Hydrosalpinges adversely affect implantation in donor oocyte cycles

Hydrosalpinges have been associated with poor in-vitro fertilization (IVF) outcome in some, but not all, studies, perhaps through endometrial effects. To determine whether hydrosalpinges affect IVF outcome via endometrial factors alone, we analysed the results of recipients of donor oocytes with hydrosalpinges, thereby controlling for confounding variables, while isolating the intrauterine environment. We retrospectively analysed 110 patients who underwent 121 donor oocyte cycles in a university-based assisted reproduction programme. Thirteen cycles involving recipients (n = 10) with hydrosalpinges were compared to 108 cycles involving recipients (n = 100) without hydrosalpinges. Pregnancy, implantation, miscarriage, and ectopic pregnancy rates were compared between women with and without hydrosalpinges. There were no significant differences between the hydrosalpinx and no hydrosalpinx groups with respect to donor age, recipient age, or number or grade of embryos transferred. Patients with a hydrosalpinx had significantly lower embryo implantation rates (7.1 versus 19.3%, P < 0.05) and significantly higher miscarriage (75.0 versus 14.9%, P < 0.05) and ectopic pregnancy rates (33.3 versus 0.0%, P < 0.05) than normal controls. We conclude that the presence of a hydrosalpinx adversely affects early pregnancy events by altering the intrauterine environment.     

Recurrence of hydrosalpinges after transvaginal aspiration of tubal fluid in an IVF cycle with development of a serometra

The presence of hydrosalpinges has been shown to be deleterious in infertility treatment. Pregnancy rates after in-vitro fertilization (IVF) with embryo transfer decline considerably. This study concerns a patient who developed bilateral hydrosalpinges during controlled ovarian stimulation in preparation for IVF treatment. Transvaginal aspiration of the tubal fluid was unsuccessful as the tubes refilled within 2 days. Additionally, on the day of embryo transfer a serometra developed which could not be seen on the day of oocyte retrieval. The uterine cavity was evacuated via an embryo transfer catheter and three embryos were transferred. The serometra reappeared 3 days after embryo transfer. A pregnancy could not be achieved. The accumulation of fluid in the uterine cavity during an IVF/embryo transfer cycle is a rare complication of hydrosalpinges. However, the retrograde flow of tubal fluid may disturb intrauterine embryo development. This study suggests that the aspiration of hydrosalpinges and intrauterine fluid accumulation during an IVF cycle is not beneficial, as the underlying pathology is not cured. Cancellation of the treatment cycle or cryopreservation of oocytes in the pronucleate stage and transfer of the cryopreserved oocytes after surgical correction of the tubes may be better options.      

Only hydrosalpinges visible on ultrasound are associated with reduced implantation and pregnancy rates after in-vitro fertilization

A retrospective analysis of clinical and laboratory data was made of all in-vitro fertilization (IVF) patients with tubal pathology who had their first ever embryo transfer cycle between January 1st, 1992 and September 1st, 1996. The aim of the study was to determine the effect of the presence of a hydrosalpinx, whether or not visible by ultrasound, on pregnancy, multiple pregnancy and implantation rates in our patient population. The IVF success rate was also analysed by calculating cumulative ongoing pregnancy rates of the same patient group using the lifetime table approach. In the presence of an ultrasound-visible hydrosalpinx, rates of pregnancy and multiple pregnancy appeared reduced, but the differences were not significant. The rates of implantation, clinical implantation and ongoing implantation were significantly lower in the presence of an ultrasound- visible hydrosalpinx (odds ratios 0.33-0.46, C.I. 0.21-0.96). The cumulative chance of achieving an ongoing pregnancy after one or more IVF cycles was significantly reduced in the presence of an ultrasound- visible hydrosalpinx (relative hazard 0.36, C.I. 0.22-0.59). In the presence of a hydrosalpinx not visible by ultrasound the IVF outcome was not reduced. This retrospective study confirms that patients with hydrosalpinges have an impaired IVF outcome. Unique to this study and previously unobserved is the finding that there is a subgroup of patients with hydrosalpinges, those with ultrasound-visible hydrosalpinges, which is exclusively responsible for this impaired outcome.      

Infertility: Hydrosalpinges in in-vitro fertilization: an unfavourable prognostic feature

The aim of this study was to determine whether the presenceof a hydrosalpinx influences in-vitro fertilization (IVF) prognosis.Comparisons were made between 69 IVF cycles in 37 patients carryinghydrosalpinges (hydrosalpinx group) and 67 IVF cycles in 41patients without tubes or surgically sterilized (control group).Twenty-two patients carrying hydrosalpinges underwent salpingectomyor salpingoplasty (operated group); they then underwent 42 IVFtrials which were compared with the two former groups. In thehydrosalpinx group, pregnancy rates by oocyte retrieval were10.1% for clinical and ongoing pregnancies. In the control group,the corresponding pregnancy rates were 23.0 and 21.3% respectively.The implantation rate per embryo was 4.2% for clinical and ongoingpregnancies in the hydrosalpinx group and 11.0 and 10.4% respectivelyin the control group. The operated group had pregnancy ratesof 38.1% for clinical pregnancies and 31.0% for ongoing pregnancies,with implantation rates of 17.4 (clinical) and 14.8% (ongoing)respectively. Pregnancy and implantation rates were statisticallylower in the hydrosalpinx group as compared with controls andwith the operated group. The differences between control andoperated groups were not significant. In conclusion, the presenceof a hydrosalpinx is thus associated with poor prognosis inIVF treatment. Surgical correction of such lesions appears torestore high success rates.     

Delivery rates after in-vitro fertilization following bilateral salpingectomy due to hydrosalpinges: a case control study.

This retrospective case-control study assessed the impact of bilateral salpingectomy due to uni- or bilateral hydrosalpinges on the outcome of in-vitro fertilization (IVF) in a large consecutive series of patients. The effect of bilateral salpingectomy due to hydrosalpinges on pregnancy outcome was compared in 139 patients (263 cycles) and 139 age-matched controls with tubal infertility without hydrosalpinges (296 cycles). The delivery rates per initiated cycle as well as the implantation rates were equal in the two groups (21.7 versus 21.6% and 19 versus 21%). The number of embryos, the cleavage stage, and the embryo morphology score were equal in the two groups. Among 92 patients treated with 182 IVF cycles who underwent salpingectomy between 1.5 and 5 years prior to their first IVF cycle, the delivery and the implantation rates were 22.5 and 20.5% respectively. Of the patients with salpingectomy after an average of 1.7 failed IVF cycles and who re-entered the IVF programme 3 and 6 months subsequent to surgery, 47 were treated with 83 IVF cycles. The live birth and the implantation rates after surgery in this group were 20.5 and 20% respectively. It is concluded that bilateral salpingectomy due to hydrosalpinges restores a normal delivery as well as implantation rate after IVF treatment compared to controls. A favourable outcome is also found in patients operated on after repeated IVF failures. Furthermore, a normal live birth rate as well as a high implantation rate is maintained for at least three IVF cycles subsequent to surgical treatment.     

Hydrosalpinx affects the implantation of previously cryopreserved embryos

The presence of hydrosalpinx has been reported to negativelyaffect the pregnancy and implantation rate after in-vitro fertilization(IVF) with embryo transfer. Hydro-salpinges are able to enlargeduring ovarian stimulation with a possible increased passageof tubal fluid into the endometrial cavity. We report the effectof hydrosalpinges during the transfer of previously cryopreserved/thawedembryos during a natural cycle. In all, 14 transfers in 10 patientswith a sonographically-documented hydrosalpinx during the studiedcycle (group I) were compared to 98 cycles in 74 patients withtubal disease but no such sonographic finding (group II). Bothpregnancy and implantation rates were significantly lower ingroup I (7.14 versus 24.49% and 5.0 versus 10.8% respectively).The presence of hydrosalpinx negatively affects pregnancy andimplantation rates during natural cycles.     

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 embryo transfer in women with a hydrosalpinx might be improved by surgical drainage of the hydrosalpinx at the time of oocyte collection for in- vitro fertilization treatment. A comparative, controlled but retrospective analysis of the results was performed of all women with infective tubal damage aged <40 years old, who had ovulatory cycles, a normal uterus and a partner with normal spermatozoa. A standardized treatment regimen was used. A maximum of three embryos were transferred. Hydrosalpinx was defined by prior hysterosalpingography and/or laparoscopy with transcervical dye injection. A total of 237 embryo transfer cycles in women with hydrosalpinges (tubal distension not visible in 151, visible but not drained in 30 and drained in 56) were compared with 705 embryo transfer cycles in women with tubal disease but no hydrosalpinx. Results were analysed in the first three cycles but also separately in the first cycle to check for bias. Success rates were higher in the first cycle, but did not significantly influence overall differences. Implantation rates were significantly reduced overall in the hydrosalpinx group (8.0 versus 13.2% for controls; P < 0.001), being 8.3% (P < 0.01) in the subgroup without evident tubal distension and 7.5% (not significant) in the drained hydrosalpinx group. This study shows that tubal damage with distal occlusion is associated with a marked reduction in embryo implantation, even in the absence of obvious fluid distension. Surgical drainage of distended hydrosalpinges appears to offer no benefit.      

The optimal number of embryos to be transferred in shared oocyte donation: walking the thin line between low pregnancy rates and multiple pregnancies

There has been growing concern about the number of multiple gestations resulting from assisted reproductive technologies. For in-vitro fertilization (IVF), there are guidelines concerning the number of embryos to be transferred. In oocyte donation, however, there is a paucity of studies addressing this issue and common practice is extrapolated from standard IVF procedures. This may not be correct since endometrial receptivity has been shown to be altered in oocyte donation. Thus the purpose of this study was to assess the optimal number of embryos to be transferred in oocyte donation. The study population included 254 patients with ovarian failure who underwent a total of 601 embryo transfers in a single shared oocyte donation programme. Pregnancy rates (PRs), multiple pregnancies, triplet pregnancy rates, and implantation rates were evaluated according to the number of embryos transferred. A significant linear increase in PRs was noted with the increasing number of embryos transferred up to five (11.1% for one embryo, 36.7% for five embryos). Multiple pregnancies increased significantly from 15.8% for two embryos transferred, to 44.4% for five embryos. The rate of triplet pregnancies also increased from 2.7% for three embryos transferred, to 8.3% for five embryos. Optimization of the number of embryos to be transferred is discussed.      

Hydrosalpinx reduces in-vitro fertilization/embryo transfer pregnancy rates

A retrospective study was designed to examine whether the presenceof a hydrosalpinx influenced pregnancy outcome following in-vitrofertilization (IVF) treatment In stimulated cycles. A totalof 254 women with tubal lesions were included. Patients withone or two hydrosalpinges were compared with patients havingother tubal lesions and pregnancy outcome was analysed. Bothpregnancy and delivery rates were significantly higher in thepatient group without a hydrosalplnx. The results after frozenembryo transfer showed the same tendency. These findings stronglyindicate that a permanent hydrosalpinx has a negative influenceon implantation, as well as on pregnancy, and suggest that amore active approach against large hydrosalpinges should beundertaken before I.VF treatment, in order to improve the pregnancyrates.     

Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF.

Many retrospective studies have shown that hydrosalpinx is associated with poor in-vitro fertilization (IVF) outcome. The mechanism of the actual cause is not yet fully understood. A clinical practice of performing salpingectomy before IVF has developed, without any evidence from prospective trials. The aim of the present prospective randomized trial was to test if a salpingectomy prior to IVF was effective in terms of increased pregnancy rates. Patients with hydrosalpinx were randomized to either a laparoscopic salpingectomy or no intervention before IVF. A total of 204 patients was available for an intention-to-treat analysis and 192 actually started IVF. Clinical pregnancy rates per included patient were 36.6% in the salpingectomy group and 23.9% in the non-intervention group (not significant, P = 0.067) and the ensuing delivery rates were 28.6% and 16.3% (P = 0.045). The corresponding delivery rates per transfer cycle were 29.5% versus 17. 5% (not significant, P = 0.083). A subgroup analysis revealed significant differences in favour of salpingectomy, in implantation rates in patients with bilateral hydrosalpinges (25.6% versus 12.3%, P = 0.038) and in clinical pregnancy rates (45.7% versus 22.5%, P = 0.029) and delivery rates (40.0% versus 17.5%, P = 0.038) in patients with ultrasound visible hydrosalpinges. The delivery rate was increased 3.5-fold in patients with bilateral hydrosalpinges visible on ultrasound (P = 0.019).     

Ultrasound-guided aspiration of hydrosalpinges is associated with improved pregnancy and implantation rates after in-vitro fertilization cycles

Previous reports have shown that the presence of hydrosalpinges may have a detrimental effect on in-vitro fertilization (IVF) outcomes and salpingectomy has been recommended by some authors as a means of improving IVF pregnancy rates. Our first objective was to determine the effect of hydrosalpinges diagnosed by ultrasound on IVF outcomes in our clinic. Our second objective was to examine the effects of aspiration of hydrosalpinges at the time of oocyte retrieval on IVF outcomes. Women with hydrosalpinges (n=34) were compared with women who had tubal disease but no hydrosalpinges (n=124) and were found to have a reduced clinical pregnancy rate (18 % versus 37%, P=0.053), a reduced ongoing pregnancy rate (15 versus 34%, P=0.051), and a reduced implantation rate (7 versus 18%, P=0.003) after IVF procedures. Among women with hydrosalpinges present, 16 had their hydrosalpinges aspirated at the time of oocyte retrieval and 18 did not. Aspiration of hydrosalpinges was associated with a higher clinical pregnancy rate (31 versus 5%, P=0.07), a higher ongoing pregnancy rate (31 versus 0%, P=0.015), and a higher implantation rate (14 versus 1%, P=0.015). This study confirms the association between the presence of hydrosalpinges and poor IVF outcomes. We find that aspiration of hydrosalpinges at the time of oocyte retrieval leads to improved pregnancy rates and may be an acceptable alternative to salpingectomy for treatment of these patients.      

Effects of human hydrosalpinx fluid on in-vitro murine fertilization

Patients with hydrosalpinges show a decrease of both fertility and clinical outcome of IVF and embryo transfer treatment. Several reports have demonstrated the negative effects of hydrosalpinx fluid (HSF) on embryo development and implantation. The aim of this study was to determine whether human HSF, collected from infertile patients, might exhibit a deleterious effect on gametes and fertilization using a murine IVF system. Murine gametes were co-incubated during IVF until first cleavage with human HSF diluted to 50% from four patients (HSF1-4). It was demonstrated that HSF affected fertilization, as determined by the count of the 2-cell embryos. Pre-incubation of spermatozoa with HSF during capacitation significantly lowered the percentage of 2-cell embryos (P < 0.05). While HSF1-3 had no significant effect on motility and viability of spermatozoa, HSF4 almost completely affected their survival. In contrast, pre-incubation of ovulated oocytes surrounded by their cumulus cells with HSF before IVF did not impede first cleavage. Taken together, these results suggest that HSF has a cytotoxic effect on spermatozoa and/or impairs the fertilization process, probably by altering capacitation/acrosome reaction and/or ligand(s)-receptor(s) interactions. Hydrosalpinges may be partly associated with sterility through HSF inhibitory effects on fertilization.     

Implantation: Low implantation rate after in-vitro fertilization in patients with hydrosalpinges diagnosed by ultrasonography

The purpose of this study was to assess whether patients withtubal infertility and a hydrosalpinx have a reduced implantationrate after in-vitro fertilization. The study included 741 patientswho had 1190 consecutive oocyte aspirations. The presence orabsence of hydrosalpinges was assessed by transvaginal ultrasonographyon day 2 of all cycles. In 62 patients treated in 104 cyclesa hydrosalpinx was diagnosed, whereas 493 patients treated in813 cycles had no hydrosalpinx and eight patients treated in16 cycles had uncertain hydrosalpinx. The results show thatthe presence of a hydrosalpinx is associated with a reducedpregnancy rate per aspiration (19.2 versus 32.6% P < 0.01),reduced implantation rate (2.9 versus 10.3%, P < 0.0005),reduced delivery rate per aspiration (5.8 versus 20.9%, P <0.0005), reduced delivery rate per embryo transfer (6.6 versus22.8%, P < 0.0005) and increased early pregnancy loss (70versus 36%, P < 0.005). Among 178 patients with unexplainedinfertility or other infertility factors treated with 257 aspirationsthe results were similar to those in patients with tubal infertilitywithout a hydrosalpinx. In conclusion, the presence of a hydrosalpinxdoes not impair the number of embryos transferred but seemsto impair the implantation process. We hypothesize that thismay be due to leakage of fluid into the uterine cavity whichmay disturb the receptivity of the endometrium and/or the developingembryos.     

New insights into the mechanisms underlying hydrosalpinx fluid formation and its adverse effect on IVF outcome

The adverse effects of hydrosalpinx on the outcome of IVF have been well documented; however, the causes for impaired implantation in patients with hydrosalpinx are poorly understood. Hydrosalpinx fluid has been shown to be toxic to mouse embryos but not human embryos, and this has become a topic of intense debate. An understanding of the mechanisms underlying hydrosalpinx formation following pelvic inflammatory disease appears to be essential in elucidating the causes for reduced implantation in hydrosalpinx patients and providing more rational treatments. This review discusses the mechanisms underlying hydrosalpinx formation and its adverse effect on IVF outcome, with new insights into possible involvement of Fallopian tube epithelial transporters and ion channels, particularly the cystic fibrosis transmembrane conductance regulator (CFTR). Possible links between Chlamydia trachomatis in pelvic inflammatory disease and the subsequent CFTR-mediated events in hydrosalpinx formation leading to infertility in hydrosalpinx are proposed. The causes of reduced implantation, particularly in patients with visible hydrosalpinges shown on ultrasound scanning, are re-examined in light of these possible mechanisms.     

Embryo quality and uterine receptivity in in-vitro fertilization cycles with or without agonists of gonadotrophin-releasing hormone

The proportion of abnormal oocytes or embryos per recovered oocyte in in-vitro fertilization (IVF) cycles had no influence on the occurrence of pregnancy following the transfer of normal embryo(s) derived from oocytes capable of fertilization. There were more implantations per transferred embryo in stimulated IVF cycles using long-acting buserelin (30.0%) compared with short-acting decapeptyl (17.3%) or no gonadotrophin-releasing hormone agonist (GnRHa, 15.2%) treatments. However, the chances of implantation per embryo transferred being in excess of one in patients who became pregnant tended to be higher in non-GnRHa (23.5%) compared to buserelin- (16.4%) or decapeptyl- (13.3%) treated IVF cycles. Moreover, frozen--thawed embryos had a higher implantation rate (P less than 0.05) when originating from IVF cycles without GnRHa (11.7%) compared to GnRHa-treated cycles (buserelin, 4.3%; decapeptyl, 5.9%). It can be concluded that GnRHa associated with gonadotrophins produced embryos of a poorer aptitude for development than stimulation treatments without GnRHa. The clinical efficacy of GnRHa in IVF--ET cycles could be the result of an improved uterine receptivity to the transferred embryos.     

Hydrosalpinges adversely affect markers of endometrial receptivity

While in-vitro fertilization (IVF) was initially developed in women with tubal factor infertility, recent clinical studies have suggested that the presence of hydrosalpinges lowers implantation and pregnancy rates. We postulated that these hydrosalpinges cause impaired endometrial receptivity. A total of 103 women with hydrosalpinges were prospectively evaluated, and compared with 55 infertile and 44 fertile controls. All women had endometrial biopsies during the window of implantation, analysed by conventional histological criteria, and also stained for three integrin markers of endometrial receptivity (alpha1beta1, alpha4beta1 and alpha vbeta3). Women with hydrosalpinges (cases) expressed significantly less of the alpha vbeta3 integrin compared with controls. There was no difference in expression of alpha1beta1 or alpha4beta1 among groups. A significantly greater number of cases had out of phase histology and missing alpha vbeta3 (type I defects) and absent integrin expression despite normal histological maturation (type II) defects, compared with controls. Of 20 women with impaired endometrial receptivity who were also biopsied after hydrosalpinx surgery, 70% demonstrated increased alpha vbeta3 expression. Seventy-seven percent of type I and 57% of type II defects were corrected postoperatively. Using markers of endometrial receptivity, this study demonstrates that inflammatory hydrosalpinges have an adverse effect on endometrial receptivity, which in some cases may be overcome by surgical treatment of the hydrosalpinx.      

In-vitro fertilization outcome in women with hydrosalpinx

Recent studies have suggested that the presence of hydro-salpinxhas a negative effect on in-vitro fertilization (IVF) outcome,with markedly diminished implantation and pregnancy rates, andincreased early pregnancy loss. We evaluated the impact of hydrosalpinxon IVF outcome in a large population with tubal factor infertility:63 patients with hydrosalpinx and 60 without hydrosalpinx (nohydro-salpinx) underwent 103 and 89 IVF cycles respectively.Hydrosalpinx was diagnosed by hysterosalpingography and/or laparoscopyprior to IVF. Patients were further subdivided into those withor without elevated quantitative serum Chlamydia trachomatisIgG antibody (Ab) titres. All couples with elevated serum Abtitres (I: 16 or more) were treated with doxycycline (100 mgbid.) 10 days prior to the first IVF cycle. In all, 88 women(71.5%) had elevated C. trachomatis Ab: 47 women (74.6%) withhydrosalpinx had elevated titres, compared to 41 (683%) in theno hydrosalpinx group. There were no significant differencesin mean age, number of mature oocytes obtained, and number ofembryos transferred between the two groups. There was a trendfor a higher implantation rate and ongoing pregnancy rate inthe no hydrosalpinx group compared to the hydrosalpinx group(12.6 versus 9.8%, and 33.7 versus 24.8% respectively); however,this did not reach statistical significance. The incidence ofearly pregnancy loss was similar in the two groups. Two ectopicpregnancies were noted in the hydrosalpinx group compared tonone in the no hydrosalpinx group. As expected, the prevalenceof elevated titres of C. trachomatis IgG Ab in patients withtubal factor infertility presenting for assisted reproductivetreatment was high. In contrast to recently published reports,our study did not confirm a negative effect of hydrosalpinxon IVF outcome when antibiotic treatment was given prior toassisted reproductive treatment. Prospective multicentre studiesevaluating the effect of hydrosalpinx and its treatment on IVFoutcome are needed.     

Is there any benefit from the culture of a single oocyte to a blastocyst-stage embryo in unstimulated cycles?

BACKGROUND: The aim of the study was to test the influence of 2- and 5-day cultivation of a single oocyte on the pregnancy rate in a non-stimulated cycle. METHODS: A retrospective chart review of 391 consecutive patients undergoing IVF and intracytoplasmic sperm injection in unstimulated cycles was performed. The embryos were kept in MediCult universal IVF medium for day 2 transfers and in BlastAssist System for day 5 transfers. RESULTS: The oocyte recovery rate in the group for 2-day cultivation and in the group for 5-day cultivation was similar, being 79.4 (162/204) and 83.6% (154/187) respectively. The same is true of the fertilization rate (73.8 versus 77.7%). The blastulation rate was 52.8%. The embryo transfer rate per cycle was higher when day 2 embryos were transferred: 64.8% (105/162) compared with 35.7% (55/154) if blastocyst-stage embryos were transferred. The pregnancy rate per transferred embryo was higher when a blastocyst was transferred (40.0%) instead of a day 2 embryo (23.8%). CONCLUSION: The expected pregnancy rate calculated per embryo available on day 2 of cultivation was similar in both groups (23.8 versus 22.2%) and it was not affected by oocyte culture to the blastocyst stage.     

Laparoscopic salpingectomy for women with hydrosalpinges enhances the success of IVF: a Cochrane review

BACKGROUND: The aim of this study was to determine whether surgical intervention is effective for women with tubal disease who are due to undergo treatment with IVF. METHODS: A systematic review employing the principles of the Cochrane Menstrual Disorders and Subfertility Group was undertaken. Three randomized controlled trials were included, the population of women in all three studies having hydrosalpinges. RESULTS: The odds of pregnancy [odds ratio (OR) = 1.75, 95% confidence interval (CI) 1.07-2.86] and of ongoing pregnancy and live birth (OR = 2.13, 95% CI 1.24-3.65) were increased with laparoscopic salpingectomy for hydrosalpinges prior to IVF. There were no significant differences in the odds of embryo implantation (OR = 1.34, 95% CI 0.87-2.05), ectopic pregnancy (OR = 0.42, 95% CI 0.08-2.14), miscarriage (OR = 0.49, 95% CI 0.16-1.52) or treatment complications (OR = 5.80, 95% CI 0.35-96.79). No data were available concerning the odds of multiple pregnancy or the proportion of IVF cycles resulting in embryo transfer. CONCLUSION: Laparoscopic salpingectomy should be considered for all women with hydrosalpinges due to undergo IVF; further research is required to assess other pre-IVF surgical interventions (such as needle aspiration of hydrosalpinx fluid, laparoscopic proximal tubal occlusion and laparoscopic salpingostomy) for women with hydrosalpinges.     

Is hydrosalpinx fluid cytotoxic?

Accumulation of oviductal fluid in the ampullar lumen as a result of occlusion of the infundibulum is referred to as hydrosalpinx. A low pregnancy rate (10%) after in-vitro fertilization (IVF) in hydrosalpinx patients and a relatively high incidence (50%) of abortions during the first trimester suggested that leakage of this fluid into the uterine cavity may exert a cytotoxic effect on the developing embryo. To examine this possibility, we analysed the composition of the hydrosalpinx fluid and tested its effect on human granulosa cells and embryos. Hydrosalpinx fluids and granulosa cells were collected from IVF patients at ovum pick-up. IVF eggs containing three pronuclei (3PN) were employed for this study. Analysis of hydrosalpinx fluids revealed electrolyte concentrations similar to those in serum with lower amounts of total protein and albumin. No blood cells were detected and bacterial cultures were negative. Granulosa cells incubated in hydrosalpinx fluid-containing medium (diluted 1:1) were not morphologically different and showed a steroidogenic capacity that was higher than that of cells incubated in its absence. Fertilized 3PN eggs incubated in IVF culture medium successfully developed into 6- to 8- and 8- to 16-cell embryos within 48 and 72 h, respectively. This rate of embryonal development was not impaired by hydrosalpinx fluid (at either 50 or 100% concentration). In the absence of a demonstrable detrimental effect we suggest that the low implantation rate in hydrosalpinx IVF patients may not be due to an embryotoxic effect. We further suggest that constant passage of fluid into the uterine cavity in these patients could possibly introduce some mechanical interference that may result in implantation failure.