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
Setting: assisted reproduction clinic
Intervention: tubal surgery
Comparison: no tubal surgery

Live birth rate

No studies reported on this outcome for the main comparison.

Surgical complication rate
‐ conversion to laparotomy

Salpingectomy (all methods)

Peto OR 5.80
(0.11 to 303.69)

204
(1 RCT)

⊕⊝⊝⊝
Very low^a,b,d

We are uncertain of the effect of salpingectomy on the rate of conversion to laparotomy.

Surgical complication rate
‐ pelvic infection

Salpingectomy (all methods)

Peto OR 5.80 (0.11 to 303.69)

204 (1 RCT)

⊕⊝⊝⊝
Very low^a,b,d

We are uncertain of the effect of salpingectomy on the rate of pelvic infection.

Transvaginal aspiration of hydrosalpingeal fluid

Not estimable

176 (1 RCT)

‐

There were insufficient data to estimate differences between groups.

Clinical pregnancy rate

Salpingectomy (all methods)

RR 2.02
(1.44 to 2.82)

455
(4 RCTs)

⊕⊕⊕⊝
Moderate^a

Salpingectomy probably increases clinical pregnancy rate.

Tubal occlusion (all methods)

RR 3.21
(1.72 to 5.99)

209
(2 RCTs)

⊕⊕⊝⊝
Low^a,b

Tubal occlusion may increase clinical pregnancy rate.

Transvaginal aspiration of hydrosalpingeal fluid

RR 1.67
(1.10 to 2.55)

311
(3 RCTs)

⊕⊝⊝⊝
Very low^a,b,c

We are uncertain whether transvaginal aspiration of hydrosalpingeal fluid increases clinical pregnancy rate.

Miscarriage rate

Salpingectomy (all methods)

Peto OR 0.91
(0.33 to 2.52)

329
(3 RCTs)

⊕⊕⊝⊝
Low^a,b

Salpingectomy may have little or no difference in miscarriage rate.

Tubal occlusion (all methods)

Peto OR 0.55
(0.04 to 8.43)

65
(1 RCT)

⊕⊝⊝⊝
Very low^a,b,d

We are uncertain of the effect of tubal occlusion on miscarriage rate.

Transvaginal aspiration of hydrosalpingeal fluid

Peto OR 1.27
(0.44 to 3.66)

311
(3 RCTs)

⊕⊝⊝⊝
Very low^a,b,c

We are uncertain of the effect of transvaginal aspiration of hydrosalpingeal fluid on miscarriage rate.

Ectopic pregnancy rate

Salpingectomy (all methods)

Peto OR 0.29
(0.04 to 2.11)

329
(3 RCTs)

⊕⊕⊝⊝
Low^a,b

Salpingectomy may reduce ectopic pregnancy rate.

Tubal occlusion (all methods)

Peto OR 3.67
(0.04 to 384.48)

65
(1 RCT)

⊕⊝⊝⊝
Very low^a,b,d

We are uncertain of the effect of tubal occlusion on miscarriage rate.

Transvaginal aspiration of hydrosalpingeal fluid

Peto OR 0.59
(0.08 to 4.61)

311
(3 RCTs)

⊕⊝⊝⊝
Very low^a,b,c

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).

CI: confidence interval; IVF/ICSI: in vitro fertilisation/intracytoplasmic sperm injection; OR: odds ratio; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

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
Setting: assisted reproduction clinic
Intervention: proximal tubal occlusion
Comparison: laparoscopic salpingectomy

Live birth rate

Laparoscopic proximal tubal occlusion vs laparoscopic salpingectomy

RR 1.21
(0.76 to 1.95)

165
(1 RCT)

⊕⊝⊝⊝
Very low^a,b,c

We are uncertain of the effect of laparoscopic proximal tubal occlusion on live birth rate compared to laparoscopic salpingectomy.

Surgical complication rate
‐ wound infection

No study reported on this outcome for laparoscopic proximal tubal occlusion.

Surgical complication rate
‐ pelvic infection

No study reported on this outcome for laparoscopic proximal tubal occlusion.

Clinical pregnancy rate

Laparoscopic proximal tubal occlusion vs laparoscopic salpingectomy

RR 0.81
(0.62 to 1.07)

347
(3 RCTs)

⊕⊝⊝⊝
Very low^a,c,d

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

Peto OR 0.74
(0.16 to 3.34)

265
(2 RCTs)

⊕⊕⊝⊝
Low^a,c

Laparoscopic proximal tubal occlusion may reduce miscarriage rate slightly compared to laparoscopic salpingectomy.

Ectopic pregnancy rate

Laparoscopic proximal tubal occlusion vs laparoscopic salpingectomy

Peto OR 7.39
(0.15 to 372.38)

100
(1 RCT)

⊕⊝⊝⊝
Very low^a,b,c

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).

CI: confidence interval; IVF/ICSI: in vitro fertilisation/intracytoplasmic sperm injection; OR: odds ratio; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

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
Setting: assisted reproduction clinic
Intervention: transvaginal aspiration of hydrosalpinx
Comparison: laparoscopic salpingectomy

Live birth rate

No studies reported on this outcome.

Surgical complication rate

not estimable

160
(1 RCT)

^‐

There were insufficient data to estimate differences between groups.

Clinical pregnancy rate

RR 0.69 (0.44 to 1.07)

160
(1 RCT)

⊕⊝⊝⊝
Very low^a,b,c

We are uncertain of the effect of transvaginal aspiration of hydrosalpingeal fluid on clinical pregnancy rate compared to laparoscopic salpingectomy.

Miscarriage rate

Peto OR 1.00 (0.20 to 5.08)

160
(1 RCT)

⊕⊝⊝⊝
Very low^a,b,c

We are uncertain of the effect of transvaginal aspiration of hydrosalpingeal fluid on miscarriage rate compared to laparoscopic salpingectomy.

Ectopic pregnancy rate

Peto OR 7.39 (0.15 to 372.38)

160
(1 RCT)

⊕⊝⊝⊝
Very low^a,b,c

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).

CI: confidence interval; IVF/ICSI: in vitro fertilisation/intracytoplasmic sperm injection; OR: odds ratio; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect