Hydrosalpinx: interstitial pregnancy following ipsilateral salpingectomy risk factor? a case-control study with propensity score matching.

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Wei-Fang Wu, Jing-Song Yi, Xi Xie, Chao-Bin Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2752929/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract To identify risk factors associated with interstitial pregnancy following ipsilateral salpingectomy and discuss possible prevention.A retrospective cohort study was conducted in a single, large, university-affiliated hospital. Data of 29 patients diagnosed with interstitial pregnancy following ipsilateral salpingectomy from January 2011 to November 2020 were assigned into the case group (IP group), whereas 87 patients derived from 6151 patients with intrauterine pregnancy following unilateral salpingectomy were served as the controls using propensity score matching (PSM) at a ratio of 1:3. After PSM, there was no statistically significant difference in patient demographic details between the two groups . The multipara was greater and the intrauterine operation was more frequent in the IP group compared with the control group (P＜0.05). There was only one patient undergoing IVF-ET in the IP group as compared with 29 cases in the control group (3.4% vs. 33.3%, P＜0.05). Salpingectomy was performed on 5 patients in the IP group and 4 patients in the control group due to hydrosalpinx (P＜0.05). Logistic regression indicated that hydrosalpinx was the high risk factor of interstitial pregnancy following ipsilateral salpingectomy (OR=8.175).Our PSM analysis suggests that hydrosalpinx has significantassociation with risk of interstitial pregnancy following ipsilateral salpingectomy in subsequent pregnancy. Interstitial pregnancy Salpingectomy Hydrosalpinx Propensity score macthing Risk factor Introduction Interstitial pregnancy ( IP ) refers to implantation of an embryo in the proximal fallopian tube where it passes through the myometrium[ 1 ].Salpingectomy is the most frequently performed procedure for tubal pregnancy to avoid recurrence of tubal pregnancy at the same side[ 2 ].It is also universally recommended in case of evident hydrosalpinx in infertile women scheduled for assisted reproductive technologies[ 3 ].It was originally thought that the risk of an ectopic pregnancy at the same site could be eliminated by removing the fallopian tubes[ 4 ].However, even if the whole visible length of the tubes was excised, there still remain the interstitial part[ 5 ].Thus ectopic pregnancy in the interstitial portion of tube after ipsilateral salpingectomy may still happen. The occurrence of interstitial ectopic pregnancy at the site of a previous salpingectomy is extremely rare, approximately accounting for 0.4–1.16% of all ectopic pregnancies [ 6 , 7 ]. While a rare phenomenon, the resulting interstitial heterotopic pregnancy is particularly dangerous, because the ectopic gestation may escape detection, yet suddenly rupture through the uterus, causing massive hemorrhage and maternal death. At present, the mechanisms of recurrent ipsilateral ectopic pregnancy are mainly based on clinical case reports, and no definitive data from randomized trials are available on this topic. Therefore, the aim of the present study was to assess the risk factors of interstitial pregnancy following ipsilateral salpingectomy using the propensity score macthing ( PSM ), and to further provide some references for its clinical treatment and prevention. This was a retrospective comparative study performed in a single, large, university-affiliated hospital. The propensity score macthing method was used to balance the influence of baseline clinical characteristics to better compare outcomes and to decrease potential biases. Materials And Methods Subjects This retrospective cohort study was conducted using data from a single, large university-affiliated center. All pregnancies with history of previous ipsilateral salpingectomy between January 1, 2011 and November 31, 2020 were reviewed. The Ethics Committee approved the study. Interstitial pregnancy was diagnosed using three-dimensional (3D) color ultrasonography when the following criteria were met: absence of a gestational sac in the uterine cavity, presence of an interstitial line sign (an echogenic line in the cornual region of the uterus bordering the mid-portion of the gestational sac), and a thin myometrial layer (5 mm) surrounding the gestational sac[ 8 ]. The operation confirmed that the pregnancy was located lateral to the round ligament in the uterotubal junction [ 9 ]. Regardless of etiology, diagnosis is made by ultrasound and/or operative exploration. Patients were assigned to the IP group, if they were diagnosed with interstitial pregnancy at the same side of salpingectomy. All other patients were assigned to the control group, if the pregnancy was intrauterine pregnancy. For all patients with history of bilateral salpingectomy or cornual resection were excluded. The PSM was applied to balance confounding factors related to risk factors. The MatchIt package in R was used to generate the propensity score-matched with a nearest neighbor matching algorithm. A 3:1 ratio was used to increase statistical power. For both cases and controls, clinical data and demographic data were extracted from the electronic health record, including age, body mass index, gravidity, parity, obstetric and gynecological history, detail surgical history of the previous ipsilateral salpingectomy, the interval time from salpingectomy to current pregnancy. It was also documented whether the current pregnancy had been conceived naturally or by In vitro fertilization and embryo transfer ( IVF-ET ). The clinical data between the two groups were compared with the analysis of discrepancy of previous salpingectomy pre-and post-PSM. The preliminary related factors of interstitial pregnancy following ipsilateral salpingectomy were evaluated by univariate regression analysis with the significant parameters further analyzed by binary Logistic regression analysis for determination of the influencing factors. Statistical analysis Continuous variables that followed a normal distribution pattern and had homogenous variance were expressed as means ± standard deviations and were compared using Student’s t-test. Non-normally distributed data were expressed as medians and analyzed using the Mann-Whitney U test. Intergroup differences in categorical variables were compared using the chi-square or Fisher tests. In addition, a p value of < 0.05 was used in the univariate analysis for inclusion of putative risk factors. Multivariate conditional logistic regression analysis was used to evaluate risk factors. Data processing and statistical analyses were completed using SPSS version 25.0 (IBM, Armonk, NY, USA) and the R software, version 3.3.1 (R Foundation for Statistical Computing, Vienna, Austria). All p-values reported are 2 sided and a p < 0.05 was considered statistically significant. Results During the study period, there were 6151 patients with intrauterine pregnancy after unilateral salpingectomy and 8877 ectopic pregnancies in our institution. Of these,270 patients were interstitial pregnancy, whereas 29 patients with the history of homolateral salpingectomy, comprised 0.33% of all ectopic pregnancies. These 29 patients were assigned into the case group (IP group). The age of the IP group with gravid 0–7 and para 0–3 ranged from 20 to 38 years old. Salpingectomy was performed in 23 cases owing to ectopic pregnancy, 5 cases owing to hydrosalpinx and 1 case owing to ovarian torsion. Only one patient conceived by IVF-ET. Seven patients suffered from interstitial pregnancy rupture. 18 patients underwent laparoscopy and 9 patients underwent laparotomy. Cornual resection was used to treat 23 patients and cornuostomy to treat 4 patients. One patient suffered from persistent ectopic pregnancy after surgery. Prior to matching, 29 IP and 6151 intrauterine pregnancy patients were available for analysis. After PSM at a ratio of 1:3, a total of 29 IP patients were successfully matched to 87 intrauterine pregnancy patients. After PSM, there was no statistically significant difference in patient demographic details between the two groups, thereby creating similar cohorts. Table 1 presents the patient demographic details before and after matching. As shown in Table 2 ,after PSM, the multipara was greater and the intrauterine operation was more frequent in the IP group when compared with the control group (P༜0.05). There was only one patient undergoing IVF-ET in the IP group as compared with 29 cases in the control group (3.4% vs. 33.3%, P༜0.05). Salpingectomy was performed on 5 patients in the IP group as compared to 4 patients in the control group due to hydrosalpinx (17.2% vs. 4.6%, P༜0.05). Four parameters with significant differences in univariate analysis, i.e., parity, intrauterine operation, hydrosalpinx and mode of conception, were further analyzed by binary Logistic regression. The results indicated that the high risk factor for interstitial pregnancy following ipsilateral salpingectomy was hydrosalpinx (OR = 8.175, 95%CI = 1.323–50.519). The result of logistic regression analysis is shown in Table 3 . Discussion Interstitial pregnancy following ipsilateral salpingectomy has been sporadically described primarily in case reports and small case series [ 6 , 7 , 9 – 14 ]. To the best of our knowledge, this is the first study assessing the risk factors of interstitial pregnancy following ipsilateral salpingectomy in a propensity-matched series. The use of PSM allowed us to assess a heterogenous group of patients without significant bias. In this retrospective, matched, cohort study, we find that hydrosalpinx affects the rate of interstitial pregnancy following ipsilateral salpingectomy. The mechanism by which an ectopic pregnancy locates in the remnant tube after homolateral salpingectomy has still not been completely elucidated. One possible explanation is that an oocyte may have been normally fertilized in the normal contralateral fallopian tube and later the fertilized egg was taken up to the remnant tube via intrauterine transmigration[ 11 , 12 , 15 ]. The other is the external chemotactic theory, which postulates that the fertilized egg migrated transperitoneally from the serosa into the interstitial portion of the tube before local embryonic nidation took place[ 6 , 10 ]. Hydrosalpinx affects pregnancy outcomes of IVF-ET [ 16 , 17 ],and thus salpingectomy is the preferred pretreatment for hydrosalpinx to improves pregnancy outcomes before IVF-ET[ 3 , 18 – 20 ]. Hydrosalpinx is a significant risk factor for interstitial pregnancy after homolateral salpingectomy, which is demonstrated in our study. It is possible that normal tubal epithelium would prevent tubal ectopic pregnancy, while inflammation may affect normal embryo implantation [ 21 ], resulting in ectopic pregnancy taking place on the tubal stump in subsequent pregnancy. However, as our study only focused on interstitial pregnancy following unilateral salpingectomy, the absolute cases of interstitial pregnancy following prior salpingectomy owing to hydrosalpinx were low. One possible explanation is that pretreatment for hydrosalpinx before IVF-ET commonly prefers to bilateral salpingectomy rather than unilateral salpingectomy. Secondly, even if one fallopian tube with less hydrosalpinx is preserved after operation owing to tubal infertility, salpingectomy may be performed on remnant tube owing to recurrent hydrosalpinx before IVF-ET. Therefore, whether hydrosalpinx is also a significant risk factor for interstitial pregnancy after bilateral salpingectomy requires to further be explored. There was one unexpected finding in our series. The incidence of interstitial pregnancy after IVF-ET with ipsilateral salpingectomy appears to be much lower than previously reported. The earlier reports of 25.9% (29/121) of all ectopic pregnancies [ 14 ] related to a mixture of bilateral salpingectomy and ipsilateral salpingectomy. The exact reason is unclear. We suppose that If only one fallopian tube is resected, when fallopian tube transmigration after IVF-ET happen, the embryos are more likely to move to the reserved tube with less resistance. If the remnant tube is normal, the embryos would be sent back to the uterine. Otherwise, If the remnant tube has suffered with inflammation, the embryos may fertilize in the remnant tube. The possibility of pregnancy after bilateral salpingectomy spontaneously is tiny, however it is largely after IVF-ET. Therefore, either intrauterine or ectopic pregnancy with bilateral salpingectomy mostly occurs after IVF-ET. The IP rate decreased with a longer interval between salpingectomy and IVF-ET, was published by Chen et al[ 13 ]. However, in this PSM analysis, we found no differences in the interval from salpingectomy to subsequent pregnancy. It is probable that Chen et al’s study focused on interstitial pregnancy following IVF-ET, so the interval between salpingectomy and IVF-ET was controllable. Nevertheless, spontaneous pregnancy constituted 96.6% of cases in our study, so the interval between salpingectomy and next pregnancy was uncontrollable. Furthermore, they only included patients who underwent salpingectomy owing to hydrosalpinx in the study, while 79.3% of cases with salpingectomy in our series were due to ectopic pregnancy. Therefore, more evidence is required to prove this speculation. Although the occurrence of interstitial pregnancy following ipsilateral salpingectomy it rare, it compels us to think whether there is something that can be done to prevent it happening. Cornual resection necessitating myometrial excision may completely avoid the occurrence of interstitial pregnancy after prior salpingectomy, however it would predispose the patient to uterine rupture in subsequent pregnancies, which is most probably a far more dangerous complication than ectopic pregnancy. In 2018 Chen et al[ 13 ] had conducted a retrospective, clinical cohort study and found that cornual suture at the time of salpingectomy would help reduce the risk of subsequent interstitial pregnancy after in vitro fertilization. Furthermore, tubal occlusion devices may be used to avoid the occurrence of interstitial pregnancy following salpingectomy[ 22 ]. Of course, our study has certain inherent limitations. The major one is that it’s a single-center, retrospective, controlled study. Although we tried to minimize selection biases using PSM, the inclusion of confounding factors in matching may not be comprehensive. Nevertheless, devising a multi-center and randomly designed prospective clinical research poses a set of unique challenges due to its low incidence. Second, our results must be interpreted with caution, in particular due to the relatively small sample size and the inability to correctly distinguish the prognostic weight of each matching parameter we used in our PSM analysis. Finally, in addition to interstitial pregnancy after ipsilateral salpingectomy, other clinical parameters have to be analyzed such as interstitial pregnancy after bilateral salpingectomy. It is therefore uncertain if the result also applies to women with the history of bilateral salpingectomy. Conclusions In conclusion, our preliminary findings indicate that significant association between hydrosalpinx and interstitial pregnancy following ipsilateral salpingectomy in subsequent pregnancy. The clinical implications of these findings need further elaboration, and larger studies are needed to confirm our results and validate them. Declarations Authors ’ contributions WFW and CBL contributed to designing the study. WFW collected the data and wrote the manuscript. JSY and XX contributed to data collection and data analyzing. All authors read and approved the final manuscript. Acknowledgements We thank all the all patients who participated in this study. Funding No funding was obtained for this study. Conflicts of interest We declare that we have no conflict of interest. Ethical approva l For this type of study formal consent is not required and was waived by the institutional review board approval. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent to Participate Not applicable. Consent for Publication Not applicable. Availability of Data and Material The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Code Availability SPSS version.25.0 for Windows (IBM, Armonk, NY, USA) and R software (version 3.3.1; R Foundation for Statistical Computing; https://www.rproject.org/). References Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril. 1999;72:207–15. Cheng X, Tian X, Yan Z, Jia M, Deng J, Wang Y, Fan D. Comparison of the Fertility Outcome of Salpingotomy and Salpingectomy in Women with Tubal Pregnancy: A Systematic Review and Meta-Analysis. PLoS ONE. 2016;11:e0152343. Strandell A, Lindhard A, Waldenström U, Thorburn J, Janson PO, Hamberger L. Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF.Hum Reprod. 1999;14:2762–2769. Steptoe PC, Edwards RG. Reimplantation of a human embryo with subsequent tubal pregnancy.Lancet. 1976;1:880–882. Herman A, Ron-el R, Golan A, Soffer Y, Bukovsky I, Caspi E. The dilemma of the optimal surgical procedure in ectopic pregnancies occurring in in-vitro fertilization. Hum Reprod. 1991;6:1167–9. Ko PC, Liang CC, Lo TS, Huang HY. Six cases of tubal stump pregnancy: complication of assisted reproductive technology?Fertil. Steril. 2011;95:2432e2431–2434. Takeda A, Manabe S, Mitsui T, Nakamura H. Spontaneous ectopic pregnancy occurring in the isthmic portion of the remnant tube after ipsilateral adnexectomy: report of two cases. J Obstet Gynaecol Res. 2006;32:190–4. Ackerman TE, Levi CS, Dashefsky SM, Holt SC. Lindsay DJ Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy.Radiology. 1993;189:83–87. Siow A, Ng S. Laparoscopic management of 4 cases of recurrent cornual ectopic pregnancy and review of literature. J Minim Invasive Gynecol. 2011;18:296–302. Simpson JW, Alford CD. Miller AC Interstitial pregnancy following homolateral salpingectomy. A report of 6 new cases and review of the literature. Am J Obstet Gynecol. 1961;82:1173–9. Muppala H, Davies J. Spontaneous proximal tubal stump pregnancy following partial salpingectomy. J Obstet Gynaecol. 2009;29:69–70. Sturlese E, Retto G, Palmara V, De Dominici R, Lo Re C, Santoro G. Ectopic pregnancy in tubal remnant stump after ipsilateral adnexectomy for cystic teratoma. Arch Gynecol Obstet. 2009;280:1015–7. Chen J, Huang D, Shi L, Zhang L, Sun D, Lin X, Zhang S. Cornual Suture at the Time of Laparoscopic Salpingectomy Reduces the Incidence of Interstitial Pregnancy after In Vitro Fertilization.J Minim Invasive Gynecol. 2018;25:1080–1087. Wang J, Huang D, Lin X, Saravelos SH, Chen J, Zhang X, Li T, Zhang S. Incidence of Interstitial Pregnancy After In Vitro Fertilization/Embryo Transfer and the Outcome of a Consecutive Series of 38 Cases Managed by Laparoscopic Cornuostomy or Cornual Repair. J Minim Invasive Gynecol. 2016;23:739–47. Keeping D, Harrison K, Sherrin D. Ectopic pregnancy contralateral to unilateral GIFT.Aust N. Z J Obstet Gynaecol. 1993;33:95–6. Camus E, Poncelet C, Goffinet F, Wainer B, Merlet F, Nisand I, Philippe HJ. Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies. Hum Reprod. 1999;14:1243–9. ASRM Salpingectomy for. hydrosalpinx prior to in vitro fertilization.Fertil Steril. 2008;90:S66-68. Déchaud H, Daurès JP, Arnal F, Humeau C, Hédon B. Does previous salpingectomy improve implantation and pregnancy rates in patients with severe tubal factor infertility who are undergoing in vitro fertilization? A pilot prospective randomized study. Fertil Steril. 1998;69:1020–5. Johnson NP, Mak W, Sowter MC. Laparoscopic salpingectomy for women with hydrosalpinges enhances the success of IVF: a Cochrane review. Hum Reprod. 2002;17:543–8. Barbosa MW, Sotiriadis A, Papatheodorou SI, Mijatovic V, Nastri CO, Martins WP. High miscarriage rate in women treated with Essure® for hydrosalpinx before embryo transfer: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016;48:556–65. Hunter RH. Components of oviduct physiology in eutherian mammals. Biol Rev Camb Philos Soc. 2012;87:244–55. McSwain H, Brodie MF. Fallopian tube occlusion, an alternative to tubal ligation.Tech Vasc Interv Radiol. 2006;9:24–29. Tables Table1 Demographic details of two groups before and after propensity score matching (PSM). Before PSM After PSM IP group Control group p-value IP group Control group p-value No. of patients 29 6151 29 87 Mean age, year 29.6±4.5 30.2±1.1 0.291 29.6±4.5 30.1±4.1 0.601 BMI , kg/m 20.8±3.2 21.2±1.8 0.507 20.8±3.2 20.9±2.7 0.869 Salpingectomy , n (%) Left 7(24.1) 2964（48.2） 0.010 7(24.1) 31(35.6) 0.253 Right 22(75.9) 3187（51.8） 22(75.9) 56(64.4) Note: BMI=body mass index Table2 Comparison of the clinical characteristics between two group after propensity score matching Variables IP group （ n=29 ） Control group （ n=87 ） p Value Gravidity 2.4±1.7 2.0±1.1 0.170 Parity, n (%) 0 14（48.3%） 60（69.0） 0.045 ≥ 1 15（51.7） 27（31.0） Reason for salpingectomy , n (%) Hydrosalpinx 5（17.2） 4（4.6） 0.028 others 24(82.8) 83(95.4) Salpingectomy-subsequent pregnancy interval ≤ 6 months 3（10.3） 10（11.5） 0.865 ＞ 6 months 26（89.7） 77（88.5） Previous surgical procedure, n (%) Laparoscopy 21(72.4) 57(65.5) 0.493 Laparotomy 8(27.6) 30(34.5) Mode of conception, n (%) spontaneous 28(96.6) 58(66.7) 0.001 IVF-ET 1(3.4) 29(33.3) History of abdominal surgery ,n (%) 10(34.5) 21（24.1） 0.276 History of intrauterine operation , n (%) 17（58.6） 32(36.8) 0.039 Sterility ,n (%) 6(20.7) 13(14.9) 0.469 History of ectopic pregnancy ,n (%) 2(6.9) 7(8.0) 0.841 Note: ET = embryo transfer; IVF = in vitro fertilization. Table3 Logistic regression analysis of risk factors for interstitial pregnancy following ipsilateral salpingectomy Variable s OR Value 95%（CI） p Value Parity 2.221 0.837～5.890 0.109 Intrauterine operation 1.509 0.569～4.002 0.408 Hydrosalpinx 8.175 1.323～50.519 0.024 IVF-ET 0.054 0.006～0.508 0.011 Note: ET = embryo transfer; IVF = in vitro fertilization. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2752929","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":192702815,"identity":"7b38c08a-5041-488f-b341-8bbff1c276cc","order_by":0,"name":"Wei-Fang Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYFACxgcHPxjY2PGzNzY++ECcFmbDxxIFacmSPYebDWcQqcXYgOfDIcYNN9LbpDmI0WBwI5lNQsLgADPDzYcN0gwMdnK6DcRoKTC4w8c4O7HBuIAh2djsAAEtZrfzjwFtecbMLJ3YkDyD4UDiNsJagLbwGBxmbJM82HCYh0gtzAYgLT0SjI3NRGmxv/+Y8bGEQVqyBE9iM+MMAyL8AowOhoMf/tjY2R8//vzHhwo7OYJa0IABacpHwSgYBaNgFOAAAMPZRhJaz3FbAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-9647-1530","institution":"Fujian Provincial Maternity and Children's Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Wei-Fang","middleName":"","lastName":"Wu","suffix":""},{"id":192702816,"identity":"392c4869-2f67-470a-9f8d-946f2268fdea","order_by":1,"name":"Jing-Song Yi","email":"","orcid":"","institution":"Fujian Provincial Maternity and Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jing-Song","middleName":"","lastName":"Yi","suffix":""},{"id":192702817,"identity":"5aa1e7f7-91d9-4e1d-87c4-805ac1aaf23e","order_by":2,"name":"Xi Xie","email":"","orcid":"","institution":"Fujian Provincial Maternity and Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xi","middleName":"","lastName":"Xie","suffix":""},{"id":192702818,"identity":"f8fcd3ea-3def-4b8d-8464-fdd88e4d225e","order_by":3,"name":"Chao-Bin Liu","email":"","orcid":"","institution":"Fujian Provincial Maternity and Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chao-Bin","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2023-03-29 16:27:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2752929/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2752929/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":37488192,"identity":"0dc0482e-0baa-43e0-ad1b-62fde46ca644","added_by":"auto","created_at":"2023-05-25 13:37:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":430805,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2752929/v1/a4d86638-512b-4723-a1bd-bd9bb952babd.pdf"}],"financialInterests":"","formattedTitle":"Hydrosalpinx: interstitial pregnancy following ipsilateral salpingectomy risk factor? a case-control study with propensity score matching.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInterstitial pregnancy (\u003cb\u003eIP\u003c/b\u003e) refers to implantation of an embryo in the proximal fallopian tube where it passes through the myometrium[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].Salpingectomy is the most frequently performed procedure for tubal pregnancy to avoid recurrence of tubal pregnancy at the same side[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].It is also universally recommended in case of evident hydrosalpinx in infertile women scheduled for assisted reproductive technologies[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].It was originally thought that the risk of an ectopic pregnancy at the same site could be eliminated by removing the fallopian tubes[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].However, even if the whole visible length of the tubes was excised, there still remain the interstitial part[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].Thus ectopic pregnancy in the interstitial portion of tube after ipsilateral salpingectomy may still happen.\u003c/p\u003e \u003cp\u003eThe occurrence of interstitial ectopic pregnancy at the site of a previous salpingectomy is extremely rare, approximately accounting for 0.4\u0026ndash;1.16% of all ectopic pregnancies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. While a rare phenomenon, the resulting interstitial heterotopic pregnancy is particularly dangerous, because the ectopic gestation may escape detection, yet suddenly rupture through the uterus, causing massive hemorrhage and maternal death. At present, the mechanisms of recurrent ipsilateral ectopic pregnancy are mainly based on clinical case reports, and no definitive data from randomized trials are available on this topic. Therefore, the aim of the present study was to assess the risk factors of interstitial pregnancy following ipsilateral salpingectomy using the propensity score macthing (\u003cb\u003ePSM\u003c/b\u003e), and to further provide some references for its clinical treatment and prevention. This was a retrospective comparative study performed in a single, large, university-affiliated hospital. The propensity score macthing method was used to balance the influence of baseline clinical characteristics to better compare outcomes and to decrease potential biases.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eThis retrospective cohort study was conducted using data from a single, large university-affiliated center. All pregnancies with history of previous ipsilateral salpingectomy between January 1, 2011 and November 31, 2020 were reviewed. The Ethics Committee approved the study. Interstitial pregnancy was diagnosed using three-dimensional (3D) color ultrasonography when the following criteria were met: absence of a gestational sac in the uterine cavity, presence of an interstitial line sign (an echogenic line in the cornual region of the uterus bordering the mid-portion of the gestational sac), and a thin myometrial layer (5 mm) surrounding the gestational sac[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The operation confirmed that the pregnancy was located lateral to the round ligament in the uterotubal junction [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Regardless of etiology, diagnosis is made by ultrasound and/or operative exploration. Patients were assigned to the IP group, if they were diagnosed with interstitial pregnancy at the same side of salpingectomy. All other patients were assigned to the control group, if the pregnancy was intrauterine pregnancy. For all patients with history of bilateral salpingectomy or cornual resection were excluded.\u003c/p\u003e \u003cp\u003eThe PSM was applied to balance confounding factors related to risk factors. The MatchIt package in R was used to generate the propensity score-matched with a nearest neighbor matching algorithm. A 3:1 ratio was used to increase statistical power. For both cases and controls, clinical data and demographic data were extracted from the electronic health record, including age, body mass index, gravidity, parity, obstetric and gynecological history, detail surgical history of the previous ipsilateral salpingectomy, the interval time from salpingectomy to current pregnancy. It was also documented whether the current pregnancy had been conceived naturally or by In vitro fertilization and embryo transfer (\u003cb\u003eIVF-ET\u003c/b\u003e). The clinical data between the two groups were compared with the analysis of discrepancy of previous salpingectomy pre-and post-PSM. The preliminary related factors of interstitial pregnancy following ipsilateral salpingectomy were evaluated by univariate regression analysis with the significant parameters further analyzed by binary Logistic regression analysis for determination of the influencing factors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables that followed a normal distribution pattern and had homogenous variance were expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations and were compared using Student\u0026rsquo;s t-test. Non-normally distributed data were expressed as medians and analyzed using the Mann-Whitney U test. Intergroup differences in categorical variables were compared using the chi-square or Fisher tests. In addition, a p value of \u0026lt;\u0026thinsp;0.05 was used in the univariate analysis for inclusion of putative risk factors. Multivariate conditional logistic regression analysis was used to evaluate risk factors. Data processing and statistical analyses were completed using SPSS version 25.0 (IBM, Armonk, NY, USA) and the R software, version 3.3.1 (R Foundation for Statistical Computing, Vienna, Austria). All p-values reported are 2 sided and a p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period, there were 6151 patients with intrauterine pregnancy after unilateral salpingectomy and 8877 ectopic pregnancies in our institution. Of these,270 patients were interstitial pregnancy, whereas 29 patients with the history of homolateral salpingectomy, comprised 0.33% of all ectopic pregnancies. These 29 patients were assigned into the case group (IP group). The age of the IP group with gravid 0\u0026ndash;7 and para 0\u0026ndash;3 ranged from 20 to 38 years old. Salpingectomy was performed in 23 cases owing to ectopic pregnancy, 5 cases owing to hydrosalpinx and 1 case owing to ovarian torsion. Only one patient conceived by IVF-ET. Seven patients suffered from interstitial pregnancy rupture. 18 patients underwent laparoscopy and 9 patients underwent laparotomy. Cornual resection was used to treat 23 patients and cornuostomy to treat 4 patients. One patient suffered from persistent ectopic pregnancy after surgery.\u003c/p\u003e \u003cp\u003ePrior to matching, 29 IP and 6151 intrauterine pregnancy patients were available for analysis. After PSM at a ratio of 1:3, a total of 29 IP patients were successfully matched to 87 intrauterine pregnancy patients. After PSM, there was no statistically significant difference in patient demographic details between the two groups, thereby creating similar cohorts. \u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e presents the patient demographic details before and after matching.\u003c/p\u003e \u003cp\u003eAs shown in \u003cb\u003eTable\u0026nbsp;2\u003c/b\u003e,after PSM, the multipara was greater and the intrauterine operation was more frequent in the IP group when compared with the control group (P༜0.05). There was only one patient undergoing IVF-ET in the IP group as compared with 29 cases in the control group (3.4% vs. 33.3%, P༜0.05). Salpingectomy was performed on 5 patients in the IP group as compared to 4 patients in the control group due to hydrosalpinx (17.2% vs. 4.6%, P༜0.05).\u003c/p\u003e \u003cp\u003eFour parameters with significant differences in univariate analysis, i.e., parity, intrauterine operation, hydrosalpinx and mode of conception, were further analyzed by binary Logistic regression. The results indicated that the high risk factor for interstitial pregnancy following ipsilateral salpingectomy was hydrosalpinx (OR\u0026thinsp;=\u0026thinsp;8.175, 95%CI\u0026thinsp;=\u0026thinsp;1.323\u0026ndash;50.519). The result of logistic regression analysis is shown in \u003cb\u003eTable\u0026nbsp;3\u003c/b\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eInterstitial pregnancy following ipsilateral salpingectomy has been sporadically described primarily in case reports and small case series [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. To the best of our knowledge, this is the first study assessing the risk factors of interstitial pregnancy following ipsilateral salpingectomy in a propensity-matched series. The use of PSM allowed us to assess a heterogenous group of patients without significant bias. In this retrospective, matched, cohort study, we find that hydrosalpinx affects the rate of interstitial pregnancy following ipsilateral salpingectomy.\u003c/p\u003e \u003cp\u003eThe mechanism by which an ectopic pregnancy locates in the remnant tube after homolateral salpingectomy has still not been completely elucidated. One possible explanation is that an oocyte may have been normally fertilized in the normal contralateral fallopian tube and later the fertilized egg was taken up to the remnant tube via intrauterine transmigration[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The other is the external chemotactic theory, which postulates that the fertilized egg migrated transperitoneally from the serosa into the interstitial portion of the tube before local embryonic nidation took place[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHydrosalpinx affects pregnancy outcomes of IVF-ET [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e],and thus salpingectomy is the preferred pretreatment for hydrosalpinx to improves pregnancy outcomes before IVF-ET[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Hydrosalpinx is a significant risk factor for interstitial pregnancy after homolateral salpingectomy, which is demonstrated in our study. It is possible that normal tubal epithelium would prevent tubal ectopic pregnancy, while inflammation may affect normal embryo implantation [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], resulting in ectopic pregnancy taking place on the tubal stump in subsequent pregnancy. However, as our study only focused on interstitial pregnancy following unilateral salpingectomy, the absolute cases of interstitial pregnancy following prior salpingectomy owing to hydrosalpinx were low. One possible explanation is that pretreatment for hydrosalpinx before IVF-ET commonly prefers to bilateral salpingectomy rather than unilateral salpingectomy. Secondly, even if one fallopian tube with less hydrosalpinx is preserved after operation owing to tubal infertility, salpingectomy may be performed on remnant tube owing to recurrent hydrosalpinx before IVF-ET. Therefore, whether hydrosalpinx is also a significant risk factor for interstitial pregnancy after bilateral salpingectomy requires to further be explored.\u003c/p\u003e \u003cp\u003eThere was one unexpected finding in our series. The incidence of interstitial pregnancy after IVF-ET with ipsilateral salpingectomy appears to be much lower than previously reported. The earlier reports of 25.9% (29/121) of all ectopic pregnancies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] related to a mixture of bilateral salpingectomy and ipsilateral salpingectomy. The exact reason is unclear. We suppose that If only one fallopian tube is resected, when fallopian tube transmigration after IVF-ET happen, the embryos are more likely to move to the reserved tube with less resistance. If the remnant tube is normal, the embryos would be sent back to the uterine. Otherwise, If the remnant tube has suffered with inflammation, the embryos may fertilize in the remnant tube. The possibility of pregnancy after bilateral salpingectomy spontaneously is tiny, however it is largely after IVF-ET. Therefore, either intrauterine or ectopic pregnancy with bilateral salpingectomy mostly occurs after IVF-ET.\u003c/p\u003e \u003cp\u003eThe IP rate decreased with a longer interval between salpingectomy and IVF-ET, was published by Chen et al[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, in this PSM analysis, we found no differences in the interval from salpingectomy to subsequent pregnancy. It is probable that Chen et al\u0026rsquo;s study focused on interstitial pregnancy following IVF-ET, so the interval between salpingectomy and IVF-ET was controllable. Nevertheless, spontaneous pregnancy constituted 96.6% of cases in our study, so the interval between salpingectomy and next pregnancy was uncontrollable. Furthermore, they only included patients who underwent salpingectomy owing to hydrosalpinx in the study, while 79.3% of cases with salpingectomy in our series were due to ectopic pregnancy. Therefore, more evidence is required to prove this speculation.\u003c/p\u003e \u003cp\u003eAlthough the occurrence of interstitial pregnancy following ipsilateral salpingectomy it rare, it compels us to think whether there is something that can be done to prevent it happening. Cornual resection necessitating myometrial excision may completely avoid the occurrence of interstitial pregnancy after prior salpingectomy, however it would predispose the patient to uterine rupture in subsequent pregnancies, which is most probably a far more dangerous complication than ectopic pregnancy. In 2018 Chen et al[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] had conducted a retrospective, clinical cohort study and found that cornual suture at the time of salpingectomy would help reduce the risk of subsequent interstitial pregnancy after in vitro fertilization. Furthermore, tubal occlusion devices may be used to avoid the occurrence of interstitial pregnancy following salpingectomy[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOf course, our study has certain inherent limitations. The major one is that it\u0026rsquo;s a single-center, retrospective, controlled study. Although we tried to minimize selection biases using PSM, the inclusion of confounding factors in matching may not be comprehensive. Nevertheless, devising a multi-center and randomly designed prospective clinical research poses a set of unique challenges due to its low incidence. Second, our results must be interpreted with caution, in particular due to the relatively small sample size and the inability to correctly distinguish the prognostic weight of each matching parameter we used in our PSM analysis. Finally, in addition to interstitial pregnancy after ipsilateral salpingectomy, other clinical parameters have to be analyzed such as interstitial pregnancy after bilateral salpingectomy. It is therefore uncertain if the result also applies to women with the history of bilateral salpingectomy.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, our preliminary findings indicate that significant association between hydrosalpinx and interstitial pregnancy following ipsilateral salpingectomy in subsequent pregnancy. The clinical implications of these findings need further elaboration, and larger studies are needed to confirm our results and validate them.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003econtributions\u003c/strong\u003e WFW and CBL contributed to designing the study. WFW collected the data and wrote the manuscript. JSY and XX contributed to data collection and data analyzing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003eWe thank all the all patients who participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u0026nbsp;\u003c/strong\u003eWe declare that we have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approva\u003c/strong\u003el\u0026nbsp;For this type of study formal consent is not required and was waived by the institutional review board approval. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Material\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode Availability\u0026nbsp;\u003c/strong\u003eSPSS version.25.0 for Windows (IBM, Armonk, NY, USA) and R software (version 3.3.1; R Foundation for Statistical Computing; https://www.rproject.org/).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril. 1999;72:207\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng X, Tian X, Yan Z, Jia M, Deng J, Wang Y, Fan D. Comparison of the Fertility Outcome of Salpingotomy and Salpingectomy in Women with Tubal Pregnancy: A Systematic Review and Meta-Analysis. PLoS ONE. 2016;11:e0152343.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrandell A, Lindhard A, Waldenstr\u0026ouml;m U, Thorburn J, Janson PO, Hamberger L. Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF.Hum Reprod. 1999;14:2762\u0026ndash;2769.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteptoe PC, Edwards RG. Reimplantation of a human embryo with subsequent tubal pregnancy.Lancet. 1976;1:880\u0026ndash;882.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHerman A, Ron-el R, Golan A, Soffer Y, Bukovsky I, Caspi E. The dilemma of the optimal surgical procedure in ectopic pregnancies occurring in in-vitro fertilization. Hum Reprod. 1991;6:1167\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKo PC, Liang CC, Lo TS, Huang HY. Six cases of tubal stump pregnancy: complication of assisted reproductive technology?Fertil. Steril. 2011;95:2432e2431\u0026ndash;2434.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakeda A, Manabe S, Mitsui T, Nakamura H. Spontaneous ectopic pregnancy occurring in the isthmic portion of the remnant tube after ipsilateral adnexectomy: report of two cases. J Obstet Gynaecol Res. 2006;32:190\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAckerman TE, Levi CS, Dashefsky SM, Holt SC. Lindsay DJ Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy.Radiology. 1993;189:83\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiow A, Ng S. Laparoscopic management of 4 cases of recurrent cornual ectopic pregnancy and review of literature. J Minim Invasive Gynecol. 2011;18:296\u0026ndash;302.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimpson JW, Alford CD. Miller AC Interstitial pregnancy following homolateral salpingectomy. A report of 6 new cases and review of the literature. Am J Obstet Gynecol. 1961;82:1173\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuppala H, Davies J. Spontaneous proximal tubal stump pregnancy following partial salpingectomy. J Obstet Gynaecol. 2009;29:69\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSturlese E, Retto G, Palmara V, De Dominici R, Lo Re C, Santoro G. Ectopic pregnancy in tubal remnant stump after ipsilateral adnexectomy for cystic teratoma. Arch Gynecol Obstet. 2009;280:1015\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen J, Huang D, Shi L, Zhang L, Sun D, Lin X, Zhang S. Cornual Suture at the Time of Laparoscopic Salpingectomy Reduces the Incidence of Interstitial Pregnancy after In Vitro Fertilization.J Minim Invasive Gynecol. 2018;25:1080\u0026ndash;1087.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Huang D, Lin X, Saravelos SH, Chen J, Zhang X, Li T, Zhang S. Incidence of Interstitial Pregnancy After In Vitro Fertilization/Embryo Transfer and the Outcome of a Consecutive Series of 38 Cases Managed by Laparoscopic Cornuostomy or Cornual Repair. J Minim Invasive Gynecol. 2016;23:739\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeeping D, Harrison K, Sherrin D. Ectopic pregnancy contralateral to unilateral GIFT.Aust N. Z J Obstet Gynaecol. 1993;33:95\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCamus E, Poncelet C, Goffinet F, Wainer B, Merlet F, Nisand I, Philippe HJ. Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies. Hum Reprod. 1999;14:1243\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eASRM Salpingectomy for. hydrosalpinx prior to in vitro fertilization.Fertil Steril. 2008;90:S66-68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026eacute;chaud H, Daur\u0026egrave;s JP, Arnal F, Humeau C, H\u0026eacute;don B. Does previous salpingectomy improve implantation and pregnancy rates in patients with severe tubal factor infertility who are undergoing in vitro fertilization? A pilot prospective randomized study. Fertil Steril. 1998;69:1020\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson NP, Mak W, Sowter MC. Laparoscopic salpingectomy for women with hydrosalpinges enhances the success of IVF: a Cochrane review. Hum Reprod. 2002;17:543\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarbosa MW, Sotiriadis A, Papatheodorou SI, Mijatovic V, Nastri CO, Martins WP. High miscarriage rate in women treated with Essure\u0026reg; for hydrosalpinx before embryo transfer: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016;48:556\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHunter RH. Components of oviduct physiology in eutherian mammals. Biol Rev Camb Philos Soc. 2012;87:244\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcSwain H, Brodie MF. Fallopian tube occlusion, an alternative to tubal ligation.Tech Vasc Interv Radiol. 2006;9:24\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"702\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"21.540656205420827%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" width=\"72.75320970042796%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic details of two groups before and after propensity score matching (PSM).\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"5.706134094151213%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"21.540656205420827%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" width=\"37.803138373751786%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore PSM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"3.9942938659058487%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" width=\"36.66191155492154%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter PSM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.818181818181818%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIP group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.363636363636363%\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl \u0026nbsp;group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.090909090909091%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.818181818181818%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIP group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.545454545454547%\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl \u0026nbsp;group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"12.363636363636363%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"18.830242510699%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"13.552068473609129%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"17.546362339514978%\"\u003e\n \u003cp\u003e6151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.4151212553495%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"3.9942938659058487%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.841654778887303%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"16.119828815977176%\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"9.70042796005706%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"18.830242510699%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean age, year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"13.552068473609129%\"\u003e\n \u003cp\u003e29.6\u0026plusmn;4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"17.546362339514978%\"\u003e\n \u003cp\u003e30.2\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.4151212553495%\"\u003e\n \u003cp\u003e0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"3.9942938659058487%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.841654778887303%\"\u003e\n \u003cp\u003e29.6\u0026plusmn;4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"16.119828815977176%\"\u003e\n \u003cp\u003e30.1\u0026plusmn;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"9.70042796005706%\"\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.830242510699%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI , kg/m\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"13.552068473609129%\"\u003e\n \u003cp\u003e20.8\u0026plusmn;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"17.546362339514978%\"\u003e\n \u003cp\u003e21.2\u0026plusmn;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.4151212553495%\"\u003e\n \u003cp\u003e0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"3.9942938659058487%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.841654778887303%\"\u003e\n \u003cp\u003e20.8\u0026plusmn;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"16.119828815977176%\"\u003e\n \u003cp\u003e20.9\u0026plusmn;2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"9.70042796005706%\"\u003e\n \u003cp\u003e0.869\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.830242510699%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSalpingectomy ,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"13.552068473609129%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.546362339514978%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.4151212553495%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"3.9942938659058487%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.119828815977176%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"9.70042796005706%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"18.830242510699%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"13.552068473609129%\"\u003e\n \u003cp\u003e7(24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"17.546362339514978%\"\u003e\n \u003cp\u003e2964（48.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.4151212553495%\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"3.9942938659058487%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e7(24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.119828815977176%\"\u003e\n \u003cp\u003e31(35.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"9.70042796005706%\"\u003e\n \u003cp\u003e 0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"18.830242510699%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"13.552068473609129%\"\u003e\n \u003cp\u003e22(75.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"17.546362339514978%\"\u003e\n \u003cp\u003e3187（51.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.4151212553495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"3.9942938659058487%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e22(75.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.119828815977176%\"\u003e\n \u003cp\u003e56(64.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"9.70042796005706%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.830242510699%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"2.710413694721826%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.546362339514978%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.4151212553495%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"3.9942938659058487%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.119828815977176%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"3.9942938659058487%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.706134094151213%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: BMI=body mass index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"672\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.113095238095237%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" width=\"82.88690476190476%\"\u003e\n \u003cp\u003e\u003cstrong\u003eComparison of the clinical characteristics\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ebetween two group after propensity score matching\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIP group\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=29\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl \u0026nbsp;group\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=87\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGravidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e2.4\u0026plusmn;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e2.0\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e14（48.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e60（69.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e15（51.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e27（31.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eReason for salpingectomy , n (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHydrosalpinx\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e5（17.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e4（4.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eothers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e24(82.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e83(95.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSalpingectomy-subsequent pregnancy interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le;\u003c/strong\u003e\u003cstrong\u003e6 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e3（10.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e10（11.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e0.865\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003e＞\u003c/strong\u003e\u003cstrong\u003e6 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e26（89.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e77（88.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious surgical procedure, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscopy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e21(72.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e57(65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparotomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e8(27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e30(34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of conception, n (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003espontaneous\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e28(96.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e58(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIVF-ET\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e1(3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e29(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of abdominal surgery ,n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e10(34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e21（24.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of intrauterine operation , n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e17（58.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e32(36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSterility ,n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e6(20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e13(14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"31.398809523809526%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of ectopic pregnancy ,n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.172619047619047%\"\u003e\n \u003cp\u003e2(6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.976190476190474%\"\u003e\n \u003cp\u003e7(8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.452380952380953%\"\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: ET = embryo transfer; IVF = in vitro fertilization.\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" width=\"90.38461538461539%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLogistic regression analysis of risk factors for interstitial pregnancy following ipsilateral salpingectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"21.153846153846153%\"\u003e\n \u003cp\u003eOR\u0026nbsp;Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"25.32051282051282%\"\u003e\n \u003cp\u003e95%（CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"20.192307692307693%\"\u003e\n \u003cp\u003ep Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.153846153846153%\"\u003e\n \u003cp\u003e2.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.32051282051282%\"\u003e\n \u003cp\u003e0.837～5.890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntrauterine operation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.153846153846153%\"\u003e\n \u003cp\u003e1.509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.32051282051282%\"\u003e\n \u003cp\u003e0.569～4.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\"\u003e\n \u003cp\u003e0.408\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHydrosalpinx\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.153846153846153%\"\u003e\n \u003cp\u003e8.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.32051282051282%\"\u003e\n \u003cp\u003e1.323～50.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIVF-ET\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.153846153846153%\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.32051282051282%\"\u003e\n \u003cp\u003e0.006～0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: ET = embryo transfer; IVF = in vitro fertilization.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Interstitial pregnancy, Salpingectomy, Hydrosalpinx, Propensity score macthing, Risk factor","lastPublishedDoi":"10.21203/rs.3.rs-2752929/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2752929/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTo identify risk factors associated with interstitial pregnancy following ipsilateral salpingectomy and discuss possible prevention.A retrospective cohort study was conducted \u0026nbsp;in a single, large, university-affiliated hospital. Data of 29 patients diagnosed with interstitial pregnancy following ipsilateral salpingectomy from January 2011 to November 2020 were assigned into the case group (IP group), whereas 87 patients derived from 6151 patients with intrauterine pregnancy following unilateral salpingectomy were served as the controls using propensity score matching (PSM) at a ratio of 1:3. After PSM, there was no statistically significant difference in patient demographic details between the two groups . The multipara was greater and the intrauterine operation was more frequent in the IP group compared with the control group (P＜0.05). There was only one patient undergoing IVF-ET in the IP group as compared with 29 cases in the control group (3.4% vs. 33.3%, P＜0.05). Salpingectomy was performed on 5 patients in the IP group and 4 patients in the control group due to hydrosalpinx (P＜0.05). Logistic regression indicated that hydrosalpinx was the high risk factor of interstitial pregnancy following ipsilateral salpingectomy (OR=8.175).Our PSM analysis suggests that hydrosalpinx has significantassociation with risk of interstitial pregnancy following ipsilateral salpingectomy in subsequent pregnancy.\u003c/p\u003e","manuscriptTitle":"Hydrosalpinx: interstitial pregnancy following ipsilateral salpingectomy risk factor? a case-control study with propensity score matching.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-04-19 14:43:14","doi":"10.21203/rs.3.rs-2752929/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"febf982b-7d9e-4896-9e37-0183661649f0","owner":[],"postedDate":"April 19th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-05-25T13:37:24+00:00","versionOfRecord":[],"versionCreatedAt":"2023-04-19 14:43:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2752929","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2752929","identity":"rs-2752929","version":["v1"]},"buildId":"369fNeqWncA4NS6XSWjrt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}