Is the outcome of in-vitro fertilization and embryo transfer treatment improved by spontaneous or surgical drainage of a hydrosalpinx?

A pilot study was designed to examine whether the outcome of embryotransfer in women with a hydrosalpinx might be improved by surgicaldrainage of the hydrosalpinx at the time of oocyte collection for in- vitrofertilization treatment. A comparative, controlled but retrospectiveanalysis of the results was performed of all women with infective tubaldamage aged <40 years old, who had ovulatory cycles, a normal uterus anda partner with normal spermatozoa. A standardized treatment regimen wasused. A maximum of three embryos were transferred. Hydrosalpinx was definedby prior hysterosalpingography and/or laparoscopy with transcervical dyeinjection. A total of 237 embryo transfer cycles in women withhydrosalpinges (tubal distension not visible in 151, visible but notdrained in 30 and drained in 56) were compared with 705 embryo transfercycles in women with tubal disease but no hydrosalpinx. Results wereanalysed in the first three cycles but also separately in the first cycleto check for bias. Success rates were higher in the first cycle, but didnot significantly influence overall differences. Implantation rates weresignificantly reduced overall in the hydrosalpinx group (8.0 versus 13.2%for controls; P < 0.001), being 8.3% (P < 0.01) in the subgroupwithout evident tubal distension and 7.5% (not significant) in the drainedhydrosalpinx group. This study shows that tubal damage with distalocclusion is associated with a marked reduction in embryo implantation,even in the absence of obvious fluid distension. Surgical drainage ofdistended hydrosalpinges appears to offer no benefit.