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

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.

Keywords: Essure; IVF; hydrosalpinx; laparoscopic; pregnancy.

Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.