Surgical treatment for tubal disease in women due to undergo in vitro fertilisation

Neil Johnson; Sabine van Voorst; Martin C Sowter; Annika Strandell; Ben Willem J Mol

doi:10.1002/14651858.CD002125.pub3

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Figure 1

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Figure 3

Forest plot of comparison: Surgical treatment (all types) VERSUS no surgical treatment: Salpingectomy (all methods) VERSUS no surgical treatment. Outcomes: Ongoing pregnancy rate, Clinical pregnancy rate, Pregnancy rate according to any definition, Ectopic pregnancy rate, Miscarriage rate, Surgical complication rate.

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Figure 4

Forest plot of comparison: Surgical treatment (all types) VERSUS no surgical treatment: Tubal occlusion (all methods) VERSUS no surgical treatment. Outcomes: Ongoing pregnancy rate, Clinical pregnancy rate, Ectopic pregnancy rate, Miscarriage rate, Surgical complication rate.

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Figure 5

Forest plot of comparison: Surgical treatment (all types) VERSUS no surgical treatment: Aspiration of hydro salpingeal fluid (all methods) VERSUS no surgical treatment. Outcomes: Ongoing pregnancy rate, Clinical pregnancy rate, Ectopic pregnancy rate, Miscarriage rate, Surgical complication rate.

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Figure 6

Forest plot of comparison: Laparoscopic surgery on the fallopian tube (all types) VERSUS (any other) laparoscopic surgery on the fallopian tube: Tubal occlusion (all methods) VERSUS Salpingectomy (all methods). Outcomes: Ongoing pregnancy rate, Clinical pregnancy rate, Ectopic pregnancy rate, Miscarriage rate.

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Analysis 1.1

Comparison 1 Laparoscopic surgery on the fallopian tube (all types) VERSUS No surgery on the fallopian tube (all types), Outcome 1 Ongoing pregnancy rate.

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Analysis 1.2

Comparison 1 Laparoscopic surgery on the fallopian tube (all types) VERSUS No surgery on the fallopian tube (all types), Outcome 2 Clinical pregnancy rate.

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Analysis 1.3

Comparison 1 Laparoscopic surgery on the fallopian tube (all types) VERSUS No surgery on the fallopian tube (all types), Outcome 3 Pregnancy rate ‐ any definition.

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Analysis 1.4

Comparison 1 Laparoscopic surgery on the fallopian tube (all types) VERSUS No surgery on the fallopian tube (all types), Outcome 4 Ectopic pregnancy rate.

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Analysis 1.5

Comparison 1 Laparoscopic surgery on the fallopian tube (all types) VERSUS No surgery on the fallopian tube (all types), Outcome 5 Miscarriage rate.

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Analysis 1.6

Comparison 1 Laparoscopic surgery on the fallopian tube (all types) VERSUS No surgery on the fallopian tube (all types), Outcome 6 Surgical complication rate.

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Analysis 2.1

Comparison 2 Occlusion of the fallopian tube VERSUS no intervention on the fallopian tube, Outcome 1 Ongoing pregnancy rate.

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Analysis 2.2

Comparison 2 Occlusion of the fallopian tube VERSUS no intervention on the fallopian tube, Outcome 2 Clinical pregnancy rate.

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Analysis 2.3

Comparison 2 Occlusion of the fallopian tube VERSUS no intervention on the fallopian tube, Outcome 3 Pregnancy rate ‐ any definition.

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Analysis 2.4

Comparison 2 Occlusion of the fallopian tube VERSUS no intervention on the fallopian tube, Outcome 4 Ectopic pregnancy rate.

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Analysis 2.5

Comparison 2 Occlusion of the fallopian tube VERSUS no intervention on the fallopian tube, Outcome 5 Miscarriage rate.

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Analysis 3.1

Comparison 3 Aspiration of the hydrosalpinges versus non aspiration of hydrosalpinges, Outcome 1 Clinical pregnancy rate.

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Analysis 3.2

Comparison 3 Aspiration of the hydrosalpinges versus non aspiration of hydrosalpinges, Outcome 2 Biochemical pregnancy rate.

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Analysis 3.3

Comparison 3 Aspiration of the hydrosalpinges versus non aspiration of hydrosalpinges, Outcome 3 Pregnancy rate ‐ any definition.

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Analysis 3.4

Comparison 3 Aspiration of the hydrosalpinges versus non aspiration of hydrosalpinges, Outcome 4 Ectopic pregnancy rate.

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Analysis 3.5

Comparison 3 Aspiration of the hydrosalpinges versus non aspiration of hydrosalpinges, Outcome 5 Miscarriage rate.

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Analysis 3.6

Comparison 3 Aspiration of the hydrosalpinges versus non aspiration of hydrosalpinges, Outcome 6 Surgical complication rate.

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Analysis 4.1

Comparison 4 Laparoscopic surgery on the fallopian tube (all types) VERSUS (any other) laparoscopic surgery on the fallopian tube, Outcome 1 Ongoing pregnancy rate.

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Analysis 4.2

Comparison 4 Laparoscopic surgery on the fallopian tube (all types) VERSUS (any other) laparoscopic surgery on the fallopian tube, Outcome 2 Clinical pregnancy rate.

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Analysis 4.3

Comparison 4 Laparoscopic surgery on the fallopian tube (all types) VERSUS (any other) laparoscopic surgery on the fallopian tube, Outcome 3 Pregnancy rate ‐ any definition.

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Analysis 4.4

Comparison 4 Laparoscopic surgery on the fallopian tube (all types) VERSUS (any other) laparoscopic surgery on the fallopian tube, Outcome 4 Ectopic pregnancy rate.

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Analysis 4.5

Comparison 4 Laparoscopic surgery on the fallopian tube (all types) VERSUS (any other) laparoscopic surgery on the fallopian tube, Outcome 5 Miscarriage rate.

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Analysis 5.1

Comparison 5 Surgical treatment (all types) VERSUS no surgical treatment, Outcome 1 Salpingectomy (all methods) VERSUS no surgical treatment.

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Analysis 5.2

Comparison 5 Surgical treatment (all types) VERSUS no surgical treatment, Outcome 2 Tubal occlusion (all methods) VERSUS no surgical treatment.

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Analysis 5.3

Comparison 5 Surgical treatment (all types) VERSUS no surgical treatment, Outcome 3 Aspiration of hydro salpingeal fluid (all methods) VERSUS no surgical treatment.

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Analysis 6.1

Comparison 6 Laparoscopic surgery on the fallopian tube (all types) VERSUS (any other) laparoscopic surgery on the fallopian tube, Outcome 1 Tubal occlusion (all methods) VERSUS Salpingectomy (all methods).

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Comparison 1. Laparoscopic surgery on the fallopian tube (all types) VERSUS No surgery on the fallopian tube (all types)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Ongoing pregnancy rate Show forest plot	3	329	Odds Ratio (M‐H, Fixed, 95% CI)	2.20 [1.26, 3.82]

1.1 Laparoscopic bilateral salpingectomy and adhesiolysis versus no surgery on the fallopian tube	1	60	Odds Ratio (M‐H, Fixed, 95% CI)	3.06 [0.97, 9.66]
1.2 Laparoscopic salpingectomy versus no intervention	2	269	Odds Ratio (M‐H, Fixed, 95% CI)	1.99 [1.06, 3.74]
2 Clinical pregnancy rate Show forest plot	3	395	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.31 [1.48, 3.62]

2.1 Laparoscopic salpingectomy versus no intervention	3	395	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.31 [1.48, 3.62]
3 Pregnancy rate ‐ any definition Show forest plot	4	455	Odds Ratio (M‐H, Fixed, 95% CI)	2.49 [1.60, 3.86]

3.1 Laparoscopic bilateral salpingectomy and adhesiolysis versus no surgery on the fallopian tube	1	60	Odds Ratio (M‐H, Fixed, 95% CI)	3.06 [0.97, 9.66]
3.2 Laparoscopic salpingectomy versus no intervention	3	395	Odds Ratio (M‐H, Fixed, 95% CI)	2.40 [1.49, 3.86]
4 Ectopic pregnancy rate Show forest plot	3	329	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.68 [0.13, 3.56]

4.1 Laparoscopic bilateral salpingectomy and adhesiolysis versus laparoscopic adhesiolysis	1	60	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.14 [0.00, 6.82]
4.2 Laparoscopic salpingectomy versus no intervention	2	269	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.96 [0.15, 6.01]
5 Miscarriage rate Show forest plot	3	115	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.38 [0.11, 1.28]

5.1 Laparoscopic bilateral salpingectomy and adhesiolysis versus laparoscopic adhesiolysis	1	38	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.17 [0.01, 5.24]
5.2 Laparoscopic salpingectomy versus no intervention	2	77	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.42 [0.12, 1.57]
6 Surgical complication rate Show forest plot	1	204	Peto Odds Ratio (Peto, Fixed, 95% CI)	5.86 [0.35, 96.79]

6.1 Laparoscopic salpingectomy versus no intervention	1	204	Peto Odds Ratio (Peto, Fixed, 95% CI)	5.86 [0.35, 96.79]

Comparison 1. Laparoscopic surgery on the fallopian tube (all types) VERSUS No surgery on the fallopian tube (all types)

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Comparison 2. Occlusion of the fallopian tube VERSUS no intervention on the fallopian tube

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Ongoing pregnancy rate Show forest plot	1	65	Odds Ratio (M‐H, Fixed, 95% CI)	7.21 [0.87, 59.57]

1.1 Laparoscopic proximal tubal occlusion by diathermy VERSUS no intervention	1	65	Odds Ratio (M‐H, Fixed, 95% CI)	7.21 [0.87, 59.57]
2 Clinical pregnancy rate Show forest plot	2	209	Odds Ratio (M‐H, Fixed, 95% CI)	4.66 [2.17, 10.01]

2.1 Laparoscopic proximal tubal occlusion by diathermy VERSUS no intervention	1	65	Odds Ratio (M‐H, Fixed, 95% CI)	4.33 [0.88, 21.30]
2.2 Proximal tubal clamping VERSUS no intervention	1	144	Odds Ratio (M‐H, Fixed, 95% CI)	4.78 [2.01, 11.38]
3 Pregnancy rate ‐ any definition Show forest plot	2	209	Odds Ratio (M‐H, Fixed, 95% CI)	4.66 [2.17, 10.01]

3.1 Laparoscopic proximal tubal occlusion by diathermy VERSUS no intervention	1	65	Odds Ratio (M‐H, Fixed, 95% CI)	4.33 [0.88, 21.30]
3.2 Laparoscopic proximal tubal clamping VERSUS no intervention	1	144	Odds Ratio (M‐H, Fixed, 95% CI)	4.78 [2.01, 11.38]
4 Ectopic pregnancy rate Show forest plot	1	65	Odds Ratio (M‐H, Fixed, 95% CI)	0.94 [0.04, 24.25]

4.1 Laparoscopic proximal tubal occlusion by diathermy VERSUS no intervention	1	65	Odds Ratio (M‐H, Fixed, 95% CI)	0.94 [0.04, 24.25]
5 Miscarriage rate Show forest plot	1	25	Odds Ratio (M‐H, Fixed, 95% CI)	0.15 [0.01, 3.09]

5.1 Laparoscopic proximal tubal occlusion by diathermy VERSUS no intervention	1	25	Odds Ratio (M‐H, Fixed, 95% CI)	0.15 [0.01, 3.09]

Comparison 2. Occlusion of the fallopian tube VERSUS no intervention on the fallopian tube

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Comparison 3. Aspiration of the hydrosalpinges versus non aspiration of hydrosalpinges

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical pregnancy rate Show forest plot	1	64	Odds Ratio (M‐H, Fixed, 95% CI)	1.97 [0.62, 6.29]

1.1 Ultrasound guided aspiration of hydrosalpinges just after oocyte retrieval VERSUS no aspiration	1	64	Odds Ratio (M‐H, Fixed, 95% CI)	1.97 [0.62, 6.29]
2 Biochemical pregnancy rate Show forest plot	1	64	Odds Ratio (M‐H, Fixed, 95% CI)	2.78 [0.93, 8.27]

2.1 Ultrasound guided aspiration of hydrosalpinges just after oocyte retrieval VERSUS no aspiration	1	64	Odds Ratio (M‐H, Fixed, 95% CI)	2.78 [0.93, 8.27]
3 Pregnancy rate ‐ any definition Show forest plot	1	64	Odds Ratio (M‐H, Fixed, 95% CI)	1.97 [0.62, 6.29]

3.1 Ultrasound guided aspiration of hydrosalpinges just after oocyte retrieval VERSUS no aspiration	1	64	Odds Ratio (M‐H, Fixed, 95% CI)	1.97 [0.62, 6.29]
4 Ectopic pregnancy rate Show forest plot	1	66	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4.1 Ultrasound guided aspiration of hydrosalpinges just after oocyte retrieval VERSUS no aspiration	1	66	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Miscarriage rate Show forest plot	1	16	Odds Ratio (M‐H, Fixed, 95% CI)	1.25 [0.09, 17.65]

5.1 Ultrasound guided aspiration of hydrosalpinges just after oocyte retrieval VERSUS no aspiration	1	16	Odds Ratio (M‐H, Fixed, 95% CI)	1.25 [0.09, 17.65]
6 Surgical complication rate Show forest plot	1	66	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

6.1 Ultrasound guided aspiration of hydrosalpinges just after oocyte retrieval VERSUS no aspiration	1	66	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. Aspiration of the hydrosalpinges versus non aspiration of hydrosalpinges

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Comparison 4. Laparoscopic surgery on the fallopian tube (all types) VERSUS (any other) laparoscopic surgery on the fallopian tube

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Ongoing pregnancy rate Show forest plot	1	100	Odds Ratio (M‐H, Fixed, 95% CI)	1.65 [0.74, 3.71]

1.1 Laparoscopic proximal tubal occlusion by diathermy VERSUS laparoscopic salpingectomy	1	100	Odds Ratio (M‐H, Fixed, 95% CI)	1.65 [0.74, 3.71]
2 Clinical pregnancy rate Show forest plot	2	238	Odds Ratio (M‐H, Fixed, 95% CI)	1.28 [0.76, 2.14]

2.1 Laparoscopic proximal tubal occlusion by diathermy VERSUS laparoscopic salpingectomy	1	100	Odds Ratio (M‐H, Fixed, 95% CI)	1.63 [0.74, 3.59]
2.2 Laparoscopic proximal tubal clamping VERSUS laparoscopic salpingectomy	1	138	Odds Ratio (M‐H, Fixed, 95% CI)	1.06 [0.53, 2.12]
3 Pregnancy rate ‐ any definition Show forest plot	2	238	Odds Ratio (M‐H, Fixed, 95% CI)	1.28 [0.76, 2.14]

3.1 Laparoscopic proximal tubal occlusion by diathermy VERSUS laparoscopic salpingectomy	1	100	Odds Ratio (M‐H, Fixed, 95% CI)	1.63 [0.74, 3.59]
3.2 Laparoscopic proximal tubal clamping VERSUS laparoscopic salpingectomy	1	138	Odds Ratio (M‐H, Fixed, 95% CI)	1.06 [0.53, 2.12]
4 Ectopic pregnancy rate Show forest plot	1	100	Odds Ratio (M‐H, Fixed, 95% CI)	3.06 [0.12, 76.95]

4.1 Laparoscopic proximal tubal occlusion by diathermy VERSUS laparoscopic salpingectomy	1	100	Odds Ratio (M‐H, Fixed, 95% CI)	3.06 [0.12, 76.95]
5 Miscarriage rate Show forest plot	1	43	Odds Ratio (M‐H, Fixed, 95% CI)	1.35 [0.20, 9.02]

5.1 Laparoscopic proximal tubal occlusion by diathermy VERSUS laparoscopic salpingectomy	1	43	Odds Ratio (M‐H, Fixed, 95% CI)	1.35 [0.20, 9.02]

Comparison 4. Laparoscopic surgery on the fallopian tube (all types) VERSUS (any other) laparoscopic surgery on the fallopian tube

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Comparison 5. Surgical treatment (all types) VERSUS no surgical treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Salpingectomy (all methods) VERSUS no surgical treatment Show forest plot	4		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Ongoing pregnancy rate	3	329	Odds Ratio (M‐H, Fixed, 95% CI)	2.20 [1.26, 3.82]
1.2 Clinical pregnancy rate	3	395	Odds Ratio (M‐H, Fixed, 95% CI)	2.40 [1.49, 3.86]
1.3 Pregnancy rate ‐ any definition	4	455	Odds Ratio (M‐H, Fixed, 95% CI)	2.49 [1.60, 3.86]
1.4 Ectopic pregnancy rate	3	329	Odds Ratio (M‐H, Fixed, 95% CI)	0.64 [0.15, 2.75]
1.5 Miscarriage rate	3	329	Odds Ratio (M‐H, Fixed, 95% CI)	0.86 [0.31, 2.38]
1.6 Surgical complication rate	1	204	Odds Ratio (M‐H, Fixed, 95% CI)	3.86 [0.18, 81.52]
2 Tubal occlusion (all methods) VERSUS no surgical treatment Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Ongoing pregnancy rate	1	65	Odds Ratio (M‐H, Fixed, 95% CI)	7.21 [0.87, 59.57]
2.2 Clinical pregnancy rate	2	209	Odds Ratio (M‐H, Fixed, 95% CI)	4.66 [2.17, 10.01]
2.3 Ectopic pregnancy rate	1	65	Odds Ratio (M‐H, Fixed, 95% CI)	0.94 [0.04, 24.25]
2.4 Miscarriage rate	1	65	Odds Ratio (M‐H, Fixed, 95% CI)	0.89 [0.09, 9.28]
3 Aspiration of hydro salpingeal fluid (all methods) VERSUS no surgical treatment Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 Clinical pregnancy rate	1	64	Odds Ratio (M‐H, Fixed, 95% CI)	1.97 [0.62, 6.29]
3.2 Biochemical pregnancy rate	1	64	Odds Ratio (M‐H, Fixed, 95% CI)	2.78 [0.93, 8.27]
3.3 Ectopic pregnancy rate	1	64	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.4 Miscarriage rate	1	64	Odds Ratio (M‐H, Fixed, 95% CI)	2.07 [0.18, 24.01]
3.5 Surgical complication rate	1	64	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 5. Surgical treatment (all types) VERSUS no surgical treatment

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Comparison 6. Laparoscopic surgery on the fallopian tube (all types) VERSUS (any other) laparoscopic surgery on the fallopian tube

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Tubal occlusion (all methods) VERSUS Salpingectomy (all methods) Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Ongoing pregnancy rate	1	100	Odds Ratio (M‐H, Fixed, 95% CI)	1.65 [0.74, 3.71]
1.2 Clinical pregnancy rate	2	238	Odds Ratio (M‐H, Fixed, 95% CI)	1.28 [0.76, 2.14]
1.3 Ectopic pregnancy rate	1	100	Odds Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.21]
1.4 Miscarriage rate	1	100	Odds Ratio (M‐H, Fixed, 95% CI)	1.53 [0.24, 9.59]

Comparison 6. Laparoscopic surgery on the fallopian tube (all types) VERSUS (any other) laparoscopic surgery on the fallopian tube

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