Long-Term Reproductive Outcomes After Palmer-Type Neosalpingostomy in Hydrosalpinx: A Seven-Year Real-World Cohort...

Background: Hydrosalpinx is a major cause of female infertility, but the long-term outcomes of Palmer-type neosalpingostomy remain insufficiently documented. Methods: We retrospectively analyzed 160 women with primary or secondary infertility and laparoscopically confirmed hydrosalpinx who underwent Palmer-type neosalpingostomy at a single specialized center in Romania (2018-2024). Patients were enrolled consecutively, and disease severity was classified intraoperatively using standardized criteria. The primary outcome was clinical pregnancy; secondary outcomes included live birth, miscarriage, ectopic pregnancy, recurrence, and time to conception. Results: The clinical pregnancy rate was 33.8%, intrauterine/live birth rate 25.6%, miscarriage rate 3.8%, and ectopic pregnancy rate 4.4%. Recurrence occurred in 21.2% of cases. Outcomes were strongly influenced by hydrosalpinx severity and pelvic adhesions: women with mild disease achieved the highest pregnancy rates, whereas those with severe adhesions had poor prognosis. Neither age, AMH, nor laterality were independent predictors. Median time to pregnancy was 9 months. Conclusions: Palmer-type neosalpingostomy can achieve satisfactory reproductive outcomes in selected women, particularly those with mild hydrosalpinx and no adhesions. This study provides long-term real-world evidence from Eastern Europe, complementing international literature and emphasizing the importance of individualized patient selection.