背景:输卵管手术在单侧输卵管病变的不孕妇女中的作用(例如输卵管积水,输卵管闭塞)希望自发或宫腔内人工授精(IUI)受孕,而体外受精是不可行的,目前尚不清楚。
目的:对单侧输卵管病变患者的生育结局进行系统评价,希望自发或通过IUI受孕,并寻找支持输卵管治疗性手术的指导,以帮助这些妇女受孕。
方法:使用在PROSPERO上注册的协议(IDCRD42021248720),我们搜索了PubMed,EMBASE,CINAHL,和Cochrane图书馆从成立到2022年6月。对文献进行了审查,以确定其他相关文章。
方法:两位作者独立选择和提取数据。第三作者解决了分歧。包括在单侧输卵管病变希望自发或IUI受孕的不育妇女中提供生育结果数据的研究。使用改良的纽卡斯尔渥太华量表进行观察研究,并使用卫生经济学研究所的病例系列质量评估清单评估方法学质量。收集的主要结果包括累积妊娠率(CPR)和每个周期的妊娠率(PR/周期)。次要结果如异位妊娠,出生结果,和盆腔炎进行了整理。这些通过单侧输卵管闭塞(UTO)的类型分层,即输卵管积水,近端输卵管闭塞(PTO),或远端输卵管闭塞(DTO)主要结果:两项研究报告了单侧输卵管积水治疗后自发性妊娠或IUI妊娠,其中一项研究报告平均5.6个月内妊娠率为88%。13项研究比较了患有UTO的女性与原因不明的不孕症和双侧输卵管通畅(对照)之间的IUI结果。几乎所有都是回顾性队列研究,并通过子宫输卵管造影确定了UTO。总的来说,与对照组相比,PTO在PR/周期和CPR方面没有差异,而与DTO相比,PR/周期明显更高。每个额外的IUI周期,患有DTO的女性的CPR益处最小。
结论:治疗性输卵管切除术或输卵管闭塞可改善输卵管积水妇女的IUI或自发性受孕,尽管还需要更多的前瞻性研究。虽然显著的研究异质性阻碍了对生育率结果的评估,总的来说,患有PTO的不孕妇女与双侧输卵管通畅者的IUI妊娠结局相似,而DTO的PR/周期较差。这篇综述强调了这组患者在证据指导管理方面的重大缺陷。
BACKGROUND: Tubal surgery\'s role in infertile women with unilateral tubal pathology (e.g. hydrosalpinx, tubal occlusion) who desire spontaneous or intrauterine insemination (IUI) conception where in-vitro fertilisation is infeasible remains unclear.
OBJECTIVE: To conduct a systematic review on fertility outcomes in women with unilateral tubal pathology desiring to conceive spontaneously or via IUI and to find guidance to support therapeutic tubal procedures to help these women conceive.
METHODS: Using a protocol registered on PROSPERO (ID CRD42021248720), we searched PubMed, EMBASE, CINAHL, and Cochrane Library from inception until June 2022. Bibliographies were reviewed to identify other relevant articles.
METHODS: Two authors independently selected and extracted data. Disagreements were resolved by a third author. Studies presenting fertility outcome data in infertile women with unilateral tubal pathologies desiring spontaneous or IUI conception were included. Methodologic quality was assessed using a modified Newcastle Ottawa Scale for observational studies and the Institute of Health Economics Quality Appraisal Checklist for case series. Primary outcomes collated included cumulative pregnancy rate (CPR) and pregnancy rate per cycle (PR/cycle). Secondary outcomes such as ectopic pregnancy, birth outcomes, and pelvic inflammatory disease were collated. These were stratified by the types of unilateral tubal occlusion (UTO) i.e. hydrosalpinx, proximal tubal occlusion (PTO), or distal tubal occlusion (DTO) MAIN RESULTS: Two studies reported spontaneous or IUI pregnancies after treatment of unilateral hydrosalpinx with one reporting a pregnancy rate of 88% within 5.6 months on average. Thirteen studies compared IUI outcomes between women with UTO vs unexplained infertility and bilateral tubal patency (controls). Almost all were retrospective cohort studies and identified UTO by hysterosalpingography. In general, PTOs had no difference in PR/cycle and CPR compared to controls and significantly higher PR/cycle to DTOs. Women with DTOs had minimal incremental CPR benefit with each additional IUI cycle.
CONCLUSIONS: Therapeutic salpingectomy or tubal occlusion improve IUI or spontaneous conception in women with hydrosalpinx, although more prospective studies are needed. While significant study heterogeneity hampered assessment of fertility outcomes, overall, infertile women with PTOs had similar IUI pregnancy outcomes to those with bilateral tubal patency while DTOs had inferior PR/cycle. This review highlights significant deficiencies in the evidence guiding management for this group of patients.