Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT
Abstract STUDY QUESTION Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy? SUMMARY ANSWER Hysteroscopic proximal tubal occlusion by intratub...
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| Veröffentlicht in: | Human reproduction (Oxford) 2016-09, Vol.31 (9), p.2005-2016 |
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| creator | Dreyer, K. Lier, M.C.I. Emanuel, M.H. Twisk, J.W.R. Mol, B.W.J. Schats, R. Hompes, P.G.A. Mijatovic, V. |
| description | Abstract
STUDY QUESTION
Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy?
SUMMARY ANSWER
Hysteroscopic proximal tubal occlusion by intratubal devices is inferior to laparoscopic salpingectomy in the treatment of hydrosalpinges in women undergoing IVF/ICSI with respect to ongoing pregnancy rates.
WHAT IS KNOWN ALREADY
It is known that women with hydrosalpinges undergoing IVF have poorer pregnancy outcomes compared with women with other forms of tubal infertility. In these women, both laparoscopic salpingectomy and laparoscopic proximal tubal ligation are known to improve IVF outcomes. At present, it is unclear whether a less-invasive hysteroscopic treatment with intratubal devices leads to similar ongoing pregnancy rates following IVF when compared with laparoscopic salpingectomy.
STUDY DESIGN, SIZE, DURATION
A two-centre, randomized, controlled, non-inferiority trial. Between October 2009 and December 2014 a total of 85 women were included in this study; of whom, 42 were randomized to hysteroscopic proximal occlusion by intratubal device placement and 43 were randomized to laparoscopic salpingectomy. Randomization was based on a computer-generated randomization list. The study was unblinded. The primary outcome was ongoing pregnancy rate, defined as a fetal heartbeat on ultrasound beyond 10-week gestation following one IVF/ICSI treatment (fresh and frozen–thawed embryo transfers).
PARTICIPANTS/MATERIALS, SETTING, METHODS
We studied women aged 18–41 years, with uni- or bilateral ultrasound visible hydrosalpinges who were scheduled for an IVF/ICSI treatment.
MAIN RESULTS AND THE ROLE OF CHANCE
The ongoing pregnancy rates per patient according to the intention-to-treat principle were 11/42 (26.2%) after hysteroscopic proximal occlusion by intratubal devices (intervention group) versus 24/43 (55.8%) after laparoscopic salpingectomy (control group) (P = 0.008) [absolute difference: 26.1%; 95% confidence interval (CI): 0.5–51.7, relative risk (RR): 0.56; 95% CI: 0.31–1.03, P = 0.01]. In the per protocol analysis, the ongoing pregnancy rate per patient following hysteroscopic proximal occlusion by intratubal devices was 9/27 (33.3%) compared with 19/32 (59.4%) following laparoscopic salpingectomy (P = 0.067) (absolute difference: 29.6%; 95% CI: 7.1 to 49.1, RR: 0.47; 95% CI: 0.27–0.83, P = 0.062).
LIMITAT |
| doi_str_mv | 10.1093/humrep/dew050 |
| format | Article |
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STUDY QUESTION
Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy?
SUMMARY ANSWER
Hysteroscopic proximal tubal occlusion by intratubal devices is inferior to laparoscopic salpingectomy in the treatment of hydrosalpinges in women undergoing IVF/ICSI with respect to ongoing pregnancy rates.
WHAT IS KNOWN ALREADY
It is known that women with hydrosalpinges undergoing IVF have poorer pregnancy outcomes compared with women with other forms of tubal infertility. In these women, both laparoscopic salpingectomy and laparoscopic proximal tubal ligation are known to improve IVF outcomes. At present, it is unclear whether a less-invasive hysteroscopic treatment with intratubal devices leads to similar ongoing pregnancy rates following IVF when compared with laparoscopic salpingectomy.
STUDY DESIGN, SIZE, DURATION
A two-centre, randomized, controlled, non-inferiority trial. Between October 2009 and December 2014 a total of 85 women were included in this study; of whom, 42 were randomized to hysteroscopic proximal occlusion by intratubal device placement and 43 were randomized to laparoscopic salpingectomy. Randomization was based on a computer-generated randomization list. The study was unblinded. The primary outcome was ongoing pregnancy rate, defined as a fetal heartbeat on ultrasound beyond 10-week gestation following one IVF/ICSI treatment (fresh and frozen–thawed embryo transfers).
PARTICIPANTS/MATERIALS, SETTING, METHODS
We studied women aged 18–41 years, with uni- or bilateral ultrasound visible hydrosalpinges who were scheduled for an IVF/ICSI treatment.
MAIN RESULTS AND THE ROLE OF CHANCE
The ongoing pregnancy rates per patient according to the intention-to-treat principle were 11/42 (26.2%) after hysteroscopic proximal occlusion by intratubal devices (intervention group) versus 24/43 (55.8%) after laparoscopic salpingectomy (control group) (P = 0.008) [absolute difference: 26.1%; 95% confidence interval (CI): 0.5–51.7, relative risk (RR): 0.56; 95% CI: 0.31–1.03, P = 0.01]. In the per protocol analysis, the ongoing pregnancy rate per patient following hysteroscopic proximal occlusion by intratubal devices was 9/27 (33.3%) compared with 19/32 (59.4%) following laparoscopic salpingectomy (P = 0.067) (absolute difference: 29.6%; 95% CI: 7.1 to 49.1, RR: 0.47; 95% CI: 0.27–0.83, P = 0.062).
LIMITATIONS, REASONS FOR CAUTION
Masking participants and investigators would be difficult due to the nature of both interventions. Since we had objective outcome measurements, we withheld sham procedures, leaving the study unblinded. Furthermore, our low sample size resulted in wide CIs. A larger sample size would result in a more accurate treatment effect; however, this was non-feasible for recruitment and inclusion.
WIDER IMPLICATIONS OF THE FINDINGS
In the treatment of hydrosalpinges prior to IVF/ICSI, hysteroscopic proximal occlusion by intratubal devices is inferior to laparoscopic salpingectomy.
STUDY FUNDING/COMPETING INTEREST(S)
The intratubal devices were received from Conceptus, Inc., San Carlos, CA, USA, which was acquired by Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ, USA in 2013. Conceptus, Inc./Bayer HealthCare Pharmaceuticals, Inc. had no role in the study design, data collection and analyses, decision to publish or preparation of the manuscript. The study as a whole was funded by the SWOG (foundation for scientific investigation in obstetrics and gynaecology of the VU University Medical Centre, Amsterdam, the Netherlands). P.G.A.H. has received non-financial support from Conceptus, Inc. during the conduct of this study. He has received grants from Ferring B.V., Merck Serono and Abbott outside the submitted work. M.H.E. has received personal fees from Smith and Nephew and IQ Medical Ventures outside the submitted work.
TRIAL REGISTRATION NUMBER
The Dutch Trial Register: NTR 2073.
TRIAL REGISTRATION DATE
October 21, 2009.
DATE OF FIRST PATIENT'S ENROLMENT
October 26, 2009.</description><identifier>ISSN: 0268-1161</identifier><identifier>EISSN: 1460-2350</identifier><identifier>DOI: 10.1093/humrep/dew050</identifier><identifier>PMID: 27209341</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adolescent ; Adult ; Fallopian Tube Diseases - diagnostic imaging ; Fallopian Tube Diseases - surgery ; Female ; Fertilization in Vitro - methods ; Humans ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Salpingectomy - methods ; Sperm Injections, Intracytoplasmic - methods ; Sterilization, Tubal - methods ; Treatment Outcome ; Young Adult</subject><ispartof>Human reproduction (Oxford), 2016-09, Vol.31 (9), p.2005-2016</ispartof><rights>The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2016</rights><rights>The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-6c4c0bc9c27670fb01f0816bc9bb97c702643bb7fe40c9753f508dfc263276bb3</citedby><cites>FETCH-LOGICAL-c365t-6c4c0bc9c27670fb01f0816bc9bb97c702643bb7fe40c9753f508dfc263276bb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,1581,27911,27912</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27209341$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dreyer, K.</creatorcontrib><creatorcontrib>Lier, M.C.I.</creatorcontrib><creatorcontrib>Emanuel, M.H.</creatorcontrib><creatorcontrib>Twisk, J.W.R.</creatorcontrib><creatorcontrib>Mol, B.W.J.</creatorcontrib><creatorcontrib>Schats, R.</creatorcontrib><creatorcontrib>Hompes, P.G.A.</creatorcontrib><creatorcontrib>Mijatovic, V.</creatorcontrib><title>Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT</title><title>Human reproduction (Oxford)</title><addtitle>Hum Reprod</addtitle><description>Abstract
STUDY QUESTION
Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy?
SUMMARY ANSWER
Hysteroscopic proximal tubal occlusion by intratubal devices is inferior to laparoscopic salpingectomy in the treatment of hydrosalpinges in women undergoing IVF/ICSI with respect to ongoing pregnancy rates.
WHAT IS KNOWN ALREADY
It is known that women with hydrosalpinges undergoing IVF have poorer pregnancy outcomes compared with women with other forms of tubal infertility. In these women, both laparoscopic salpingectomy and laparoscopic proximal tubal ligation are known to improve IVF outcomes. At present, it is unclear whether a less-invasive hysteroscopic treatment with intratubal devices leads to similar ongoing pregnancy rates following IVF when compared with laparoscopic salpingectomy.
STUDY DESIGN, SIZE, DURATION
A two-centre, randomized, controlled, non-inferiority trial. Between October 2009 and December 2014 a total of 85 women were included in this study; of whom, 42 were randomized to hysteroscopic proximal occlusion by intratubal device placement and 43 were randomized to laparoscopic salpingectomy. Randomization was based on a computer-generated randomization list. The study was unblinded. The primary outcome was ongoing pregnancy rate, defined as a fetal heartbeat on ultrasound beyond 10-week gestation following one IVF/ICSI treatment (fresh and frozen–thawed embryo transfers).
PARTICIPANTS/MATERIALS, SETTING, METHODS
We studied women aged 18–41 years, with uni- or bilateral ultrasound visible hydrosalpinges who were scheduled for an IVF/ICSI treatment.
MAIN RESULTS AND THE ROLE OF CHANCE
The ongoing pregnancy rates per patient according to the intention-to-treat principle were 11/42 (26.2%) after hysteroscopic proximal occlusion by intratubal devices (intervention group) versus 24/43 (55.8%) after laparoscopic salpingectomy (control group) (P = 0.008) [absolute difference: 26.1%; 95% confidence interval (CI): 0.5–51.7, relative risk (RR): 0.56; 95% CI: 0.31–1.03, P = 0.01]. In the per protocol analysis, the ongoing pregnancy rate per patient following hysteroscopic proximal occlusion by intratubal devices was 9/27 (33.3%) compared with 19/32 (59.4%) following laparoscopic salpingectomy (P = 0.067) (absolute difference: 29.6%; 95% CI: 7.1 to 49.1, RR: 0.47; 95% CI: 0.27–0.83, P = 0.062).
LIMITATIONS, REASONS FOR CAUTION
Masking participants and investigators would be difficult due to the nature of both interventions. Since we had objective outcome measurements, we withheld sham procedures, leaving the study unblinded. Furthermore, our low sample size resulted in wide CIs. A larger sample size would result in a more accurate treatment effect; however, this was non-feasible for recruitment and inclusion.
WIDER IMPLICATIONS OF THE FINDINGS
In the treatment of hydrosalpinges prior to IVF/ICSI, hysteroscopic proximal occlusion by intratubal devices is inferior to laparoscopic salpingectomy.
STUDY FUNDING/COMPETING INTEREST(S)
The intratubal devices were received from Conceptus, Inc., San Carlos, CA, USA, which was acquired by Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ, USA in 2013. Conceptus, Inc./Bayer HealthCare Pharmaceuticals, Inc. had no role in the study design, data collection and analyses, decision to publish or preparation of the manuscript. The study as a whole was funded by the SWOG (foundation for scientific investigation in obstetrics and gynaecology of the VU University Medical Centre, Amsterdam, the Netherlands). P.G.A.H. has received non-financial support from Conceptus, Inc. during the conduct of this study. He has received grants from Ferring B.V., Merck Serono and Abbott outside the submitted work. M.H.E. has received personal fees from Smith and Nephew and IQ Medical Ventures outside the submitted work.
TRIAL REGISTRATION NUMBER
The Dutch Trial Register: NTR 2073.
TRIAL REGISTRATION DATE
October 21, 2009.
DATE OF FIRST PATIENT'S ENROLMENT
October 26, 2009.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Fallopian Tube Diseases - diagnostic imaging</subject><subject>Fallopian Tube Diseases - surgery</subject><subject>Female</subject><subject>Fertilization in Vitro - methods</subject><subject>Humans</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Pregnancy Rate</subject><subject>Salpingectomy - methods</subject><subject>Sperm Injections, Intracytoplasmic - methods</subject><subject>Sterilization, Tubal - methods</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0268-1161</issn><issn>1460-2350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkD9PwzAQxS0EoqUwsiKPLKF2_tgJG6oojVQJCQprZDs2DUriENtAPgFfG6OUMrLcnU6_e6f3ADjH6AqjLJpvXdPLbl7KD5SgAzDFMUFBGCXoEExRSNIAY4In4MSYV4T8mJJjMAlp6G9jPAVfq8FY2WsjdFcJ2PX6s2pYDa3jvmohamcq3cJ32RtnYM06tocNq7uqfZHC6maAzEAGbS-ZbWRrodI93A6lh3eU8eKVX1oN8-cl9FO-eMyvIWvhw2JzCo4Uq4082_UZeFrebharYH1_ly9u1oGISGIDImKBuMhESAlFiiOsUIqJ33CeUUG94zjinCoZI5HRJFIJSkslQhL5C86jGbgcdb3TNyeNLZrKCFnXrJXamQKnOExTQhPi0WBEhTdheqkKb6Bh_VBgVPxkX4zZF2P2nr_YSTveyHJP_4b991u77h-tbztqkhE</recordid><startdate>20160901</startdate><enddate>20160901</enddate><creator>Dreyer, K.</creator><creator>Lier, M.C.I.</creator><creator>Emanuel, M.H.</creator><creator>Twisk, J.W.R.</creator><creator>Mol, B.W.J.</creator><creator>Schats, R.</creator><creator>Hompes, P.G.A.</creator><creator>Mijatovic, V.</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160901</creationdate><title>Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT</title><author>Dreyer, K. ; Lier, M.C.I. ; Emanuel, M.H. ; Twisk, J.W.R. ; Mol, B.W.J. ; Schats, R. ; Hompes, P.G.A. ; Mijatovic, V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-6c4c0bc9c27670fb01f0816bc9bb97c702643bb7fe40c9753f508dfc263276bb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Fallopian Tube Diseases - diagnostic imaging</topic><topic>Fallopian Tube Diseases - surgery</topic><topic>Female</topic><topic>Fertilization in Vitro - methods</topic><topic>Humans</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Pregnancy Rate</topic><topic>Salpingectomy - methods</topic><topic>Sperm Injections, Intracytoplasmic - methods</topic><topic>Sterilization, Tubal - methods</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dreyer, K.</creatorcontrib><creatorcontrib>Lier, M.C.I.</creatorcontrib><creatorcontrib>Emanuel, M.H.</creatorcontrib><creatorcontrib>Twisk, J.W.R.</creatorcontrib><creatorcontrib>Mol, B.W.J.</creatorcontrib><creatorcontrib>Schats, R.</creatorcontrib><creatorcontrib>Hompes, P.G.A.</creatorcontrib><creatorcontrib>Mijatovic, V.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Human reproduction (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dreyer, K.</au><au>Lier, M.C.I.</au><au>Emanuel, M.H.</au><au>Twisk, J.W.R.</au><au>Mol, B.W.J.</au><au>Schats, R.</au><au>Hompes, P.G.A.</au><au>Mijatovic, V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT</atitle><jtitle>Human reproduction (Oxford)</jtitle><addtitle>Hum Reprod</addtitle><date>2016-09-01</date><risdate>2016</risdate><volume>31</volume><issue>9</issue><spage>2005</spage><epage>2016</epage><pages>2005-2016</pages><issn>0268-1161</issn><eissn>1460-2350</eissn><abstract>Abstract
STUDY QUESTION
Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy?
SUMMARY ANSWER
Hysteroscopic proximal tubal occlusion by intratubal devices is inferior to laparoscopic salpingectomy in the treatment of hydrosalpinges in women undergoing IVF/ICSI with respect to ongoing pregnancy rates.
WHAT IS KNOWN ALREADY
It is known that women with hydrosalpinges undergoing IVF have poorer pregnancy outcomes compared with women with other forms of tubal infertility. In these women, both laparoscopic salpingectomy and laparoscopic proximal tubal ligation are known to improve IVF outcomes. At present, it is unclear whether a less-invasive hysteroscopic treatment with intratubal devices leads to similar ongoing pregnancy rates following IVF when compared with laparoscopic salpingectomy.
STUDY DESIGN, SIZE, DURATION
A two-centre, randomized, controlled, non-inferiority trial. Between October 2009 and December 2014 a total of 85 women were included in this study; of whom, 42 were randomized to hysteroscopic proximal occlusion by intratubal device placement and 43 were randomized to laparoscopic salpingectomy. Randomization was based on a computer-generated randomization list. The study was unblinded. The primary outcome was ongoing pregnancy rate, defined as a fetal heartbeat on ultrasound beyond 10-week gestation following one IVF/ICSI treatment (fresh and frozen–thawed embryo transfers).
PARTICIPANTS/MATERIALS, SETTING, METHODS
We studied women aged 18–41 years, with uni- or bilateral ultrasound visible hydrosalpinges who were scheduled for an IVF/ICSI treatment.
MAIN RESULTS AND THE ROLE OF CHANCE
The ongoing pregnancy rates per patient according to the intention-to-treat principle were 11/42 (26.2%) after hysteroscopic proximal occlusion by intratubal devices (intervention group) versus 24/43 (55.8%) after laparoscopic salpingectomy (control group) (P = 0.008) [absolute difference: 26.1%; 95% confidence interval (CI): 0.5–51.7, relative risk (RR): 0.56; 95% CI: 0.31–1.03, P = 0.01]. In the per protocol analysis, the ongoing pregnancy rate per patient following hysteroscopic proximal occlusion by intratubal devices was 9/27 (33.3%) compared with 19/32 (59.4%) following laparoscopic salpingectomy (P = 0.067) (absolute difference: 29.6%; 95% CI: 7.1 to 49.1, RR: 0.47; 95% CI: 0.27–0.83, P = 0.062).
LIMITATIONS, REASONS FOR CAUTION
Masking participants and investigators would be difficult due to the nature of both interventions. Since we had objective outcome measurements, we withheld sham procedures, leaving the study unblinded. Furthermore, our low sample size resulted in wide CIs. A larger sample size would result in a more accurate treatment effect; however, this was non-feasible for recruitment and inclusion.
WIDER IMPLICATIONS OF THE FINDINGS
In the treatment of hydrosalpinges prior to IVF/ICSI, hysteroscopic proximal occlusion by intratubal devices is inferior to laparoscopic salpingectomy.
STUDY FUNDING/COMPETING INTEREST(S)
The intratubal devices were received from Conceptus, Inc., San Carlos, CA, USA, which was acquired by Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ, USA in 2013. Conceptus, Inc./Bayer HealthCare Pharmaceuticals, Inc. had no role in the study design, data collection and analyses, decision to publish or preparation of the manuscript. The study as a whole was funded by the SWOG (foundation for scientific investigation in obstetrics and gynaecology of the VU University Medical Centre, Amsterdam, the Netherlands). P.G.A.H. has received non-financial support from Conceptus, Inc. during the conduct of this study. He has received grants from Ferring B.V., Merck Serono and Abbott outside the submitted work. M.H.E. has received personal fees from Smith and Nephew and IQ Medical Ventures outside the submitted work.
TRIAL REGISTRATION NUMBER
The Dutch Trial Register: NTR 2073.
TRIAL REGISTRATION DATE
October 21, 2009.
DATE OF FIRST PATIENT'S ENROLMENT
October 26, 2009.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>27209341</pmid><doi>10.1093/humrep/dew050</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0268-1161 |
| ispartof | Human reproduction (Oxford), 2016-09, Vol.31 (9), p.2005-2016 |
| issn | 0268-1161 1460-2350 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1812886756 |
| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Fallopian Tube Diseases - diagnostic imaging Fallopian Tube Diseases - surgery Female Fertilization in Vitro - methods Humans Pregnancy Pregnancy Outcome Pregnancy Rate Salpingectomy - methods Sperm Injections, Intracytoplasmic - methods Sterilization, Tubal - methods Treatment Outcome Young Adult |
| title | Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT |
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