A 31-year-old woman with a history of pelvic inflammatory disease has bilateral hydrosalpinges confirmed on ultrasound. She is counselled for in vitro fertilization because her tubes are irreversibly damaged. Which intervention BEFORE embryo transfer is proven to improve implantation and pregnancy rates?

• A Transcervical hydrosalpinx aspiration at oocyte retrieval
• B Laparoscopic bilateral salpingectomy ✓
• C Laparoscopic fimbrioplasty and neosalpingostomy
• D Proceeding directly to IVF without tubal intervention

Explanation

Hydrosalpinx fluid is embryotoxic and mechanically interferes with implantation; meta-analyses show laparoscopic salpingectomy before IVF roughly doubles live birth rates in these women. Simple aspiration offers only transient benefit because fluid reaccumulates. Neosalpingostomy restores patency poorly in established hydrosalpinx and leaves the toxic fluid source in situ. Proceeding without intervention accepts the reduced implantation rate attributable to the diseased tubes.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.