Abstract
BACKGROUND: Hydrosalpinx remains a major cause of female infertility, with Palmer-type neosalpingostomy representing a fertility-preserving alternative to salpingectomy in selected patients. While disease severity is a well-established prognostic factor, the contribution of endocrine and infectious comorbidities to reproductive outcomes after tubal reconstruction remains poorly characterized. PATIENTS, MATERIALS AND METHODS: This retrospective cohort study included 160 women with hydrosalpinx who underwent Palmer-type neosalpingostomy between January 2018 and December 2024 at Independenţa VitaPlus Hospital, Craiova, Romania. Endocrine and infectious comorbidities were systematically assessed preoperatively, including polycystic ovary syndrome (PCOS), thyroid dysfunction, obesity, diabetes, pelvic inflammatory disease (PID), and urinary tract infections (UTI). Pregnancy outcomes were evaluated over a 24-month follow-up period. Statistical analysis included Kaplan-Meier survival estimates and multivariate logistic regression to identify independent predictors of clinical pregnancy. RESULTS: PCOS (30.6%), PID (28.2%), and UTI (18.1%) were the most common comorbidities. Hydrosalpinx severity was the only independent predictor of clinical pregnancy [odds ratio (OR) 0.38, p<0.001]. Although endocrine and infectious comorbidities did not reach statistical significance in multivariate models, Kaplan-Meier analysis revealed observable prolongation in time-to-pregnancy for patients with PID, PCOS, or obesity. Increasing infectious burden (≥2 pathogens) was associated with higher pelvic adhesion rates and reduced conception probabilities. CONCLUSIONS: Hydrosalpinx severity remains the main determinant of reproductive prognosis after Palmer-type neosalpingostomy. However, endocrine and infectious comorbidities exert clinically relevant negative effects, supporting a comorbidity-informed approach to patient selection and preoperative optimization. Prospective, multicenter studies with in vitro fertilization (IVF) comparison arms are warranted to refine prognostic models and optimize fertility counseling and treatment strategies.