Proximal Fallopian Tubal Embolization by Interventional Radiology Prior to Embryo Transfer in Infertile Patients With Hydrosalpinx: A Prospective Study of an Off-Label Treatment.

Abstract

STUDY OBJECTIVE\nTo evaluate in vitro fertility (IVF) outcomes of proximal fallopian tube embolization by interventional radiology compared with laparoscopic salpingectomy before embryo transfer (ET) in patients with hydrosalpinx.\n\n\nDESIGN\nA single-center, off-label, nonrandomized prospective study.\n\n\nSETTING\nAcademic university hospital.\n\n\nPATIENTS\nOne hundred and fifty-five patients with hydrosalpinx were identified on ultrasound or hysterosalpingography desiring IVF between April 2016 and December 2017.\n\n\nINTERVENTIONS\nRadiologically guided tubal occlusion with embolization microcoils (RTO-EM) and laparoscopic salpingectomy.\n\n\nMEASUREMENTS AND MAIN RESULTS\nOf 155 analyzed patients, 42 were treated with RTO-EM and 113 with laparoscopic salpingectomy. The subsequent IVF outcomes including implantation, clinical pregnancy, miscarriage, ectopic pregnancy, and ongoing pregnancy (fetal heartbeat on ultrasound beyond 10 weeks) were compared between the two groups. Implantation and clinical pregnancy per ET cycle in the RTO-EM group were similar to that of the salpingectomy group (26.7% vs. 30.2%, p\u202f=\u202f.511, and 39.0% vs. 45.3%, p\u202f=\u202f.400, respectively), with a similar miscarriage rate. There was no statistically significant difference in ectopic pregnancies between the two groups. Moreover, no difference was detected in ongoing pregnancy per cycle between the two groups (33.9% vs. 41.2%, p\u202f=\u202f.324). The ongoing-pregnancy rate per patient following RTO-EM was 47.6% (20 of 42) compared with 61.9% (70 of 113) following salpingectomy (p\u202f=\u202f.108; odds ratio: 0.56; 95% confidence interval, 0.27-1.14).\n\n\nCONCLUSION\nPregnancy in the RTO-EM group was comparable to the salpingectomy group in patients with hydrosalpinx prior to ET treatment. Radiologically guided tubal occlusion with embolization microcoils may be an alternative to salpingectomy for patients with hydrosalpinx planning IVF-ET.