Hydrosalpinx functional surgery or salpingectomy? The importance of hydrosalpinx fluid in assisted reproductive technologies

Mandakini Parihar, Aparna Mirge, Reshma Hasabe, Mandakini Parihar, Aparna Mirge, Reshma Hasabe

Abstract

The first IVF baby, Louise Brown, was born in a natural cycle IVF of a woman who had bilateral tubal block making IVF the only option for having a child. The last 3 decades has seen astounding progress in the field of ART. Today thanks to ART, tubal disease and tubal factor infertility is easily overcome. The accepted theory today is that the hydrosalpinx fluid plays a causative role in the reduced pregnancy rate with ART. It is well known that the success of ART for patients with tubal disease with hydrosalpinx is reduced by half compared with patients without hydrosalpinx. Ideal would be removal of a hydrosalpinx by laparoscopic salpingectomy to improve pregnancy rates. However in some cases this is not feasible due to dense pelvic adhesions making access difficult. In such cases it is recommended that even de-linking the tube from the uterus would help in improving the ART outcome. There is suggestion that sonographically visible hydrosalpinges and those affected bilaterally have a poorer prognosis than those seen incidentally at laparoscopy. While there is clinical evidence supporting the causative role of the fluid itself, there is a lack of knowledge as to how the fluid exerts its negative effects. It is generally believed that the fluid holds a key position in impairing implantation potential. The aim of this review is to highlight the importance of identifying hydrosalpinges and its association with reduced fertility outcome using assisted reproductive technologies. Here we have discussed the different options available for the same, and highlighted the current modes of treatment.

Keywords: ART; Hydrosalpinx; hydrosalpinx fluid; pregnancy outcome.

Conflict of interest statement

Conflict of Interest: None.

References

    1. Strandell A. The influence of hydrosalpinx on in-vitro fertilisation and embryo transfer: A review. Hum Reprod Update. 2000;6:387–95.
    1. Puttemans P, Campo R, Gordts R, Brosens I. Hydrosalpinx and ART. Hum Reprod. 2000;15:1427–30.
    1. Camus E, Poncelet C, Goffinet F, Wainer B, Merlet F, Nisand I, et al. Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: A meta-analysis of published comparative studies. Hum Reprod. 1999;14:1243–9.
    1. Dar P, Sachs GS, Strassburger D, Bukovsky I, Arieli S. Ovarian function before and after salpingectomy in artificial reproductive technology patients. Hum Reprod. 2000;15:142–4.
    1. Strandell A, Lindhard A, Waldenström U, Thorburn J, Janson PO, Hamberger L. Hydrosalpinx and IVF outcome: A prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF. Hum Reprod. 1999;14:2762–9.
    1. Strandell A, Sjogren A, Bentin-Ley U, Thorburn J, Hamberger L, Brännström M. Hydrosalpinx fluid does not adversely affect the normal development of human embryos and implantation in vitro. Hum Reprod. 1998;13:2921–5.
    1. Chen CD, Yang JH, Lin KC, Chao KH, Ho HN, Yang YS. The significance of cytokines, chemical composition, and murine embryo development in hydrosalpinx fluid for predicting the IVF outcome in women with hydrosalpinx. Hum Reprod. 2002;17:128–33.
    1. Johnson NP, Mak W, Sowter MC. Laparoscopic salpingectomy for women with hydrosalpinges enhances the success of IVF: A Cochrane review. Hum Reprod. 2002;17:543–8.
    1. Johnson NP, Mak W, Sowter MC. Surgical treatment for tubal disease in women due to undergo in vitro fertilization. Cochrane Database Syst Rev. 2004;4:CD002125.
    1. de Wit W, Gowrising CJ, Kuik DJ, Lens JW, Schats R. Only hydrosalpinges visible on ultrasound are associated with reduced implantation and pregnancy rates after in-vitro fertilization. Hum Reprod. 1998;13:1696–701.
    1. Lass A. What effect does a hydrosalpinx have on assisted reproduction? What is the preferred treatment for hydrosalpinges? The ovary's perspective. Hum Reprod. 1999;14:1674–7.
    1. Strandell A, Lindhard A, Waldenstrom U, Thorburn J. Hydrosalpinx and IVF outcome: Cumulative results in a randomized controlled trial. Hum Reprod. 2001;16:2403–10.
    1. Levi AJ, Segars JH, Miller BT, Leondires MP. Endometrial cavity fluid is associated with poor ovarian response and increased cancellation rates in ART cycles. Hum Reprod. 2001;16:2610–5.
    1. Eytan O, Azem F, Gull I, Wolman I, Elad D, Jaffa AJ. The mechanism of hydrosalpinx in embryo implantation. Hum Reprod. 2001;16:2662–7.
    1. Chen CD, Yang JH, Lin KC, Chao KH, Ho HN, Yang YS. The significance of cytokines, chemical composition, and murine embryo development in hydrosalpinx fluid for predicting the in-vitro fertilization outcome in women with hydrosalpinx. Hum Reprod. 2002;17:128–33.
    1. IJland MM, Hoogland HJ, Dunselman GA, Lo CR, Evers JL. Endometrial wave direction switch and the outcome of in vitro fertilization. Fertil Steril. 1999;71:476–81.
    1. Dechaud H, Daurès JP, Arnal F, Humeau C, Hédon B. Does previous salpingectomy improve implantation and pregnancy rates in patients with severe tubal factor infertility who are undergoing in vitro fertilization. A prospective randomized pilot study? Fertil Steril. 1998a;69:1020–5.
    1. Puttemans PJ, Brosens IA. Salpingectomy improves in-vitro fertilization outcome in patients with a hydrosalpinx: Blind victimization of the Fallopian tube? Hum Reprod. 1996;11:2079–81.
    1. Strandell A, Waldenström U, Nilsson L, Hamberger L. Hydrosalpinx reduces in-vitro fertilization/embryo transfer pregnancy rates. Hum Reprod. 1994;9:861–3.
    1. Sharara FI. What effect does hydrosalpinx have on assisted reproduction. The role of hydrosalpinx in IVF: Simply mechanical? Hum Reprod. 1999;14:577–8.
    1. Vasquez G, Boeckx W, Brosens I. Prospective study of tubal mucosal lesions and fertility in hydrosalpinges. Hum Reprod. 1995a;10:1075–8.
    1. Vasquez G, Boeckx W, Brosens I. No correlation between peritubal and mucosal adhesions in hydrosalpinges. Fertil Steril. 1995b;64:1032–3.
    1. Puttemans PJ, De Bruyne F, Heylen SM. A decade of salpingoscopy. Eur J Obstet Gynecol Reprod Biol. 1998;81:197–206.
    1. Dechaud H, Daurès JP, Hedon B. Prospective evaluation of falloposcopy. Hum Reprod. 1998b;13:1815–8.
    1. Marana R, Muzii L, Rizzi M, dell’Acqua S, Mancuso S. Prognostic role of laparoscopic salpingoscopy of the only remaining tube after contralateral ectopic pregnancy. Fertil Steril. 1995;63:303–6.
    1. Marana R, Catalano GF, Muzii L, Caruana P, Margutti F, Mancuso S. The prognostic role of salpingoscopy in laparoscopic tubal surgery. Hum Reprod. 1999;14:2991–5.
    1. Watrelot A, Dreyfus JM, Andine JP. Evaluation of the performance of fertiloscopy in 160 consecutive infertile patients with no obvious pathology. Hum Reprod. 1999;14:707–11.
    1. Surrey ES. Microendoscopy of the human fallopian tube. J Am Assoc Gynecol Laparosc. 1999;6:383–9.
    1. De Bruyne F, Puttemans P, Boeckx W, Brosens I. The clinical value of salpingoscopy in tubal infertility. Fertil Steril. 1989;51:339–40.
    1. Andersen AN, Lindhard A, Loft A, Ziebe S, Andersen CY. The infertile patient with hydrosalpinges - IVF with or without salpingectomy? Hum Reprod. 1996;11:2081–4.
    1. Zeyneloglu HB, Arici A, Olive DL. Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization-embryo transfer. Fertil Steril. 1998;70:492–9.
    1. Strandell A, Lindhard A. Why does hydrosalpinx reduce fertility. The importance of hydrosalpinx fluid? Hum Reprod. 2002;17:1141–5.
    1. Puttemans P, Campo R, Gordts S, Brosens I. Hydrosalpinx and ART - surgery or ART? Hum Reprod. 2000;15:1427–30.
    1. Bontis JN. Laparoscopic management of hydrosalpinx. Ann N Y Acad Sci. 2006;1092:199–210.
    1. Granot I, Dekel N, Segal I, Fieldust S, Shoham Z, Barash A. Is hydrosalpinx fluid cytotoxic? Hum Reprod. 1998;13:1620–4.
    1. Barmat LI, Nasti K, Yang X, Spandorfer S, Kowalik A, El-Roeiy A. Are cytokines and growth factors responsible for the detrimental effects of hydrosalpingeal fluid on pregnancy rates after in vitro fertilization-embryo transfer? Fertil Steril. 1999;72:1110–2.
    1. Dechaud H, Hedon B. What effect does hydrosalpinx have on assisted reproduction. The role of salpingectomy remains controversial? Hum Reprod. 2000;15:234–5.
    1. Hammadieh N, Coomarasamy A. Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves pregnancy outcome in IVF: A randomized controlled trial. Hum Reprod. 2008;23:1113–7.
    1. Sharara FI. Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves outcome in IVF. Hum Reprod. 2009;24:756.
    1. Van Voorhis BJ, Sparks AE, Syrop CH, Stovall DW. Ultrasound-guided aspiration of hydrosalpinges is associated with improved pregnancy and implantation rates after in-vitro fertilization cycles. Hum Reprod. 1998;13:736–9.
    1. Bedaiwy MA, Goldberg JM, Singh M, Sharma R, Wang X, Nelson D, et al. Relationship between oxidative stress and embryotoxicity of hydrosalpingeal fluid. Hum Reprod. 2002;17:601–4.
    1. de Vantéry Arrighi C, Lucas H, El-Mowafi D, Campana A, Chardonnens D. Effects of human hydrosalpinx fluid on in-vitro murine fertilization. Hum Reprod. 2001;16:676–82.
    1. Tay JI, Rutherford AJ, Killick SR, Maguiness SD, Partridge RJ, Leese HJ. Human tubal fluid: Production, nutrient composition and response to adrenergic agents. Hum Reprod. 1997;12:2451–6.
    1. Dickens CJ, Maguiness SD, Comer MT, Palmer A, Rutherford AJ, Leese HJ. Human tubal fluid: Formation and composition during vascular perfusion of the Fallopian tube. Hum Reprod. 1995;10:505–8.
    1. Simón C, Gimeno MJ, Mercader A, O’Connor JE, Remohi J, Polan ML, et al. Embryonic regulation of integrins beta 3, alpha 4, and alpha 1 in human endometrial epithelial cells in vitro. J Clin Endocrinol Metab. 1997;82:2607–16.
    1. Sawin SW, Loret de Mola JR, Monzon-Bordonaba F, Wang CL, Feinberg RF. Hydrosalpinx fluid enhances human trophoblast viability and function in vitro: implications for embryonic implantation in assisted reproduction. Fertil Steril. 1997;68:65–71.
    1. Meyer WR, Castelbaum AJ, Somkuti S, Sagoskin AW, Doyle M, Harris JE, et al. Hydrosalpinges adversely affect markers of endometrial receptivity. Hum Reprod. 1997;12:1393–8.
    1. Mansour RT, Aboulghar MA, Serrour GI, Riad R. Fluid accumulation of the uterine cavity before embryo transfer: A possible hindrance for implantation. J In vitro Fert Embryo Transf. 1991;8:157–9.
    1. Kontoravdis A, Makrakis E, Pantos K, Botsis D, Deligeoroglou E, Creatsas G. Proximal tubal occlusion and salpingectomy result in similar improvement in IVF outcome in patients with hydrosalpinx. Fertil Steril. 2006:1642–9.
    1. Ozmen B, Diedrich K, Al-Hasani S. Hydrosalpinx and IVF: Assessment of treatments implemented prior to IVF. Reprod Biomed Online. 2007;14:235–41.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere