Abstract / Summary
To investigate the effects of different pretreatment modalities and hydrosalpinx severity on clinical pregnancy and live birth outcomes following first fresh in vitro fertilization and embryo transfer (IVF-ET) cycles in patients with tubal infertility. This retrospective cohort study enrolled 740 patients diagnosed with hydrosalpinx who underwent their first IVF-ET cycle at the Reproductive Medicine Center of the First Affiliated Hospital of Hainan Medical University from January 2014 to December 2023. Patients were stratified into four subgroups based on pre-transfer pretreatment modalities: untreated group ( n = 337), ultrasound-guided transvaginal hydrosalpinx aspiration (US-A) group ( n = 171), laparoscopic salpingostomy (LS) group ( n = 124), and laparoscopic salpingectomy (LC) group ( n = 108). All patients were further categorized into mild, moderate, and severe hydrosalpinx subgroups according to lesion severity. Baseline characteristics, IVF cycle parameters, and pregnancy outcomes were compared across groups. Multivariate logistic regression analysis was performed to adjust for confounding factors and identify independent predictors of clinical pregnancy and live birth. Baseline demographic and ovarian reserve parameters, including age, BMI, AMH level, antral follicle count, and infertility duration, were comparable among the four pretreatment subgroups (all P > 0.05), while the distribution of hydrosalpinx severity differed significantly ( P < 0.001). Ovarian stimulation characteristics, oocyte yield, and embryo quality indicators were comparable among all subgroups (all P > 0.05). Univariate analysis showed that clinical pregnancy and live birth rates differed significantly across pretreatment groups (both P < 0.001), with the LC group achieving the highest clinical pregnancy rate (65.7%) and live birth rate (52.8%). Stratified analysis revealed that pretreatment modalities had no significant impact on pregnancy outcomes in patients with mild or moderate hydrosalpinx (all P > 0.05), whereas LC was associated with significantly higher clinical pregnancy and live birth rates in the severe hydrosalpinx subgroup ( P < 0.05). After adjusting for confounding factors including hydrosalpinx severity, multivariate logistic regression confirmed that LC was an independent protective factor for both clinical pregnancy (OR = 3.635, 95%CI: 1.773–7.451, P < 0.001) and live birth (OR = 3.045, 95%CI: 1.873–4.948, P < 0.001); LS was an independent protective factor for live birth only (OR = 1.606, 95%CI: 1.019–2.529, P = 0.041), while US-A showed no significant effect on either pregnancy endpoint. Severe hydrosalpinx was identified as an independent risk factor for reduced clinical pregnancy and live birth rates ( P < 0.05). Hydrosalpinx, especially severe disease, significantly compromises IVF-ET pregnancy outcomes. Laparoscopic salpingectomy significantly improves clinical pregnancy and live birth rates in patients with severe hydrosalpinx, independent of baseline confounding factors, and is the optimal pretreatment strategy prior to IVF-ET. Laparoscopic salpingostomy provides limited benefit for live birth, while ultrasound-guided aspiration yields no significant improvement in reproductive outcomes.