Acta obstetricia et gynecologica Scandinavica · 2007
Is there a role for hysteroscopic tubal occlusion of functionless hydrosalpinges prior to IVF/ICSI in modern practice?
Сравнительное исследованиеСтатьяРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Darwish Atef M, El Saman Ali M
Аннотация
OBJECTIVES: To determine whether hysteroscopic tubal occlusion will produce the same efficacy as laparoscopic tubal occlusion of functionless hydrosalpinx prior to IVF/ICSI.
DESIGN: A prospective comparative study. Setting. Endoscopy Unit of the Women's Health Center, Faculty of Medicine, Assiut University, Assiut, Egypt.
SUBJECTS: A pilot safety phase included 10 uteri removed by hysterectomy in perimenopausal women subjected to roller ball coagulation of the peritubal bulge. The study phase included 27 patients with uni- or bilateral functionless hydrosalpinges, who were randomly divided into 2 groups. Group A comprised 14 patients who were randomly allocated for laparoscopic occlusion. Group B included 13 patients scheduled for a hysteroscopic approach. Interventions. Laparoscopic occlusion of the isthmic part of the fallopian tube was carried out using bipolar diathermy in 9 (64%) cases or clips in 3 (21.4%) cases in Group A. Roller ball electrode of the resectoscope was utilised for occlusion of the tubal ostium under local, spinal, or general anesthesia in Group B. Second-look office hysteroscopy was performed in Group B whenever possible. In both groups, hysterosalpingography or sonohysterography was carried out 1 month later to confirm tubal occlusion.
MAIN OUTCOME MEASURES: Safety phase aimed at confirming tubal occlusion with minimal harm to adjacent tissues. Confirmed tubal occlusion of the functionless hydrosalpinx.
RESULTS: The safety phase resulted in bilateral complete occlusion of the proximal part of the tubes with secondary coagulation <8 mm, as shown in the histopathologic sections. The suspected main cause of functionless hydrosalpinges was iatrogenic (pelvic surgery) in 9 (64%) and 8 (61.5%) cases in both groups, respectively. The mean number of abdominal scars/patient was 1.4 and 1.5 in both groups, respectively. Unilateral functionless hydrosalpinx was encountered in 7 (50%) and 5 (38%) cases in both groups, respectively. In Group A, the procedure was possible and successful in 10 cases (76.9%), while in Group B, hysteroscopic access and occlusion were achieved in 12 (85.7%) and 9 (64.2%) cases, respectively. In Group B, diagnostic hysteroscopy showed fine marginal adhesions in 2 cases (15%), and a small polyp in 1 case (7.7%). Hysteroscopic tubal occlusion showed shorter operative time (9+/-2.8 versus 24+/-4.8 min, p=0.0001) and hospital stay (2+/-1.8 versus 5+/-1.1h, p=0.0001). Second-look office hysteroscopy was performed in 8 cases in Group B and revealed no significant corneal lesions at the site of hysteroscopic occlusion.
CONCLUSIONS: This preliminary study demonstrates the feasibility of hysteroscopic tubal occlusion of functionless hydrosalpinx in all cases with acceptable efficacy. It has the advantage of adding a valuable evaluation of the endometrial cavity prior to IVF/ICSI. It should be an option for treatment protocol in cases of functionless hydrosalpinges. Further large sample-sized studies are required to test its impact on the implantation rate and clinical outcome.
DESIGN: A prospective comparative study. Setting. Endoscopy Unit of the Women's Health Center, Faculty of Medicine, Assiut University, Assiut, Egypt.
SUBJECTS: A pilot safety phase included 10 uteri removed by hysterectomy in perimenopausal women subjected to roller ball coagulation of the peritubal bulge. The study phase included 27 patients with uni- or bilateral functionless hydrosalpinges, who were randomly divided into 2 groups. Group A comprised 14 patients who were randomly allocated for laparoscopic occlusion. Group B included 13 patients scheduled for a hysteroscopic approach. Interventions. Laparoscopic occlusion of the isthmic part of the fallopian tube was carried out using bipolar diathermy in 9 (64%) cases or clips in 3 (21.4%) cases in Group A. Roller ball electrode of the resectoscope was utilised for occlusion of the tubal ostium under local, spinal, or general anesthesia in Group B. Second-look office hysteroscopy was performed in Group B whenever possible. In both groups, hysterosalpingography or sonohysterography was carried out 1 month later to confirm tubal occlusion.
MAIN OUTCOME MEASURES: Safety phase aimed at confirming tubal occlusion with minimal harm to adjacent tissues. Confirmed tubal occlusion of the functionless hydrosalpinx.
RESULTS: The safety phase resulted in bilateral complete occlusion of the proximal part of the tubes with secondary coagulation <8 mm, as shown in the histopathologic sections. The suspected main cause of functionless hydrosalpinges was iatrogenic (pelvic surgery) in 9 (64%) and 8 (61.5%) cases in both groups, respectively. The mean number of abdominal scars/patient was 1.4 and 1.5 in both groups, respectively. Unilateral functionless hydrosalpinx was encountered in 7 (50%) and 5 (38%) cases in both groups, respectively. In Group A, the procedure was possible and successful in 10 cases (76.9%), while in Group B, hysteroscopic access and occlusion were achieved in 12 (85.7%) and 9 (64.2%) cases, respectively. In Group B, diagnostic hysteroscopy showed fine marginal adhesions in 2 cases (15%), and a small polyp in 1 case (7.7%). Hysteroscopic tubal occlusion showed shorter operative time (9+/-2.8 versus 24+/-4.8 min, p=0.0001) and hospital stay (2+/-1.8 versus 5+/-1.1h, p=0.0001). Second-look office hysteroscopy was performed in 8 cases in Group B and revealed no significant corneal lesions at the site of hysteroscopic occlusion.
CONCLUSIONS: This preliminary study demonstrates the feasibility of hysteroscopic tubal occlusion of functionless hydrosalpinx in all cases with acceptable efficacy. It has the advantage of adding a valuable evaluation of the endometrial cavity prior to IVF/ICSI. It should be an option for treatment protocol in cases of functionless hydrosalpinges. Further large sample-sized studies are required to test its impact on the implantation rate and clinical outcome.