Impact of Hydrosalpinx and Surgical Timing on Ovarian Reserve and Response in in vitro fertilization or intracytoplasmic sperm injection patients: A Retrospective Cohort Study with Propensity Score Analysis

Objective To investigate the impact of hydrosalpinx and the timing of surgical intervention on ovarian reserve and ovarian response in in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) patients. Design, setting, and participants: This study retrospectively collected the medical records of IVF/ICSI patients who underwent IVF/ICSI treatment in Reproductive Hospital Affiliated to Shandong University from January 2017 to December 2021. Patients were divided into hydrosalpinx group (n = 1366) and control group (n = 16038), and according to whether the hydrosalpinx was treated before controlled ovarian hyperstimulation (COH), the hydrosalpinx group was further divided into COH-first group (A) and surgery-first group (B). Finally, Group B was subdivided into three subgroups based on different surgical approaches. Results Compared to controls, the hydrosalpinx group had significantly lower AMH and AFC levels ( P  < 0.0001). Additionally, this group required higher starting and total gonadotropin (Gn) doses, a longer duration of ovarian stimulation, and greater human chorionic gonadotropin (hCG) dosages during COH (all P  < 0.05). Similarly, the A group showed markedly reduced AMH ( P  < 0.0001) and AFC (vs. surgery-first and control groups, P  < 0.0001). And AMH levels were higher in the salpingostomy group than in Group A (4.12 ± 2.93 vs 2.91 ± 2.00 ng/mL, P  = 0.012). Gn starting doses were lower in the B and control groups than in the A group ( P  < 0.0001), whereas stimulation duration and hCG dosage were elevated in the latter ( P  < 0.05). On hCG trigger day, the B group had more follicles ≥ 14 mm ( P  < 0.05), higher number of oocytes retrieved ( P  < 0.05), and superior embryological outcomes (2PN, good-quality embryos, and blastocyst numbers; all P  < 0.05) relative to both A and control groups. However, the salpingostomy group yielded more high-quality embryos than the salpingectomy group (4.85 ± 3.36 vs 3.33 ± 3.11, P =  0.034). Conclusion Hydrosalpinx is associated with diminished ovarian reserve and an impaired ovarian response during COH. Surgical treatment (especially salpingostomy) of hydrosalpinx prior to COH may improve these functional parameters.