With great interest, we read the article of Zhang et al. They describe a large cohort of patients treated with sclerotherapy for hydrosalpinx prior to in vitro fertilization (IVF). All patients tolerated the procedure well and no complications occurred. The pregnancy rate after IVF in the patients with sclerotherapy was higher compared with the group of patients without sclerotherapy. Therefore, the authors concluded that “ultrasound sclerotherapy could improve pregnancy rate and might be served as an effective, safe, and acceptable prophylactic intervention alternative to salpingectomy for patients with hydrosalpinx.”

The treatment for hydrosalpinx advised by the American Society for Reproductive Medicine is salpingectomy or proximal tubal occlusion. When investigating the efficacy of a new therapy, a comparison should be made with the standard treatment option. Is it correct to state that sclerotherapy could serve as an alternative to salpingectomy without the use of patients who underwent salpingectomy for hydrosalpinx as a control group? Moreover, is it ethical to perform a new treatment without offering the investigated patients the choice for the standard treatment?

Unbiased comparison of sclerotherapy with the standard treatment can be investigated only in a randomized controlled trail (RCT). In the current paper, the selection of the patient population is not thoroughly described. Moreover, it is unknown whether the patients, included in the study by Jiang et al, were also used for analysis in the current paper. In particular, the introduction of a new treatment should be performed within a RCT.

So far, the literature on the negative effect of salpingectomy on the ovarian function is controversial. Whereas the possible complications of salpingectomy are widely discussed in the current paper, the description of possible complications of sclerotherapy for hydrosalpinx is sparse. It is reported that no complications occurred and also the neonatal outcome was not negatively affected. Unfortunately, the manner of detection of the complications was not described. Thorough screening for possible side effects of a new treatment is necessary to prevent widespread use of an unsafe technique. The finding of multiple adhesions at laparoscopy after sclerotherapy described by Shokeir is shocking and warrants further investigation on the safety of sclerotherapy.

Every new treatment option is potentially harmful. Therefore, it is essential to investigate the possible negative and positive effects a new treatment carefully. The only accurate way in which this can be performed is an RCT in which the new treatment is compared with the standard treatment. We are looking forward to the first RCT on ethanol sclerotherapy compared with salpingectomy or proximal tubal occlusion for patients with hydrosalpinx prior to IVF.