et al. 1999, Camus 1999