A 33-year-old woman with bilateral distal tubal block and visible hydrosalpinges on ultrasound is scheduled for IVF. Her physician plans to intervene before embryo transfer because hydrosalpinx fluid reduces implantation. The intervention with the BEST evidence for improving live birth rate is:

• A Aspiration of hydrosalpinx fluid at the time of oocyte retrieval
• B Laparoscopic salpingectomy ✓
• C A 3-month course of oral doxycycline
• D Intrauterine hyaluronan-enriched transfer medium

Explanation

Meta-analysis of randomized trials shows that removing or occluding a hydrosalpinx before IVF approximately doubles implantation and live birth rates compared with no treatment, because the inflammatory fluid leaks into the cavity, is embryotoxic, and impairs endometrial receptivity. Simple aspiration at retrieval is technically feasible but recurrence is rapid and benefits are inconsistent, so it is not the evidence-backed choice. Antibiotics treat infection, not the mechanical reflux.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.