Comparative Study Between Laparoscopic Tubal Disconnection, Ultrasound-Guided Tubal Aspiration and Hysteroscopic Tubal Occlusion in the Management of Hydrosalpinx Prior to ICSI

Abstract

To compare the efficacy of laparoscopic proximal tubal disconnection, hysteroscopic tubal occlusion, and ultrasound-guided aspiration in the management of hydrosalpinx prior to intracytoplasmic sperm injection (ICSI). Sixty women with unilateral or bilateral hydrosalpinx undergoing ICSI were randomly allocated into three equal groups. Participants underwent laparoscopic proximal tubal disconnection, hysteroscopic tubal occlusion, or ultrasound-guided aspiration of hydrosalpinx fluid. The primary outcome was the clinical pregnancy rate, while the secondary outcome was the chemical pregnancy rate. Baseline demographic characteristics, hormonal profile, ovarian response, endometrial thickness, oocyte yield, and embryo quality were comparable among the three groups. Clinical pregnancy rates were 50.0% (10/20), 50.0% (10/20), and 40.0% (8/20) in the laparoscopic disconnection, hysteroscopic occlusion, and aspiration groups, respectively (p = 0.765). Chemical pregnancy rates were 55.0% (11/20), 50.0% (10/20), and 40.0% (8/20), respectively (p = 0.627). No statistically significant differences were observed among the three treatment groups regarding ovarian response, embryological outcomes, or pregnancy rates. Laparoscopic proximal tubal disconnection, hysteroscopic tubal occlusion, and ultrasound-guided aspiration demonstrated comparable reproductive outcomes in women with hydrosalpinx undergoing ICSI. All three approaches may be considered effective treatment options before assisted reproductive treatment.