A 31-year-old woman with tubal disease is scheduled for IVF. Transvaginal ultrasound shows bilaterally dilated, fluid-filled fallopian tubes with incomplete septations, visible without stimulation. What intervention performed BEFORE embryo transfer best improves her implantation and live birth rates?

• A Laparoscopic bilateral salpingectomy ✓
• B Proceed to IVF without intervening surgery
• C Laparoscopic salpingostomy to open the fimbrial ends
• D Hysteroscopic placement of intratubal occlusion devices

Explanation

Hydrosalpinges reduce IVF success because inflammatory fluid leaks into the uterine cavity, damaging embryos and impairing implantation through mechanical flush, toxins, and altered receptivity markers such as integrins. Laparoscopic removal of visibly diseased hydrosalpinges before IVF significantly improves implantation, pregnancy, and live birth rates, as shown in randomized trials of severe cases. Salpingostomy restores anatomy but the tube refills and results are inferior for IVF-bound patients. Simple continuation of IVF leaves the adverse environment untouched and wastes cycles.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.