Background

Tubal surgery’s role in infertile women with unilateral tubal pathology (e.g. hydrosalpinx, tubal occlusion) who desire spontaneous or intrauterine insemination (IUI) conception where in-vitro fertilisation is infeasible remains unclear.

Objective

To conduct a systematic review on fertility outcomes in women with unilateral tubal pathology desiring to conceive spontaneously or via IUI and to find guidance to support therapeutic tubal procedures to help these women conceive.

Search strategy

Using a protocol registered on PROSPERO (ID CRD42021248720), we searched PubMed, EMBASE, CINAHL, and Cochrane Library from inception until June 2022. Bibliographies were reviewed to identify other relevant articles.

Data collection and analysis

Two authors independently selected and extracted data. Disagreements were resolved by a third author. Studies presenting fertility outcome data in infertile women with unilateral tubal pathologies desiring spontaneous or IUI conception were included. Methodologic quality was assessed using a modified Newcastle Ottawa Scale for observational studies and the Institute of Health Economics Quality Appraisal Checklist for case series. Primary outcomes collated included cumulative pregnancy rate (CPR) and pregnancy rate per cycle (PR/cycle). Secondary outcomes such as ectopic pregnancy, birth outcomes, and pelvic inflammatory disease were collated. These were stratified by the types of unilateral tubal occlusion (UTO) i.e. hydrosalpinx, proximal tubal occlusion (PTO), or distal tubal occlusion (DTO)

Main results

Two studies reported spontaneous or IUI pregnancies after treatment of unilateral hydrosalpinx with one reporting a pregnancy rate of 88% within 5.6 months on average. Thirteen studies compared IUI outcomes between women with UTO vs unexplained infertility and bilateral tubal patency (controls). Almost all were retrospective cohort studies and identified UTO by hysterosalpingography. In general, PTOs had no difference in PR/cycle and CPR compared to controls and significantly higher PR/cycle to DTOs. Women with DTOs had minimal incremental CPR benefit with each additional IUI cycle.

Conclusions

Therapeutic salpingectomy or tubal occlusion improve IUI or spontaneous conception in women with hydrosalpinx, although more prospective studies are needed.

While significant study heterogeneity hampered assessment of fertility outcomes, overall, infertile women with PTOs had similar IUI pregnancy outcomes to those with bilateral tubal patency while DTOs had inferior PR/cycle. This review highlights significant deficiencies in the evidence guiding management for this group of patients.

中文翻译：

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优化单侧输卵管积水或输卵管病变女性的宫腔内人工授精和自发受孕：系统回顾和叙述综合

背景

输卵管手术在单侧输卵管病变（如输卵管积水、输卵管闭塞）的不孕女性中的作用尚不清楚，这些女性希望在体外受精不可行的情况下自发或宫腔内受精 (IUI) 受孕。

客观的

对希望自发或通过 IUI 受孕的单侧输卵管病变女性的生育结果进行系统评价，并寻找支持治疗性输卵管手术的指南，以帮助这些女性受孕。

搜索策略

我们使用在 PROSPERO 上注册的协议（ID CRD42021248720）搜索了 PubMed、EMBASE、CINAHL 和 Cochrane 图书馆，从成立到 2022 年 6 月。审查了参考书目以确定其他相关文章。

数据收集与分析

两位作者独立选择和提取数据。分歧由第三作者解决。纳入的研究显示了单侧输卵管病变的不孕女性希望自发或 IUI 受孕的生育结果数据。方法学质量的评估使用修改后的纽卡斯尔渥太华量表进行观察性研究，并使用卫生经济学研究所质量评估清单进行病例系列研究。整理的主要结果包括累积妊娠率 (CPR) 和每个周期的妊娠率 (PR/cycle)。整理了异位妊娠、分娩结局和盆腔炎等次要结局。这些按单侧输卵管阻塞 (UTO) 的类型进行分层，即输卵管积水、近端输卵管阻塞 (PTO) 或远端输卵管阻塞 (DTO)

主要结果

两项研究报告了单侧输卵管积水治疗后的自发或 IUI 妊娠，其中一项研究报告平均 5.6 个月内的妊娠率为 88%。13 项研究比较了 UTO 女性与不明原因不孕症女性和双侧输卵管通畅率（对照）之间的 IUI 结果。几乎所有都是回顾性队列研究，并通过子宫输卵管造影确定了 UTO。一般而言，与对照组相比，PTO 在 PR/周期和 CPR 方面没有差异，而 DTO 的 PR/周期明显更高。患有 DTO 的女性每增加一个 IUI 周期，心肺复苏术的增量收益就微乎其微。

结论

治疗性输卵管切除术或输卵管阻塞可改善输卵管积水女性的 IUI 或自发受孕，但还需要更多的前瞻性研究。

虽然显着的研究异质性阻碍了对生育结果的评估，但总体而言，具有 PTO 的不孕女性与双侧输卵管通畅的不孕女性具有相似的 IUI 妊娠结局，而 DTO 的 PR/周期较差。这篇综述强调了指导这组患者管理的证据的重大缺陷。