A 31-year-old woman with bilateral hydrosalpinges confirmed on ultrasound is preparing for in vitro fertilisation. Her uterine cavity is normal and ovarian reserve is adequate. Which intervention before embryo transfer is proven to improve implantation and live birth rates?

• A Intrauterine instillation of hyaluronic acid at embryo transfer
• B Fourteen days of oral levofloxacin immediately before transfer
• C Laparoscopic salpingectomy prior to starting the IVF cycle ✓
• D Suppressive acyclovir therapy for three months before the cycle

Explanation

Hydrosalpingeal fluid leaks into the uterine cavity and is embryotoxic and endometrium-hostile, reducing implantation. Meta-analyses and systematic reviews show that laparoscopic salpingectomy before IVF significantly increases implantation, clinical pregnancy, and live birth rates in women with ultrasound-visible hydrosalpinges. Prophylactic antibiotics, intrauterine additives, and antiviral suppression have no evidence of correcting this mechanical and biochemical insult.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.