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

<b>Background:</b> Hydrosalpinx is a major cause of female infertility, but the long-term outcomes of Palmer-type neosalpingostomy remain insufficiently documented. <b>Methods:</b> 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. <b>Results:</b> The clinical pregnancy rate was <b>33.8%</b>, intrauterine/live birth rate <b>25.6%</b>, miscarriage rate <b>3.8%</b>, and ectopic pregnancy rate <b>4.4%</b>. Recurrence occurred in <b>21.2%</b> 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 <b>9 months</b>. <b>Conclusions:</b> 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.