Pregnancy Success Rates Of Hysteroscopic Coil Occlusion In Patients With Hydrosalpinx

Pregnancy Success Rates Of Hysteroscopic Coil Occlusion In Patients With Hydrosalpinx | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pregnancy Success Rates Of Hysteroscopic Coil Occlusion In Patients With Hydrosalpinx Ozge Karaosmanoglu, Elif Goknur Topcu, Aysen Yuceturk, Nuri Peker, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6931961/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background To assess pregnancy success rates in hydrosalpinx patients who were unable to go under laparoscopic occlusion and treated with hysteroscopic coil insertion before in vitro fertilization. Methods A retrospective analysis was conducted from January 2023 to May 2025 to evaluate the outcomes of assisted reproductive treatments in patients with hydrosalpinx who were unable to undergo laparoscopic tubal occlusion and instead underwent hysteroscopic coil occlusion prior to an in vitro fertilization cycle. All hysteroscopic coil occlusions were scheduled two months before embryo transfer. Consecutive hysterosalpingographies were performed before and after the hysteroscopic coil insertions to confirm the occlusion of hydrosalpinx. The clinical pregnancy rate and live birth rate were assessed. Results A total of 10,427 patients were evaluated, of whom 147 were offered laparoscopic tubal ligation for at least one side of hydrosalpinx. Of these, 109 patients consented to undergo tubal ligation at our clinic. However, twelve patients were unable to complete the procedure via laparoscopy and subsequently underwent hysteroscopic proximal tubal occlusion using detachable nylon fiber coils. The mean age of the patients was 36.9 ± 3.9 years, and the mean duration of infertility was 7.1 ± 5 years. Among these twelve patients, eleven had documented endometriosis. One-third of the patients presented with bilateral hydrosalpinx. A total of 11 out of 12 patients experienced successful hysteroscopic coil occlusion with a total number of 16 hydrosalpinges. Only one patient had a complication of coil retention in the uterine cavity, but a third attempt at coil occlusion was successful. Conclusions Hysteroscopic coil insertion for tubal occlusion presents a promising alternative treatment for infertility associated with hydrosalpinx, particularly in women for whom laparoscopic procedures are contraindicated. Infertility hydrosalpinx coil hysteroscopy tubal factor Figures Figure 1 INTRODUCTION Tubal disease is a major cause of female factor infertility, accounting for approximately 25–35% of cases ( 1 ). It is one of the primary indications for in vitro fertilization (IVF). Hydrosalpinx (HS), the most severe manifestation of tubal disease, is observed in 10–30% of patients undergoing IVF ( 2 ). Hydrosalpinx is characterized by fluid-filled, dilated fallopian tubes with distal tubal occlusion, most commonly resulting from salpingitis ( 3 ). Salpingitis is often a consequence of pelvic inflammatory disease (PID), frequently caused by sexually transmitted infections such as Neisseria gonorrhoeae or Chlamydia trachomatis ( 4 ). Other etiologies include tuberculosis, endometriosis, prior abdominal surgeries, and appendicitis. Hydrosalpinx significantly contributes to poor IVF outcomes and cycle failure ( 5 ). Its detrimental impact on assisted reproductive technology (ART) outcomes has been well-documented. Meta-analyses indicate that hydrosalpinx reduces implantation rates by approximately 50% and doubles the risk of spontaneous abortion ( 6 , 7 ). Compared with other tubal factors, hydrosalpinx reduces the live birth rate after IVF by up to 50% ( 4 ). Although the exact mechanisms remain unclear, several theories have been proposed. These include retrograde leakage of hydrosalpinx fluid into the uterine cavity causing mechanical flushing of embryos, chemical embryotoxicity impairing embryo development, disruption of endometrial receptivity, and altered expression of implantation-related genes and proteins ( 8 – 14 ). Current standard management of hydrosalpinx before ART is surgical intervention. This may involve laparoscopic salpingectomy or proximal tubal occlusion via hysteroscopy or laparoscopy ( 15 – 17 ). Compared with no intervention, patients who undergo salpingectomy or laparoscopic tubal occlusion prior to IVF have significantly improved outcomes, with ongoing pregnancy rates increasing from 17–34% ( 16 ). A Cochrane review further supports the benefit of surgical management, showing significantly higher odds of pregnancy with laparoscopic salpingectomy or tubal occlusion ( 15 ). However, laparoscopy may not be feasible in all patients, particularly those with severe abdominopelvic adhesions, and carries inherent risks such as injury to intra-abdominal or pelvic organs. In contrast, hysteroscopic tubal occlusion is a less invasive alternative that can often be performed in an office setting. Devices such as Adiana® and Essure® have been previously employed for hysteroscopic tubal occlusion and were commonly used for sterilization. Off-label use of these devices, particularly Essure®, has been reported for the management of hydrosalpinx in infertile patients ( 15 , 18 , 19 ). However, due to safety concerns, both devices have been withdrawn from the market. Given the limitations of existing surgical and hysteroscopic options, there is a need to explore novel minimally invasive techniques for proximal tubal occlusion. In this study, we aimed to evaluate the effectiveness of hysteroscopic proximal coil insertion for tubal occlusion in patients with hydrosalpinx, focusing on pregnancy outcomes. Our goal is to offer an alternative, less invasive treatment option prior to embryo transfer in patients with hydrosalpinx-associated infertility. METHODS This retrospective study was conducted between January 2023 and May 2025 at the IVF Unit of Maslak Acibadem Hospital. Ethical approval was obtained from the local ethics committee (Approval No: 2024-5/182), and the study adhered to the principles outlined in the Declaration of Helsinki. Informed consent was obtained from all participants for the use of their medical records, including hysterosalpingography (HSG) imaging and pre- and post-hysteroscopy documentation. Inclusion criteria encompassed patients diagnosed with unilateral or bilateral hydrosalpinx on hysterosalpingogram (HSG) who were not eligible for laparoscopic treatment due to severe pelvic adhesions, high surgical risk, or contraindications. Exclusion criteria included patients who discontinued treatment, had incomplete records, or declined to provide consent. Data collected included: patients’ age, duration and reason of infertility, agre, obstetric and medical history, presence of endometriosis, side of hydrosalpinx, reason for coil occlusion, number of trials for coil occlusion, images of HSG before and after coil occlusions, complications, number of embryos transferred, quality of embryos transferred, details of embryo transfer (easy or difficult), clinical pregnancy with a fetal heartbeat, live births and pregnancy outcomes. All procedures were performed during the follicular phase under general anesthesia in an operating theatre, as office hysteroscopy was not available. Patients received 1 gram of intravenous cephalosporin prophylactically. Following antiseptic preparation with povidone-iodine and cervical dilation, a 5-mm continuous-flow operative hysteroscope was introduced. The proximal tubal ostia were identified, and a detachable nylon fiber coil (3 mm in diameter, 8 cm in length; Concerto Detachable Coil System) was inserted into the affected ostium using a guidewire passed through the operating channel of the hysteroscope. All procedures were performed by the same infertility specialist, with an average insertion time of 10 minutes. Patients were discharged within three hours post-procedure and returned within three days for transvaginal ultrasound verification of coil placement. HSG was repeated two months after coil insertion to confirm tubal occlusion. If occlusion was not achieved, HSG was repeated monthly for up to four months. Data analysis was conducted using SPSS version 26.0 (IBM Corp., Armonk, NY). A p -value < 0.05 was considered statistically significant. RESULTS A total of 10.427 patients were examined during the time of the study period, 147 patients were offered laparoscopic tubal ligation for at least one side of hydrosalpinx. Out of these patients, 109 accepted to have tubal ligation in our clinic and 12 of them were not able to have their tubal ligations completed via laparoscopy and underwent hysteroscopic proximal tubal occlusion using detachable nylon fiber coils. The mean age of the patients was 36.9 ± 3.9 years, and the mean duration of infertility was 7.1 ± 5 years. Reason of infertility were low ovarian reserve in three patients, low ovarian reserve and male factor in one patient, only male factor in one patient, advanced maternal age in two patients, advanced maternal age and male factor in one patient, peritoneal tuberculosis in one patient and unexplained infertility in three patients (Table 1 ). Nine patients had history of previous surgery and 11 patients had at least one endometrioma detected in the transvaginal ultrasound on their first visit. Among the 12 patients, 11 had documented endometriosis. One third of these patients had bilateral hydrosalpinx and a total of 16 hydrosalpinx was attempted to be treated with hysteroscopic coil occlusion. Table 1 Demographic features Age (years) Duration of Infertility (years) Reason of Infertility Previous Surgeries Endometriosis Hydrosalpinx 32 3 unexplained laparotomy 1 bilateral 43 19 advanced maternal age & male factor c-section 0 unilateral (R) 44 6 advanced maternal age hysteroscopy 1 bilateral 42 7 advanced maternal age laparoscopy & hysteroscopy 1 unilateral (R) 40 8 male factor 0 1 unilateral (L) 36 5 unexplained 0 1 unilateral (L) 40 5 low ovarian reserve laparotomy 1 unilateral (R) 36 6 unexplained laparotomy 1 bilateral 33 3 peritoneal tuberculosis laparotomy 0 unilateral (R) 37 8 low ovarian reserve 0 1 unilateral (R) 35 1 low ovarian reserve laparotomy 1 unilateral (R) 32 14 low ovarian reserve & male factor laparoscopy & laparotomy & curettage 1 bilateral The reason why patients could not go under laparoscopic tubal occlusion was severe abdominal adhesions in almost all cases but one, who had frozen pelvis due to peritoneal tuberculosis. Two patients had a laparoscopic attempt of tubal occlusion and had one of their fallopian tubes occluded (right side for both patients), followed by coil occlusion to the contralateral fallopian tube. Coi l occlusion was successfully achieved in 91.6% (11 out of 12 evaluable cases) of patients. A video of hysteroscopic coil replacement from a tubal ostium can be seen in Video 1. An example of before and after HSGs of a patient can be seen in Fig. 1 . There were no reported complications associated with the hysteroscopic coil occlusion procedure. In one of the cases, coil retention in the uterine cavity was seen on the follow up ultrasound examination on day 3 for the first two trials on the same fallopian tube and she had her successful occlusion after the third hysteroscopic replacement. One patient had two trials of coil occlusion and did not accept a third trial after unsuccessful results. Another patient discontinued her IVF care in our unit after receiving hysteroscopic proximal tubal occlusion (Table 2 ). Table 2 Hysteroscopic coil occlusion attributes, IVF cycles and Results Number of coil occlusion trials Coil occlusion success Complication Number of transferred embryos Quality of transferred embryo Clinical pregnancy Live birth 1 1 0 2 5AB,4BC 1 1 1 1 0 1 6 cells 0 0 1 1 0 2 5BC,4BC 1 0 1 1 0 2 compaction, compaction 0 0 2 0 0 0 0 0 0 2 1 0 2 8cells, 7 cells 1 1 1 1 0 2 5BA,4BB 1 1 1 1 0 1 5BB 1 ongoing pregnancy 1 1 0 Patient discontinued Patient discontinued Patient discontinued Patient discontinued 2 1 0 1 compaction 1 ongoing pregnancy 1 1 0 2 4AA,4AA 0 0 3 1 Coil retention in uterine cavity, twice 1 compaction 1 ongoing pregnancy Embryo transfer was done in 10 of these patients. Following embryo transfer, the clinical pregnancy rate among patients who underwent successful occlusion was 70%. Heartbeat was detected in 60% of cases, and the live birth rate was 30% while three patients have still ongoing pregnancy (Table 2 ). DISCUSSION This study demonstrates that hysteroscopic proximal coil insertion is a promising alternative approach for tubal occlusion in patients with hydrosalpinx who are not candidates for laparoscopic surgery. Hydrosalpinx represents the most severe form of tubal factor infertility and is characterized by the accumulation of serous fluid in a distally blocked fallopian tube ( 2 , 6 ). The presence of hydrosalpinges has been consistently associated with poor reproductive outcomes in patients undergoing ART, particularly in vitro fertilization ( 6 , 7 ). Epidemiological studies estimate that hydrosalpinx is present in 10–30% of infertile women undergoing IVF, highlighting its clinical relevance. A landmark meta-analysis by Strandell and colleagues demonstrated that hydrosalpinx significantly reduces pregnancy and implantation rates, and increases miscarriage rates ( 20 ). More recent studies continue to confirm that the presence of hydrosalpinges can reduce implantation and live birth rates by up to 50%, underscoring the importance of pre-IVF intervention ( 15 , 21 ). Several pathophysiological mechanisms have been proposed to explain these adverse effects such as mechanical embryo washout by reflux of hydrosalpinx fluid into the endometrial cavity, physically flushing out embryos post-transfer, embryotoxicity of the fluid, endometrial receptivity impairment and chronic inflammation ( 21 – 25 ). The combination of these mechanisms supports the routine evaluation of tubal status prior to initiating IVF, with strong recommendations for pre-treatment of hydrosalpinx to optimize outcomes for the past couple of decades. Surgical removal of the hydrosalpinx via laparoscopic salpingectomy is currently the gold standard of care for patients with this condition undergoing IVF. This approach is backed by evidence from a Cochrane review and randomized controlled trials that show a significant improvement in pregnancy and live birth rates compared to no intervention ( 15 , 23 ). Salpingectomy eliminates the source of toxic fluid and improves uterine conditions, often without adversely affecting ovarian response. However, laparoscopic surgery is not always feasible. Patients with dense pelvic adhesions, prior surgeries, endometriosis, or poor surgical candidates due to comorbidities may face increased operative risks. In such cases, minimally invasive alternatives become critical. Historically, two hysteroscopic devices—Essure® and Adiana®—were repurposed for proximal tubal occlusion in women with hydrosalpinx. These devices were originally developed for permanent sterilization but were used off-label to block the reflux of hydrosalpinx fluid before IVF ( 18 , 26 , 27 ). Studies showed that these methods could improve IVF outcomes similarly to laparoscopic techniques while avoiding abdominal surgery. However, long-term safety concerns, including reports of chronic pelvic pain, device migration, and systemic symptoms, led to the withdrawal of these devices from the market in many countries. This has created a gap in treatment options for patients who are not surgical candidates. As a result, there is a renewed interest in developing novel hysteroscopic approaches to proximal tubal occlusion that are safe, effective, and well-tolerated. Different approaches to hydrosalpinx treatment have been developed in recent years, including hydrosalpinx fluid aspiration by guided ultrasound and hydrosalpinx sclerotherapy ( 28 – 31 ). All interventions reported higher clinical pregnancy rates than no intervention. Even though these approaches can have a potential to be safer, better tolerated and cost-effective, studies resulted in different outcomes and are too scarce to use in daily practice. In a recent systematic review and network meta-analysis, sclerotherapy was found to be an auspicious alternative to conventional techniques ( 28 ). Coi l occlusion has been widely used in endovascular treatments for almost 30 years including treatment of vascular malformations such as patent ductus arteriosus, cystic arteries or intracranial aneurysms ( 32 – 37 ). However it has not been widely studied for treating hydrosalpinx. Wu et al have published the first study in 2018 where they enrolled patients with hydrosalpinx and suspected severe pelvic adhesions, and achieved successful placement in 55 patients. Similarly, they had a control transvaginal ultrasound on the third day after coil replacement and a control HSG after 3 months. In one patient, they noticed a coil displacement but in the right ovary. In our case, coil displacement was in the uterine cavity and we successfully confirmed occlusion after the third trial of hysteroscopy. They have divided patients by age, under or above 40 years old and presented pregnancy outcomes. Clinical pregnancy rate below and above 40 years of age was found to be 60% and 33%, respectively. In our study, we did not divide by age since almost half of our patients were above 40, but our clinical pregnancy rate overall was found higher with 70%. This could be related to better embryo quality in our small group of patients, since even though the duration of our studies were similar, we had a smaller number of patients who were not able to go under laparoscopic treatment in our center. In any case, both of these studies prove that the use of a nylon fiber detachable coil under hysteroscopic guidance represents a new, off-label solution to this clinical challenge and hysteroscopic coil occlusion is a promising technique that can play a more dominant role in hydrosalpinx management, especially for high-risk or surgically complex patients. Our data support the feasibility and potential efficacy of hysteroscopic coil occlusion as a minimally invasive, low-complication alternative to laparoscopy. The fact that 90.9% of patients achieved successful tubal occlusion, and that clinical pregnancy was achieved in 70% of these cases, is noteworthy. Although the sample size was small, the live birth rate of 30% and ongoing pregnancy rate with 30% is consistent with outcomes reported in salpingectomy series ( 28 , 38 ). Importantly, no adverse outcomes were observed in patients undergoing coil placement. This safety profile may make the procedure an attractive option in low-resource settings or for patients with surgical risks. The main limitations of our study include the small sample size and the retrospective design, which restrict the generalizability of our findings and preclude robust statistical comparisons. There is a need for further research with larger sample size and long-term follow ups. CONCLUSION Hysteroscopic coil insertion is an effective treatment model for proximal tubal occlusion in patients with hydrosalpinx. For patients who can not go under laparoscopy, hysteroscopic coil insertion can be an alternative before embryo transfer in IVF cycles. Abbreviations International Federation of Gynecology and Obstetrics (FIGO), intrauterine adhesions (IUA), Intrauterine device (IUD), hysterosalpingography (HSG), saline infusion sonography (SIS), body mass index (BMI) Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. The study involving human participants were reviewed and approved by the institutional review board and ethics committee of the Acibadem University (Acıbadem Üniversitesi ve Acıbadem Sağlık Kuruluşları Tıbbi Araştırma Etik Kurulu) with approval number: 2025/07-56. Written informed consent from the patients were not required to participate in this study in accordance with the national legislation and the institutional requirements. Consent for publication not applicable Availability of data and material The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. 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Hysteroscopic coil replacement Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 25 Mar, 2026 Reviews received at journal 07 Nov, 2025 Reviews received at journal 07 Nov, 2025 Reviewers agreed at journal 29 Oct, 2025 Reviewers agreed at journal 27 Oct, 2025 Reviews received at journal 23 Oct, 2025 Reviewers agreed at journal 20 Oct, 2025 Reviewers agreed at journal 18 Oct, 2025 Reviewers agreed at journal 13 Oct, 2025 Reviewers invited by journal 13 Oct, 2025 Editor invited by journal 19 Sep, 2025 Editor assigned by journal 20 Jun, 2025 Submission checks completed at journal 20 Jun, 2025 First submitted to journal 19 Jun, 2025 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. 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16:12:02","extension":"jpeg","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":579123,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6931961/v1/11944d515216088d4243271e.jpeg"},{"id":94480624,"identity":"34dbabd9-f184-4f47-9a82-2330b9665b30","added_by":"auto","created_at":"2025-10-27 16:11:29","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":181311,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6931961/v1/30b9f86e6b82c23dcdcd250a.png"},{"id":94480729,"identity":"0e154770-4306-42ec-bf6e-7640bba9d384","added_by":"auto","created_at":"2025-10-27 16:11:45","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":95610,"visible":true,"origin":"","legend":"","description":"","filename":"ddefbb9797c4467887066fed8373085f1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-6931961/v1/3b01334cb784fd5a08319c3f.xml"},{"id":94480361,"identity":"6f2d5e81-e810-4233-80bb-c3e476dbf18f","added_by":"auto","created_at":"2025-10-27 16:10:47","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":104982,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6931961/v1/276bdaeaabcbb711902137a6.html"},{"id":94480749,"identity":"bb67907b-8649-4084-b0dc-ad590e3f535c","added_by":"auto","created_at":"2025-10-27 16:11:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":537568,"visible":true,"origin":"","legend":"\u003cp\u003eExample of before-and-control HSG of coil replacement\u003c/p\u003e\n\u003cp\u003ea: before coil insertion,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eb: after coil insertion\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6931961/v1/1bcfef0ec591dc72446131f4.png"},{"id":94491368,"identity":"6643efd3-8782-46cb-a399-85767325247d","added_by":"auto","created_at":"2025-10-27 17:24:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1341881,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6931961/v1/967af3ba-95f5-48b4-a350-aea4715bc093.pdf"},{"id":94479947,"identity":"8f167e3b-e23e-45cd-934c-73b9c770e251","added_by":"auto","created_at":"2025-10-27 16:08:46","extension":"mp4","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":11702888,"visible":true,"origin":"","legend":"\u003cp\u003eVideo 1. Hysteroscopic coil replacement\u003c/p\u003e","description":"","filename":"VIDEO20250619154425.mp4","url":"https://assets-eu.researchsquare.com/files/rs-6931961/v1/e2eceba03980eab8a973bbc5.mp4"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pregnancy Success Rates Of Hysteroscopic Coil Occlusion In Patients With Hydrosalpinx","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eTubal disease is a major cause of female factor infertility, accounting for approximately 25\u0026ndash;35% of cases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is one of the primary indications for in vitro fertilization (IVF). Hydrosalpinx (HS), the most severe manifestation of tubal disease, is observed in 10\u0026ndash;30% of patients undergoing IVF (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Hydrosalpinx is characterized by fluid-filled, dilated fallopian tubes with distal tubal occlusion, most commonly resulting from salpingitis (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Salpingitis is often a consequence of pelvic inflammatory disease (PID), frequently caused by sexually transmitted infections such as \u003cem\u003eNeisseria gonorrhoeae\u003c/em\u003e or \u003cem\u003eChlamydia trachomatis\u003c/em\u003e (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Other etiologies include tuberculosis, endometriosis, prior abdominal surgeries, and appendicitis.\u003c/p\u003e\u003cp\u003eHydrosalpinx significantly contributes to poor IVF outcomes and cycle failure (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Its detrimental impact on assisted reproductive technology (ART) outcomes has been well-documented. Meta-analyses indicate that hydrosalpinx reduces implantation rates by approximately 50% and doubles the risk of spontaneous abortion (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Compared with other tubal factors, hydrosalpinx reduces the live birth rate after IVF by up to 50% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Although the exact mechanisms remain unclear, several theories have been proposed. These include retrograde leakage of hydrosalpinx fluid into the uterine cavity causing mechanical flushing of embryos, chemical embryotoxicity impairing embryo development, disruption of endometrial receptivity, and altered expression of implantation-related genes and proteins (\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCurrent standard management of hydrosalpinx before ART is surgical intervention. This may involve laparoscopic salpingectomy or proximal tubal occlusion via hysteroscopy or laparoscopy (\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Compared with no intervention, patients who undergo salpingectomy or laparoscopic tubal occlusion prior to IVF have significantly improved outcomes, with ongoing pregnancy rates increasing from 17\u0026ndash;34% (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). A Cochrane review further supports the benefit of surgical management, showing significantly higher odds of pregnancy with laparoscopic salpingectomy or tubal occlusion (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, laparoscopy may not be feasible in all patients, particularly those with severe abdominopelvic adhesions, and carries inherent risks such as injury to intra-abdominal or pelvic organs. In contrast, hysteroscopic tubal occlusion is a less invasive alternative that can often be performed in an office setting. Devices such as Adiana\u0026reg; and Essure\u0026reg; have been previously employed for hysteroscopic tubal occlusion and were commonly used for sterilization. Off-label use of these devices, particularly Essure\u0026reg;, has been reported for the management of hydrosalpinx in infertile patients (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). However, due to safety concerns, both devices have been withdrawn from the market.\u003c/p\u003e\u003cp\u003eGiven the limitations of existing surgical and hysteroscopic options, there is a need to explore novel minimally invasive techniques for proximal tubal occlusion. In this study, we aimed to evaluate the effectiveness of hysteroscopic proximal coil insertion for tubal occlusion in patients with hydrosalpinx, focusing on pregnancy outcomes. Our goal is to offer an alternative, less invasive treatment option prior to embryo transfer in patients with hydrosalpinx-associated infertility.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis retrospective study was conducted between January 2023 and May 2025 at the IVF Unit of Maslak Acibadem Hospital. Ethical approval was obtained from the local ethics committee (Approval No: 2024-5/182), and the study adhered to the principles outlined in the Declaration of Helsinki. Informed consent was obtained from all participants for the use of their medical records, including hysterosalpingography (HSG) imaging and pre- and post-hysteroscopy documentation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e encompassed patients diagnosed with unilateral or bilateral hydrosalpinx on hysterosalpingogram (HSG) who were not eligible for laparoscopic treatment due to severe pelvic adhesions, high surgical risk, or contraindications. \u003cb\u003eExclusion criteria\u003c/b\u003e included patients who discontinued treatment, had incomplete records, or declined to provide consent.\u003c/p\u003e\u003cp\u003eData collected included: patients\u0026rsquo; age, duration and reason of infertility, agre, obstetric and medical history, presence of endometriosis, side of hydrosalpinx, reason for coil occlusion, number of trials for coil occlusion, images of HSG before and after coil occlusions, complications, number of embryos transferred, quality of embryos transferred, details of embryo transfer (easy or difficult), clinical pregnancy with a fetal heartbeat, live births and pregnancy outcomes.\u003c/p\u003e\u003cp\u003eAll procedures were performed during the follicular phase under general anesthesia in an operating theatre, as office hysteroscopy was not available. Patients received 1 gram of intravenous cephalosporin prophylactically. Following antiseptic preparation with povidone-iodine and cervical dilation, a 5-mm continuous-flow operative hysteroscope was introduced. The proximal tubal ostia were identified, and a detachable nylon fiber coil (3 mm in diameter, 8 cm in length; Concerto Detachable Coil System) was inserted into the affected ostium using a guidewire passed through the operating channel of the hysteroscope. All procedures were performed by the same infertility specialist, with an average insertion time of 10 minutes.\u003c/p\u003e\u003cp\u003ePatients were discharged within three hours post-procedure and returned within three days for transvaginal ultrasound verification of coil placement. HSG was repeated two months after coil insertion to confirm tubal occlusion. If occlusion was not achieved, HSG was repeated monthly for up to four months.\u003c/p\u003e\u003cp\u003eData analysis was conducted using SPSS version 26.0 (IBM Corp., Armonk, NY). A \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 10.427 patients were examined during the time of the study period, 147 patients were offered laparoscopic tubal ligation for at least one side of hydrosalpinx. Out of these patients, 109 accepted to have tubal ligation in our clinic and 12 of them were not able to have their tubal ligations completed via laparoscopy and underwent hysteroscopic proximal tubal occlusion using detachable nylon fiber coils. The mean age of the patients was 36.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 years, and the mean duration of infertility was 7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5 years. Reason of infertility were low ovarian reserve in three patients, low ovarian reserve and male factor in one patient, only male factor in one patient, advanced maternal age in two patients, advanced maternal age and male factor in one patient, peritoneal tuberculosis in one patient and unexplained infertility in three patients (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Nine patients had history of previous surgery and 11 patients had at least one endometrioma detected in the transvaginal ultrasound on their first visit. Among the 12 patients, 11 had documented endometriosis. One third of these patients had bilateral hydrosalpinx and a total of 16 hydrosalpinx was attempted to be treated with hysteroscopic coil occlusion.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic features\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003cp\u003e(years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDuration of Infertility (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReason of Infertility\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePrevious Surgeries\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEndometriosis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHydrosalpinx\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eunexplained\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003elaparotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ebilateral\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eadvanced maternal age \u0026amp; male factor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ec-section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eunilateral (R)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eadvanced maternal age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ehysteroscopy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ebilateral\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eadvanced maternal age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003elaparoscopy \u0026amp; hysteroscopy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eunilateral (R)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003emale factor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eunilateral (L)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eunexplained\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eunilateral (L)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003elow ovarian reserve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003elaparotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eunilateral (R)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eunexplained\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003elaparotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ebilateral\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eperitoneal tuberculosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003elaparotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eunilateral (R)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003elow ovarian reserve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eunilateral (R)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003elow ovarian reserve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003elaparotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eunilateral (R)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003elow ovarian reserve \u0026amp; male factor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003elaparoscopy \u0026amp; laparotomy \u0026amp; curettage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ebilateral\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe reason why patients could not go under laparoscopic tubal occlusion was severe abdominal adhesions in almost all cases but one, who had frozen pelvis due to peritoneal tuberculosis. Two patients had a laparoscopic attempt of tubal occlusion and had one of their fallopian tubes occluded (right side for both patients), followed by coil occlusion to the contralateral fallopian tube.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCoi\u003c/strong\u003e\u003cp\u003el occlusion was successfully achieved in 91.6% (11 out of 12 evaluable cases) of patients. A video of hysteroscopic coil replacement from a tubal ostium can be seen in Video 1. An example of before and after HSGs of a patient can be seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There were no reported complications associated with the hysteroscopic coil occlusion procedure. In one of the cases, coil retention in the uterine cavity was seen on the follow up ultrasound examination on day 3 for the first two trials on the same fallopian tube and she had her successful occlusion after the third hysteroscopic replacement. One patient had two trials of coil occlusion and did not accept a third trial after unsuccessful results. Another patient discontinued her IVF care in our unit after receiving hysteroscopic proximal tubal occlusion (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHysteroscopic coil occlusion attributes, IVF cycles and Results\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of coil occlusion trials\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoil occlusion success\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eComplication\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNumber of transferred embryos\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQuality of transferred embryo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eClinical pregnancy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLive birth\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5AB,4BC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 cells\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5BC,4BC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ecompaction, compaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8cells, 7 cells\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5BA,4BB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5BB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eongoing pregnancy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePatient discontinued\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePatient discontinued\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePatient discontinued\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePatient discontinued\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ecompaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eongoing pregnancy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4AA,4AA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCoil retention in uterine cavity, twice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ecompaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eongoing pregnancy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/p\u003e\u003cp\u003eEmbryo transfer was done in 10 of these patients. Following embryo transfer, the clinical pregnancy rate among patients who underwent successful occlusion was 70%. Heartbeat was detected in 60% of cases, and the live birth rate was 30% while three patients have still ongoing pregnancy (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study demonstrates that hysteroscopic proximal coil insertion is a promising alternative approach for tubal occlusion in patients with hydrosalpinx who are not candidates for laparoscopic surgery.\u003c/p\u003e\u003cp\u003eHydrosalpinx represents the most severe form of tubal factor infertility and is characterized by the accumulation of serous fluid in a distally blocked fallopian tube (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The presence of hydrosalpinges has been consistently associated with poor reproductive outcomes in patients undergoing ART, particularly in vitro fertilization (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Epidemiological studies estimate that hydrosalpinx is present in 10\u0026ndash;30% of infertile women undergoing IVF, highlighting its clinical relevance. A landmark meta-analysis by Strandell and colleagues demonstrated that hydrosalpinx significantly reduces pregnancy and implantation rates, and increases miscarriage rates (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). More recent studies continue to confirm that the presence of hydrosalpinges can reduce implantation and live birth rates by up to 50%, underscoring the importance of pre-IVF intervention (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Several pathophysiological mechanisms have been proposed to explain these adverse effects such as mechanical embryo washout by reflux of hydrosalpinx fluid into the endometrial cavity, physically flushing out embryos post-transfer, embryotoxicity of the fluid, endometrial receptivity impairment and chronic inflammation (\u003cspan additionalcitationids=\"CR22 CR23 CR24\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The combination of these mechanisms supports the routine evaluation of tubal status prior to initiating IVF, with strong recommendations for pre-treatment of hydrosalpinx to optimize outcomes for the past couple of decades.\u003c/p\u003e\u003cp\u003eSurgical removal of the hydrosalpinx via laparoscopic salpingectomy is currently the gold standard of care for patients with this condition undergoing IVF. This approach is backed by evidence from a Cochrane review and randomized controlled trials that show a significant improvement in pregnancy and live birth rates compared to no intervention (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Salpingectomy eliminates the source of toxic fluid and improves uterine conditions, often without adversely affecting ovarian response. However, laparoscopic surgery is not always feasible. Patients with dense pelvic adhesions, prior surgeries, endometriosis, or poor surgical candidates due to comorbidities may face increased operative risks. In such cases, minimally invasive alternatives become critical. Historically, two hysteroscopic devices\u0026mdash;Essure\u0026reg; and Adiana\u0026reg;\u0026mdash;were repurposed for proximal tubal occlusion in women with hydrosalpinx. These devices were originally developed for permanent sterilization but were used off-label to block the reflux of hydrosalpinx fluid before IVF (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Studies showed that these methods could improve IVF outcomes similarly to laparoscopic techniques while avoiding abdominal surgery. However, long-term safety concerns, including reports of chronic pelvic pain, device migration, and systemic symptoms, led to the withdrawal of these devices from the market in many countries. This has created a gap in treatment options for patients who are not surgical candidates. As a result, there is a renewed interest in developing novel hysteroscopic approaches to proximal tubal occlusion that are safe, effective, and well-tolerated.\u003c/p\u003e\u003cp\u003eDifferent approaches to hydrosalpinx treatment have been developed in recent years, including hydrosalpinx fluid aspiration by guided ultrasound and hydrosalpinx sclerotherapy (\u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). All interventions reported higher clinical pregnancy rates than no intervention. Even though these approaches can have a potential to be safer, better tolerated and cost-effective, studies resulted in different outcomes and are too scarce to use in daily practice. In a recent systematic review and network meta-analysis, sclerotherapy was found to be an auspicious alternative to conventional techniques (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCoi\u003c/strong\u003e\u003cp\u003el occlusion has been widely used in endovascular treatments for almost 30 years including treatment of vascular malformations such as patent ductus arteriosus, cystic arteries or intracranial aneurysms (\u003cspan additionalcitationids=\"CR33 CR34 CR35 CR36\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). However it has not been widely studied for treating hydrosalpinx.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eWu et al have published the first study in 2018 where they enrolled patients with hydrosalpinx and suspected severe pelvic adhesions, and achieved successful placement in 55 patients. Similarly, they had a control transvaginal ultrasound on the third day after coil replacement and a control HSG after 3 months. In one patient, they noticed a coil displacement but in the right ovary. In our case, coil displacement was in the uterine cavity and we successfully confirmed occlusion after the third trial of hysteroscopy. They have divided patients by age, under or above 40 years old and presented pregnancy outcomes. Clinical pregnancy rate below and above 40 years of age was found to be 60% and 33%, respectively. In our study, we did not divide by age since almost half of our patients were above 40, but our clinical pregnancy rate overall was found higher with 70%. This could be related to better embryo quality in our small group of patients, since even though the duration of our studies were similar, we had a smaller number of patients who were not able to go under laparoscopic treatment in our center. In any case, both of these studies prove that the use of a nylon fiber detachable coil under hysteroscopic guidance represents a new, off-label solution to this clinical challenge and hysteroscopic coil occlusion is a promising technique that can play a more dominant role in hydrosalpinx management, especially for high-risk or surgically complex patients.\u003c/p\u003e\u003cp\u003eOur data support the feasibility and potential efficacy of hysteroscopic coil occlusion as a minimally invasive, low-complication alternative to laparoscopy. The fact that 90.9% of patients achieved successful tubal occlusion, and that clinical pregnancy was achieved in 70% of these cases, is noteworthy. Although the sample size was small, the live birth rate of 30% and ongoing pregnancy rate with 30% is consistent with outcomes reported in salpingectomy series (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eImportantly, no adverse outcomes were observed in patients undergoing coil placement. This safety profile may make the procedure an attractive option in low-resource settings or for patients with surgical risks.\u003c/p\u003e\u003cp\u003eThe main limitations of our study include the small sample size and the retrospective design, which restrict the generalizability of our findings and preclude robust statistical comparisons. There is a need for further research with larger sample size and long-term follow ups.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eHysteroscopic coil insertion is an effective treatment model for proximal tubal occlusion in patients with hydrosalpinx. For patients who can not go under laparoscopy, hysteroscopic coil insertion can be an alternative before embryo transfer in IVF cycles.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eInternational Federation of Gynecology and Obstetrics (FIGO), intrauterine adhesions (IUA), Intrauterine device (IUD), hysterosalpingography (HSG), saline infusion sonography (SIS), body mass index (BMI)\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki. The study involving human participants were reviewed and approved by the institutional review board and ethics committee of the Acibadem University (Acıbadem \u0026Uuml;niversitesi ve Acıbadem Sağlık Kuruluşları Tıbbi Araştırma Etik Kurulu) with approval number: 2025/07-56. Written informed consent from the patients were not required to participate in this study in accordance with the national legislation and the institutional requirements.\u003cbr\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003cbr\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eThere is no funding.\u003cbr\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026Ouml;.K and E.G.T collected patient\u0026rsquo;s data\u003c/p\u003e\n\u003cp\u003eN.P, E.G.T and B.T wrote the main manuscript task\u003c/p\u003e\n\u003cp\u003eİ.\u0026Ouml;.A and A.Y prepared tables and the statistics of the study\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eASRM Fertility Evaluation of Infertilte Women: A Committee Opinion (2021). Available at: https://www.asrm.org/practice-guidance/practice-committee-documents/fertility-evaluation-of-infertile-women-a-committee-opinion-2021/ Accessed May 14, 2025.\u003c/li\u003e\n\u003cli\u003eEvers JL. Female subfertility. Lancet. 2002 Jul 13;360(9327):151-9. \u003c/li\u003e\n\u003cli\u003eHonore GM, Holden AE, Schenken RS. Pathophysiology and management of proximal tubal blockage. Fertil Steril 1999; 71:785\u0026ndash;95. \u003c/li\u003e\n\u003cli\u003eD\u0026apos;Arpe S, Franceschetti S, Caccetta J, Pietrangeli D, Muzii L, Panici PB. Management of hydrosalpinx before IVF: a literature review. J Obstet Gynaecol. 2015;35(6):547-50. \u003c/li\u003e\n\u003cli\u003eLorente Gonz\u0026aacute;lez J, R\u0026iacute;os Castillo JE, Pomares Toro E, Romero Nieto MI, Castelo-Branco C, Arjona Berral JE. Essure a novel option for the treatment of hydrosalpinx: a case series and literature review. Gynecol Endocrinol. 2016;32(2):166-70. \u003c/li\u003e\n\u003cli\u003eZeyneloglu HB, Arici A, Olive DL. Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization\u0026ndash;embryo transfer. Fertil Steril 1998; 70:492\u0026ndash;9. 3.\u003c/li\u003e\n\u003cli\u003eCamus E, Poncelet C, Goffinet F, et al. 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/li\u003e\n\u003cli\u003eArora R, Shapiro H, Liu K, Arthur R, Cruickshank B, Sharma P, Glass K, Baratz A, Librach C, Greenblatt EM. Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment. J Obstet Gynaecol Can. 2020 Jun;42(6):779-786. \u003c/li\u003e\n\u003cli\u003eSeli E, Kayisli UA, Cakmak H, et al. Removal of hydrosalpinges increases endometrial leukaemia inhibitory factor (LIF) expression at the time of the implantation window. Hum Reprod 2005; 20:3012\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eDaftary GS, Kayisli U, Seli E, et al. Salpingectomy increases periimplantation endometrial HOXA10 expression in women with hydrosalpinx. Fertil Steril 2007; 87:367\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003eMeyer WR, Castelbaum AJ, Somkuti S, et al. Hydrosalpinges adversely affect markers of endometrial receptivity. Hum Reprod 1997; 12:1393\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eBedaiwy MA, Falcone T, Goldberg JM, et al. Relationship between cytokines and the embryotoxicity of hydrosalpingeal fluid. J Assist Reprod Genet 2005; 22:161\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eBarmat LI, Nasti K, Yang X, et al. Are cytokines and growth factors responsible for the detrimental effects of hydrosalpingeal fluid on pregnancy rates after in vitro fertilization-embryo transfer? Fertil Steril 1999; 72:1110\u0026ndash;2.\u003c/li\u003e\n\u003cli\u003eNg KYB, Cheong Y. Hydrosalpinx - Salpingostomy, salpingectomy or tubal occlusion. Best Pract Res Clin Obstet Gynaecol. 2019; 59:41-47. \u003c/li\u003e\n\u003cli\u003eJohnson N, van Voorst S, Sowter MC, et al. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev 2010(1):CD002125.\u003c/li\u003e\n\u003cli\u003ePractice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons. Salpingectomy for hydrosalpinx prior to in vitro fertilization. Fertil Steril 2008;90(5 Suppl): S66\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eXu B, Zhang Q, Zhao J, et al. Pregnancy outcome of in vitro fertilization after Essure and laparoscopic management of hydrosalpinx: a systematic review and meta-analysis. Fertil Steril 2017; 108:84\u0026ndash;95.e85.\u003c/li\u003e\n\u003cli\u003eCohen SB, Bouaziz J, Schiff E, Simon A, Nadjary M, Goldenberg M, Orvieto R, Revel A. In Vitro Fertilization Outcomes After Placement of Essure Microinserts in Patients With Hydrosalpinges Who Previously Failed In Vitro Fertilization Treatment: A Multicenter Study. J Minim Invasive Gynecol. 2016 Sep-Oct;23(6):939-43. \u003c/li\u003e\n\u003cli\u003eLegendre G, Gallot V, Levaillant JM, Capmas P, Fernandez H. Obturation tubaire d\u0026apos;un hydrosalpinx avant f\u0026eacute;condation in vitro par Adiana(\u0026reg;) : \u0026agrave; propos d\u0026apos;un cas [Adiana(\u0026reg;) hysteroscopic tubal occlusion device for the treatment of hydrosalpinx prior to in vitro fertilization: a case report]. J Gynecol Obstet Biol Reprod (Paris). 2013 Jun;42(4):401-4. French. doi: 10.1016/j.jgyn.2013.03.008. Epub 2013 Apr 15. PMID: 23597488.\u003c/li\u003e\n\u003cli\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 Nov;14(11):2762-9\u003c/li\u003e\n\u003cli\u003eVolodarsky-Perel A, Buckett W, Tulandi T. Treatment of hydrosalpinx in relation to IVF outcome: a systematic review and meta-analysis. Reprod Biomed Online. 2019 Sep;39(3):413-432. \u003c/li\u003e\n\u003cli\u003eAndersen AN, Lindhard A, Loft A, Ziebe S, Andersen CY. The infertile patient with hydrosalpinges--IVF with or without salpingectomy? Hum Reprod. 1996 Oct;11(10):2081-4. \u003c/li\u003e\n\u003cli\u003eStrandell A, Lindhard A, Waldenstr\u0026ouml;m U, Thorburn J. Hydrosalpinx and IVF outcome: cumulative results after salpingectomy in a randomized controlled trial. Hum Reprod. 2001 Nov;16(11):2403-10. \u003c/li\u003e\n\u003cli\u003eCohen MA, Lindheim SR, Sauer MV. Hydrosalpinges adversely affect implantation in donor oocyte cycles. Hum Reprod. 1999; 14(4):1087-9. \u003c/li\u003e\n\u003cli\u003eStrandell A. The influence of hydrosalpinx on IVF and embryo transfer: a review. Hum Reprod Update. 2000;6(4):387-95. \u003c/li\u003e\n\u003cli\u003eMijatovic V, Veersema S, Emanuel MH, Schats R, Hompes PG. Essure hysteroscopic tubal occlusion device for the treatment of hydrosalpinx prior to in vitro fertilization-embryo transfer in patients with a contraindication for laparoscopy. Fertil Steril. 2010;93(4):1338-42. \u003c/li\u003e\n\u003cli\u003eRosenfield RB, Stones RE, Coates A, Matteri RK, Hesla JS. Proximal occlusion of hydrosalpinx by hysteroscopic placement of microinsert before in vitro fertilization-embryo transfer. Fertil Steril. 2005;83(5):1547-50. \u003c/li\u003e\n\u003cli\u003eP\u0026eacute;rez-Mil\u0026aacute;n F, Caballero-Campo M, Carrera-Roig M, Moratalla-Bartolom\u0026eacute; E, Dom\u0026iacute;nguez-Arroyo JA, Alc\u0026aacute;zar-Zambrano JL, Alonso-Pacheco L, Carugno JA; Spanish Fertility Society Special Interest Group on Organic Reproductive Disorders. Hydrosalpinx treatment before in-vitro fertilization: systematic review and network meta-analysis. Ultrasound Obstet Gynecol. 2025;65(4):414-426.\u003c/li\u003e\n\u003cli\u003eBi B, Han X, Dai W, Fang L, Shi H, Hu L. Comparisons of different treatment outcomes in IVF/ET patients with hydrosalpinx: a retrospective study. Gynecol Endocrinol. 2023;39(1):2249999. \u003c/li\u003e\n\u003cli\u003eCohen A, Almog B, Tulandi T. Hydrosalpinx Sclerotherapy Before In Vitro Fertilization: Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2018;25(4):600-607. \u003c/li\u003e\n\u003cli\u003eGil Y, Krishnamurthy S, Feng J, Tulandi T. Hydrosalpinx Sclerotherapy. J Obstet Gynaecol Can. 2020;42(10):1193. \u003c/li\u003e\n\u003cli\u003eWiebers D.O., Whisnant J.P., Huston J., 3rd, Meissner I., Brown R.D., Jr., Piepgras D.G., Forbes G.S., Thielen K., Nichols D., O\u0026rsquo;Fallon W.M., et al. Unruptured intracranial aneurysms: Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362:103\u0026ndash;110. \u003c/li\u003e\n\u003cli\u003eBae H, Kang T, Jeong DE, Shim K, Kang M. Cilioretinal Artery Occlusion after Endovascular Coil Embolization for Anterior Communicating Artery. Brain Sci. 2021;11(5):542. \u003c/li\u003e\n\u003cli\u003eKumar R, Nair A. Coil occlusion of the large patent ductus arteriosus. Images Paediatr Cardiol. 2008;10(1):8-26. \u003c/li\u003e\n\u003cli\u003eColey SC, Jackson JE. Endovascular occlusion with a new mechanical detachable coil. AJR Am J Roentgenol. 1998;171(4):1075-9. \u003c/li\u003e\n\u003cli\u003eChoi JW, Yoo MY, Kim HC, Paeng JC, Kim YJ, Chung JW. Prophylactic Temporary Occlusion of the Cystic Artery Using a Fibered Detachable Coil During 90Y Radioembolization. Cardiovasc Intervent Radiol. 2017;40(10):1624-1630. \u003c/li\u003e\n\u003cli\u003eWu YC, Huang XF, Yang HY, Chen X, Wang PY, Hu Y, Lin F. Fibered platinum coil: A novel option for the patients of hydrosalpinx with laparoscopic contradiction. Eur J Obstet Gynecol Reprod Biol. 2018; 229:179-184. \u003c/li\u003e\n\u003cli\u003eMelo P, Georgiou EX, Johnson N, van Voorst SF, Strandell A, Mol BWJ, Becker C, Granne IE. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev. 2020;10(10):CD002125. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Infertility, hydrosalpinx, coil, hysteroscopy, tubal factor","lastPublishedDoi":"10.21203/rs.3.rs-6931961/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6931961/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eTo assess pregnancy success rates in hydrosalpinx patients who were unable to go under laparoscopic occlusion and treated with hysteroscopic coil insertion before in vitro fertilization.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective analysis was conducted from January 2023 to May 2025 to evaluate the outcomes of assisted reproductive treatments in patients with hydrosalpinx who were unable to undergo laparoscopic tubal occlusion and instead underwent hysteroscopic coil occlusion prior to an in vitro fertilization cycle. All hysteroscopic coil occlusions were scheduled two months before embryo transfer. Consecutive hysterosalpingographies were performed before and after the hysteroscopic coil insertions to confirm the occlusion of hydrosalpinx. The clinical pregnancy rate and live birth rate were assessed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 10,427 patients were evaluated, of whom 147 were offered laparoscopic tubal ligation for at least one side of hydrosalpinx. Of these, 109 patients consented to undergo tubal ligation at our clinic. However, twelve patients were unable to complete the procedure via laparoscopy and subsequently underwent hysteroscopic proximal tubal occlusion using detachable nylon fiber coils. The mean age of the patients was 36.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 years, and the mean duration of infertility was 7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5 years. Among these twelve patients, eleven had documented endometriosis. One-third of the patients presented with bilateral hydrosalpinx. A total of 11 out of 12 patients experienced successful hysteroscopic coil occlusion with a total number of 16 hydrosalpinges. Only one patient had a complication of coil retention in the uterine cavity, but a third attempt at coil occlusion was successful.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eHysteroscopic coil insertion for tubal occlusion presents a promising alternative treatment for infertility associated with hydrosalpinx, particularly in women for whom laparoscopic procedures are contraindicated.\u003c/p\u003e","manuscriptTitle":"Pregnancy Success Rates Of Hysteroscopic Coil Occlusion In Patients With Hydrosalpinx","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-27 15:21:41","doi":"10.21203/rs.3.rs-6931961/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-25T18:35:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-07T20:14:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-07T07:11:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256870744207253559567144713396099582460","date":"2025-10-29T20:30:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287391572169330084605530962665605617555","date":"2025-10-28T02:30:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-23T20:52:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26409281563029948996516883595237471037","date":"2025-10-20T09:52:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"331832074646270538196160853871648336205","date":"2025-10-18T14:41:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221123807710001571692866529118400436288","date":"2025-10-13T11:19:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-13T10:52:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-19T13:46:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-21T00:49:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-21T00:48:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-06-19T13:54:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fdbf492d-4c8b-44be-bc90-0e7d010bd5fe","owner":[],"postedDate":"October 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T14:09:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-27 15:21:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6931961","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6931961","identity":"rs-6931961","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}