The influence of hydrosalpinx on IVF and embryo transfer: a review

Several retrospective studies have shown an impaired outcomeof IVF in the presence of hydrosalpinx. The retrospective datahave been compiled and presented in meta-analyses, demonstratinga reduction by half in the probability of achieving a pregnancyin the presence of hydrosalpinx and a doubled rate of spontaneousabortion. The main theories trying to explain the underlyingmechanisms have focused on potential embryotoxic propertiesof the fluid or impaired endometrial receptivity to implantation.Several mouse studies have suggested an embryotoxic effect ofthe hydrosalpingeal fluid, a finding which is not supportedin studies on human embryos. It is believed that the fluid exertsa detrimental effect on the endometrium by altering the receptivityor simply by causing a mechanical hindrance for implantation.Different treatment options would then be tubal ligation, salpingostomy,aspiration of hydrosalpinx fluid or salpingectomy. The effectof aspiration has been studied in a few retrospective trialswith contradictory results. Treatment with salpingectomy hasentered into clinical practice without proper evidence for itsbenefit. Concerns have also been raised about the potentialhazard of surgical intervention to ovarian circulation and function.A randomized controlled trial on salpingectomy prior to IVFhas now been conducted as a multicentre study in Scandinavia.Laparoscopic salpingectomy prior to IVF was shown to be beneficialin patients with large hydrosalpinges that were visible on ultrasound,a result which supports the theory of the fluid being involvedin the impaired implantation process.