Tratamiento quirúrgico para la enfermedad tubárica en mujeres a las que se les realizará fecundación in vitro
Information
- DOI:
- https://doi.org/10.1002/14651858.CD002125.pub4Copy DOI
- Database:
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- Cochrane Database of Systematic Reviews
- Version published:
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- 22 October 2020see what's new
- Type:
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- Intervention
- Stage:
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- Review
- Cochrane Editorial Group:
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Cochrane Gynaecology and Fertility Group
- Copyright:
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- Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Authors
Contributions of authors
PM was the lead author in writing the full review update and was involved in preparing all sections of the review. EXG was involved in data extraction for the review. CB and IEG made substantial editorial amendments to the review.
NJ conceptualised the protocol and the review primarily, and carried out the search, selection of trials and risk of bias assessment as a first reviewer and first author in the first version of the review and as a second reviewer in the previous update.
SVV updated the review in 2010 as a first reviewer performing the search, selection of trials and risk of bias assessment. She proofread the current review.
Ben Willem Mol and Annika Strandell proofread the updated review.
Sources of support
Internal sources
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University of Auckland, School of Medicine, Auckland, New Zealand
External sources
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None, Other
Declarations of interest
PM has no interests to declare.
EXG has no interests to declare.
NJ works as a gynaecologist at Auckland Gynaecology Group and Fertility Specialist at Repromed Auckland. Within the last 3 years NJ has had consultancy with Guerbet, Myovant Sciences, Vifor Pharma and Roche Diagnostics and has received research funding from Guerbet, AbbVie and Myovant Sciences.
SVV ‐ at the time of the update in 2010 ‐ was a medical student of the faculty of Health, Medicine and Life Sciences of the University of Maastricht. She is now a resident in Obstetrics and Gynaecology at the Erasmus Medical Center, Rotterdam, the Netherlands. She has no financial conflicts of interest.
AS led one of the trials included in this review (Strandell 1999). She is a gynaecologist at Sahlgrenska Hospital, associate professor at the University of Gothenburg and employed at the regional centre for Health Technology Assessment in Göteborg, Sweden. She has received fees from Guerbet for an expert consultancy.
BWJM is an author on one of the trials included in this review (Dreyer 2016) and confirms he took no part in selecting this study, extracting data or assessing risk of bias. In addition, BWJM is supported by a NHMRC Investigator grant (GNT1176437) and reports consultancy for ObsEva, Merk KGaA, iGenomix and Guerbet.
CMB has received research support by Bayer, Volition Rx, Roche Diagnostics and MDNA Life Sciences. He has also received consultancy fees from ObsEva, AbbVie and Myovant.
IEG's institution has received research support from Finox and Bayer.
Acknowledgements
We would like to thank Helen Nagels, CGF Managing Editor, for her support and guidance in the preparation of this review; Marian Showell, Cochrane Information Specialist, for her help in preparing and conducting the search strategies; and Ms Xiaojing Wu for assessing two Chinese manuscripts and extracting relevant data. We also thank Martin Sowter for his significant contributions to previous versions of this systematic review, and the peer reviewers (Dr Vivienne Moore, Dr Vanessa Jordan and Dr Mohan Kamath) whose helpful comments made this a better piece of work.
Finally, we wish to thank the trial authors who contributed to this review by supplying additional details of their research in all the versions of this review, particularly Evangelos Makrakis, Herve Déchaud, Nahed Hammadieh, Vaeceslav Moshin, Kareem Labib and Kim Dreyer.
Version history
| Published | Title | Stage | Authors | Version |
| 2020 Oct 22 | Surgical treatment for tubal disease in women due to undergo in vitro fertilisation | Review | Pedro Melo, Ektoras X Georgiou, Neil Johnson, Sabine F. Voorst, Annika Strandell, Ben Willem J Mol, Christian Becker, Ingrid E Granne | |
| 2010 Jan 20 | Surgical treatment for tubal disease in women due to undergo in vitro fertilisation | Review | Neil Johnson, Sabine van Voorst, Martin C Sowter, Annika Strandell, Ben Willem J Mol | |
| 2004 Jul 19 | Surgical treatment for tubal disease in women due to undergo in vitro fertilisation | Review | Neil Johnson, Sabine van Voorst, Martin C Sowter, Annika Strandell, Ben Willem J Mol | |
| 2001 Jul 23 | Surgical treatment for tubal disease in women due to undergo in vitro fertilisation | Review | Neil NP Johnson, W Mak, M C Sowter | |
Differences between protocol and review
In the current version of the review, ongoing pregnancy rate and viable pregnancy rate were combined with clinical pregnancy rate, as ongoing pregnancy is currently not a recognised outcome by The International Glossary on Infertility and Fertility Care 2017 (Zegers‐Hochschild 2017). We no longer report on biochemical pregnancy rates, contrary to the previous version of this review, because clinical pregnancy and live birth rates are more clinically relevant outcomes.
We added the following outcomes to the meta‐analysis:
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Mean number of oocytes, to investigate concerns of tubal surgery affecting the ovarian blood supply;
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Mean number of embryos, to investigate whether tubal surgery had an impact upon fertilisation.
We added a subgroup analysis for women younger or older than 40 years to account for the effect of age on expected ovarian response, although this was not possible due to a lack of data.
We carried out analyses of dichotomous outcomes using RR, instead of OR, in this review, in line with Cochrane guidance recommending RR as it is a more easily interpretable measure of relative effect (Higgins 2011).
We have also updated the list of outcomes according to the most recent edition of the Cochrane Handbook of Systematic Reviews of Interventions. Additionally, we have used GradePRO to grade the evidence and produce a Summary of Findings Table for the main comparison of tubal surgery versus no tubal surgery.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Abortion, Spontaneous [epidemiology];
- Fallopian Tube Diseases [*surgery];
- Fallopian Tubes [*surgery];
- *Fertilization in Vitro;
- Pregnancy Outcome;
- Pregnancy, Ectopic [epidemiology];
- Randomized Controlled Trials as Topic;
- Salpingectomy [statistics & numerical data];
- Sperm Injections, Intracytoplasmic;
- Sterilization, Tubal [statistics & numerical data];
Medical Subject Headings Check Words
Female; Humans; Pregnancy;
PICOs
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Forest plot of comparison: Tubal surgery (all methods) versus no tubal surgery, outcome: 8.1 Clinical pregnancy rate.
Forest plot of comparison: 2 Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, outcome: 2.1 Live birth rate.
Forest plot of comparison: 2 Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, outcome: 2.4 Clinical pregnancy rate.
Comparison 1: Tubal surgery (all methods) vs no tubal surgery, Outcome 1: Surgical complication rate ‐ conversion to laparotomy
Comparison 1: Tubal surgery (all methods) vs no tubal surgery, Outcome 2: Surgical complication rate ‐ pelvic infection
Comparison 1: Tubal surgery (all methods) vs no tubal surgery, Outcome 3: Clinical pregnancy rate
Comparison 1: Tubal surgery (all methods) vs no tubal surgery, Outcome 4: Multiple pregnancy rate
Comparison 1: Tubal surgery (all methods) vs no tubal surgery, Outcome 5: Miscarriage rate
Comparison 1: Tubal surgery (all methods) vs no tubal surgery, Outcome 6: Ectopic pregnancy rate
Comparison 1: Tubal surgery (all methods) vs no tubal surgery, Outcome 7: Mean number of oocytes
Comparison 1: Tubal surgery (all methods) vs no tubal surgery, Outcome 8: Mean number of embryos
Comparison 1: Tubal surgery (all methods) vs no tubal surgery, Outcome 9: Multiple pregnancy rate (per clinical pregnancy)
Comparison 1: Tubal surgery (all methods) vs no tubal surgery, Outcome 10: Miscarriage rate (per clinical pregnancy)
Comparison 2: Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, Outcome 1: Live birth rate
Comparison 2: Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, Outcome 2: Surgical complication rate ‐ wound infection
Comparison 2: Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, Outcome 3: Surgical complication rate ‐ pelvic infection
Comparison 2: Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, Outcome 4: Clinical pregnancy rate
Comparison 2: Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, Outcome 5: Multiple pregnancy rate
Comparison 2: Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, Outcome 6: Miscarriage rate
Comparison 2: Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, Outcome 7: Ectopic pregnancy rate
Comparison 2: Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, Outcome 8: Mean number of oocytes
Comparison 2: Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, Outcome 9: Mean number of embryos
Comparison 2: Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, Outcome 10: Multiple pregnancy rate (per clinical pregnancy)
Comparison 2: Proximal tubal occlusion (all methods) vs laparoscopic salpingectomy, Outcome 11: Miscarriage rate (per clinical pregnancy)
Comparison 3: Transvaginal aspiration of hydrosalpingeal fluid vs laparoscopic salpingectomy, Outcome 1: Surgical complication rate
Comparison 3: Transvaginal aspiration of hydrosalpingeal fluid vs laparoscopic salpingectomy, Outcome 2: Clinical pregnancy rate
Comparison 3: Transvaginal aspiration of hydrosalpingeal fluid vs laparoscopic salpingectomy, Outcome 3: Miscarriage rate
Comparison 3: Transvaginal aspiration of hydrosalpingeal fluid vs laparoscopic salpingectomy, Outcome 4: Ectopic pregnancy rate
Comparison 3: Transvaginal aspiration of hydrosalpingeal fluid vs laparoscopic salpingectomy, Outcome 5: Mean number of oocytes
Comparison 3: Transvaginal aspiration of hydrosalpingeal fluid vs laparoscopic salpingectomy, Outcome 6: Mean number of embryos
Comparison 3: Transvaginal aspiration of hydrosalpingeal fluid vs laparoscopic salpingectomy, Outcome 7: Miscarriage rate (per clinical pregnancy)
| Tubal surgery compared to no surgery for tubal disease in women due to undergo in vitro fertilisation | ||||||
| Patient or population: tubal disease in women due to undergo in vitro fertilisation | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with no tubal surgery | Risk with tubal surgery | |||||
| Live birth rate | No studies reported on this outcome for the main comparison. | |||||
| Surgical complication rate | ||||||
| Salpingectomy (all methods) | 0 per 1,000 | 0 per 1,000 | Peto OR 5.80 | 204 | ⊕⊝⊝⊝ | We are uncertain of the effect of salpingectomy on the rate of conversion to laparotomy. |
| Surgical complication rate | ||||||
| Salpingectomy (all methods) | 0 per 1,000 | 0 per 1,000 (0 to 0) | Peto OR 5.80 (0.11 to 303.69) | 204 (1 RCT) | ⊕⊝⊝⊝ | We are uncertain of the effect of salpingectomy on the rate of pelvic infection. |
| Transvaginal aspiration of hydrosalpingeal fluid | 0 per 1,000 | 0 per 1,000 (0 to 0) | Not estimable | 176 (1 RCT) | ‐ | There were insufficient data to estimate differences between groups. |
| Clinical pregnancy rate | ||||||
| Salpingectomy (all methods) | 186 per 1,000 | 376 per 1,000 | RR 2.02 | 455 | ⊕⊕⊕⊝ | Salpingectomy probably increases clinical pregnancy rate. |
| Tubal occlusion (all methods) | 123 per 1,000 | 396 per 1,000 | RR 3.21 | 209 | ⊕⊕⊝⊝ | Tubal occlusion may increase clinical pregnancy rate. |
| Transvaginal aspiration of hydrosalpingeal fluid | 178 per 1,000 | 297 per 1,000 | RR 1.67 | 311 | ⊕⊝⊝⊝ | We are uncertain whether transvaginal aspiration of hydrosalpingeal fluid increases clinical pregnancy rate. |
| Miscarriage rate | ||||||
| Salpingectomy (all methods) | 53 per 1,000 | 48 per 1,000 | Peto OR 0.91 | 329 | ⊕⊕⊝⊝ | Salpingectomy may have little or no difference in miscarriage rate. |
| Tubal occlusion (all methods) | 67 per 1,000 | 40 per 1,000 | Peto OR 0.55 | 65 | ⊕⊝⊝⊝ | We are uncertain of the effect of tubal occlusion on miscarriage rate. |
| Transvaginal aspiration of hydrosalpingeal fluid | 44 per 1,000 | 56 per 1,000 | Peto OR 1.27 | 311 | ⊕⊝⊝⊝ | We are uncertain of the effect of transvaginal aspiration of hydrosalpingeal fluid on miscarriage rate. |
| Ectopic pregnancy rate | ||||||
| Salpingectomy (all methods) | 23 per 1,000 | 8 per 1,000 | Peto OR 0.29 | 329 | ⊕⊕⊝⊝ | Salpingectomy may reduce ectopic pregnancy rate. |
| Tubal occlusion (all methods) | 0 per 1,000 | 0 per 1,000 | Peto OR 3.67 | 65 | ⊕⊝⊝⊝ | We are uncertain of the effect of tubal occlusion on miscarriage rate. |
| Transvaginal aspiration of hydrosalpingeal fluid | 15 per 1,000 | 10 per 1,000 | Peto OR 0.59 | 311 | ⊕⊝⊝⊝ | We are uncertain of the effect of transvaginal aspiration of hydrosalpingeal fluid on ectopic pregnancy rate. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level for imprecision: wide confidence intervals. bDowngraded one level for imprecision: low number of participants. cDowngraded one level for risk of bias: at least one study with two domains at high risk of bias. dDowngraded one level for imprecision: single small study. | ||||||
| Laparoscopic proximal tubal occlusion versus laparoscopic salpingectomy for tubal disease in women due to undergo in vitro fertilisation | ||||||
| Patient or population: tubal disease in women due to undergo in vitro fertilisation | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with laparoscopic salpingectomy | Risk with proximal tubal occlusion | |||||
| Live birth rate | ||||||
| Laparoscopic proximal tubal occlusion vs laparoscopic salpingectomy | 268 per 1,000 | 325 per 1,000 | RR 1.21 | 165 | ⊕⊝⊝⊝ | We are uncertain of the effect of laparoscopic proximal tubal occlusion on live birth rate compared to laparoscopic salpingectomy. |
| Surgical complication rate | No study reported on this outcome for laparoscopic proximal tubal occlusion. | |||||
| Surgical complication rate | No study reported on this outcome for laparoscopic proximal tubal occlusion. | |||||
| Clinical pregnancy rate | ||||||
| Laparoscopic proximal tubal occlusion vs laparoscopic salpingectomy | 410 per 1,000 | 332 per 1,000 | RR 0.81 | 347 | ⊕⊝⊝⊝ | We are uncertain of the effect of laparoscopic proximal tubal occlusion on clinical pregnancy rate compared to laparoscopic salpingectomy. |
| Miscarriage rate | ||||||
| Laparoscopic proximal tubal occlusion vs laparoscopic salpingectomy | 30 per 1,000 | 23 per 1,000 | Peto OR 0.74 | 265 | ⊕⊕⊝⊝ | Laparoscopic proximal tubal occlusion may reduce miscarriage rate slightly compared to laparoscopic salpingectomy. |
| Ectopic pregnancy rate | ||||||
| Laparoscopic proximal tubal occlusion vs laparoscopic salpingectomy | 0 per 1,000 | 0 per 1,000 | Peto OR 7.39 | 100 | ⊕⊝⊝⊝ | We are uncertain of the effect of laparoscopic proximal tubal occlusion on ectopic pregnancy rate compared to laparoscopic salpingectomy. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level for imprecision: low number of participants. bDowngraded one level for imprecision: single small study. cDowngraded one level for imprecision: wide confidence intervals. dDowngraded one level for inconsistency: high degree of heterogeneity. | ||||||
| Transvaginal aspiration of hydrosalpinx versus laparoscopic salpingectomy for tubal disease in women due to undergo in vitro fertilisation | ||||||
| Patient or population: tubal disease in women due to undergo in vitro fertilisation | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with laparoscopic salpingectomy | Risk with transvaginal aspiration of hydrosalpingeal fluid | |||||
| Live birth rate | No studies reported on this outcome. | |||||
| Surgical complication rate | 0 per 1,000 | 0 per 1,000 | not estimable | 160 | ‐ | There were insufficient data to estimate differences between groups. |
| Clinical pregnancy rate | 400 per 1,000 | 276 per 1,000 | RR 0.69 (0.44 to 1.07) | 160 | ⊕⊝⊝⊝ | We are uncertain of the effect of transvaginal aspiration of hydrosalpingeal fluid on clinical pregnancy rate compared to laparoscopic salpingectomy. |
| Miscarriage rate | 38 per 1,000 | 38 per 1,000 | Peto OR 1.00 (0.20 to 5.08) | 160 | ⊕⊝⊝⊝ | We are uncertain of the effect of transvaginal aspiration of hydrosalpingeal fluid on miscarriage rate compared to laparoscopic salpingectomy. |
| Ectopic pregnancy rate | 0 per 1,000 | 0 per 1,000 | Peto OR 7.39 (0.15 to 372.38) | 160 | ⊕⊝⊝⊝ | We are uncertain of the effect of transvaginal aspiration of hydrosalpingeal fluid on ectopic pregnancy rate compared to laparoscopic salpingectomy. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level for imprecision: low number of participants. bDowngraded one level for imprecision: single small study. cDowngraded one level for imprecision: wide confidence intervals. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Surgical complication rate ‐ conversion to laparotomy Show forest plot | 1 | 204 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 5.80 [0.11, 303.69] |
| 1.1.1 Salpingectomy (all methods) vs no tubal surgery | 1 | 204 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 5.80 [0.11, 303.69] |
| 1.2 Surgical complication rate ‐ pelvic infection Show forest plot | 3 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Subtotals only | |
| 1.2.1 Salpingectomy (all methods) vs no tubal surgery | 1 | 204 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 5.80 [0.11, 303.69] |
| 1.2.2 Transvaginal aspiration of hydrosalpingeal fluid vs no tubal surgery | 2 | 176 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Not estimable |
| 1.3 Clinical pregnancy rate Show forest plot | 7 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 1.3.1 Salpingectomy (all methods) vs no tubal surgery | 4 | 455 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.02 [1.44, 2.82] |
| 1.3.2 Tubal occlusion (all methods) vs no tubal surgery | 2 | 209 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.21 [1.72, 5.99] |
| 1.3.3 Transvaginal aspiration of hydrosalpingeal fluid vs no tubal surgery | 3 | 311 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.67 [1.10, 2.55] |
| 1.4 Multiple pregnancy rate Show forest plot | 1 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Subtotals only | |
| 1.4.1 Transvaginal aspiration of hydrosalpingeal fluid vs no tubal surgery | 1 | 135 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 2.15 [0.59, 7.85] |
| 1.5 Miscarriage rate Show forest plot | 6 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Subtotals only | |
| 1.5.1 Salpingectomy (all methods) vs no tubal surgery | 3 | 329 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.91 [0.33, 2.52] |
| 1.5.2 Tubal occlusion (all methods) vs no tubal surgery | 1 | 65 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.55 [0.04, 8.43] |
| 1.5.3 Transvaginal aspiration of hydrosalpingeal fluid vs no tubal surgery | 3 | 311 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 1.27 [0.44, 3.66] |
| 1.6 Ectopic pregnancy rate Show forest plot | 6 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Subtotals only | |
| 1.6.1 Salpingectomy (all methods) vs no tubal surgery | 3 | 329 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.29 [0.04, 2.11] |
| 1.6.2 Tubal occlusion (all methods) vs no tubal surgery | 1 | 65 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 3.67 [0.04, 384.48] |
| 1.6.3 Transvaginal aspiration of hydrosalpingeal fluid vs no tubal surgery | 3 | 311 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.59 [0.08, 4.61] |
| 1.7 Mean number of oocytes Show forest plot | 4 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.7.1 Salpingectomy (all methods) vs no tubal surgery | 2 | 191 | Mean Difference (IV, Fixed, 95% CI) | 0.79 [‐0.87, 2.45] |
| 1.7.2 Tubal occlusion (all methods) vs no tubal surgery | 2 | 244 | Mean Difference (IV, Fixed, 95% CI) | 0.54 [‐0.80, 1.88] |
| 1.7.3 Transvaginal aspiration of hydrosalpingeal fluid vs no tubal surgery | 2 | 176 | Mean Difference (IV, Fixed, 95% CI) | 0.96 [‐0.67, 2.59] |
| 1.8 Mean number of embryos Show forest plot | 4 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.8.1 Salpingectomy (all methods) vs no tubal surgery | 2 | 191 | Mean Difference (IV, Fixed, 95% CI) | 0.31 [‐1.10, 1.72] |
| 1.8.2 Tubal occlusion (all methods) vs no tubal surgery | 2 | 209 | Mean Difference (IV, Fixed, 95% CI) | 0.26 [‐1.07, 1.58] |
| 1.8.3 Transvaginal aspiration of hydrosalpingeal fluid vs no tubal surgery | 2 | 176 | Mean Difference (IV, Fixed, 95% CI) | 0.98 [‐0.24, 2.19] |
| 1.9 Multiple pregnancy rate (per clinical pregnancy) Show forest plot | 1 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Subtotals only | |
| 1.9.1 Transvaginal aspiration of hydrosalpingeal fluid vs no tubal surgery | 1 | 38 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 2.05 [0.45, 9.42] |
| 1.10 Miscarriage rate (per clinical pregnancy) Show forest plot | 6 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Subtotals only | |
| 1.10.1 Salpingectomy (all methods) vs no tubal surgery | 3 | 106 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.45 [0.14, 1.48] |
| 1.10.2 Tubal occlusion (all methods) vs no tubal surgery | 1 | 22 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.04 [0.00, 2.45] |
| 1.10.3 Transvaginal aspiration of hydrosalpingeal fluid vs no tubal surgery | 3 | 78 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.65 [0.19, 2.27] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Live birth rate Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.1.1 Proximal tubal occlusion (laparoscopy) vs laparoscopic salpingectomy | 1 | 165 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.21 [0.76, 1.95] |
| 2.1.2 Proximal tubal occlusion (hysteroscopy) vs laparoscopic salpingectomy | 1 | 85 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.46 [0.24, 0.89] |
| 2.2 Surgical complication rate ‐ wound infection Show forest plot | 1 | 85 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.14 [0.00, 6.98] |
| 2.2.1 Proximal tubal occlusion (hysteroscopy) vs laparoscopic salpingectomy | 1 | 85 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.14 [0.00, 6.98] |
| 2.3 Surgical complication rate ‐ pelvic infection Show forest plot | 1 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Subtotals only | |
| 2.3.1 Proximal tubal occlusion (hysteroscopy) vs laparoscopic salpingectomy | 1 | 85 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 7.57 [0.15, 381.46] |
| 2.4 Clinical pregnancy rate Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.4.1 Proximal tubal occlusion (laparoscopy) vs laparoscopic salpingectomy | 3 | 347 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.81 [0.62, 1.07] |
| 2.4.2 Proximal tubal occlusion (hysteroscopy) vs laparoscopic salpingectomy | 1 | 85 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.53 [0.32, 0.89] |
| 2.5 Multiple pregnancy rate Show forest plot | 1 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Subtotals only | |
| 2.5.1 Proximal tubal occlusion (hysteroscopy) vs laparoscopic salpingectomy | 1 | 85 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.14 [0.00, 6.98] |
| 2.6 Miscarriage rate Show forest plot | 3 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Subtotals only | |
| 2.6.1 Proximal tubal occlusion (laparoscopy) vs laparoscopic salpingectomy | 2 | 265 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.74 [0.16, 3.34] |
| 2.6.2 Proximal tubal occlusion (hysteroscopy) vs laparoscopic salpingectomy | 1 | 85 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 2.03 [0.21, 20.04] |
| 2.7 Ectopic pregnancy rate Show forest plot | 2 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Subtotals only | |
| 2.7.1 Proximal tubal occlusion (laparoscopy) vs laparoscopic salpingectomy | 1 | 100 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 7.39 [0.15, 372.38] |
| 2.7.2 Proximal tubal occlusion (hysteroscopy) vs laparoscopic salpingectomy | 1 | 85 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Not estimable |
| 2.8 Mean number of oocytes Show forest plot | 2 | 265 | Mean Difference (IV, Fixed, 95% CI) | 0.40 [‐0.67, 1.48] |
| 2.8.1 Proximal tubal occlusion (laparoscopy) vs laparoscopic salpingectomy | 2 | 265 | Mean Difference (IV, Fixed, 95% CI) | 0.40 [‐0.67, 1.48] |
| 2.9 Mean number of embryos Show forest plot | 2 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 2.9.1 Proximal tubal occlusion (laparoscopy) vs laparoscopic salpingectomy | 1 | 100 | Mean Difference (IV, Fixed, 95% CI) | 0.17 [‐1.38, 1.72] |
| 2.9.2 Proximal tubal occlusion (hysteroscopy) vs laparoscopic salpingectomy | 1 | 85 | Mean Difference (IV, Fixed, 95% CI) | 0.10 [‐1.77, 1.97] |
| 2.10 Multiple pregnancy rate (per clinical pregnancy) Show forest plot | 1 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Subtotals only | |
| 2.10.1 Proximal tubal occlusion (hysteroscopy) vs laparoscopic salpingectomy | 1 | 38 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.22 [0.00, 13.62] |
| 2.11 Miscarriage rate (per clinical pregnancy) Show forest plot | 3 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Subtotals only | |
| 2.11.1 Proximal tubal occlusion (laparoscopy) vs laparoscopic salpingectomy | 2 | 95 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.82 [0.17, 3.86] |
| 2.11.2 Proximal tubal occlusion (hysteroscopy) vs laparoscopic salpingectomy | 1 | 38 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 4.59 [0.40, 53.35] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Surgical complication rate Show forest plot | 1 | 160 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Not estimable |
| 3.2 Clinical pregnancy rate Show forest plot | 1 | 160 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.44, 1.07] |
| 3.3 Miscarriage rate Show forest plot | 1 | 160 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 1.00 [0.20, 5.08] |
| 3.4 Ectopic pregnancy rate Show forest plot | 1 | 160 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 7.39 [0.15, 372.38] |
| 3.5 Mean number of oocytes Show forest plot | 1 | 160 | Mean Difference (IV, Fixed, 95% CI) | 0.34 [‐0.85, 1.53] |
| 3.6 Mean number of embryos Show forest plot | 1 | 160 | Mean Difference (IV, Fixed, 95% CI) | 0.35 [‐0.70, 1.40] |
| 3.7 Miscarriage rate (per clinical pregnancy) Show forest plot | 1 | 54 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 1.53 [0.28, 8.45] |
