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Hydrosalpinx and IVF: Effect and Management

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Hydrosalpinx and IVF: Effect and Management ARC Journal of Gynecology and Obstetrics Volume 4, Issue 1, 2019, PP 21-23 ISSN 2456-0561 DOI: http://dx.doi.org/10.20431/2456-0561.0401004 www.arcjournals.org Hydrosalpinx and IVF: Effect and Management Akmal El-Mazny, MD, FICS* Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt *Corresponding Author: Akmal El-Mazny, MD, FICS, Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt, Email: [email protected] Abstract : Patients with a hydrosalpinx have been found to have significantly poorer IVF outcome than do patients with tubal factor infertility but no hydrosalpinx. The exact mechanism by which hydrosalpingial fluid impacts implantation and pregnancy is not clear; however, many theories exist. The rationale behind treatment of hydrosalpinx prior to IVF is to eliminate the detrimental effect of hydrosalpingel fluid either by removing the fallopian tube (salpingectomy) or by isolating it from the uterine cavity (laparoscopic or hysteroscopic occlusion, or Essure insert), or by aspirating the hydrosalpingel fluid (ultrasound-guided). Keywords: Hydrosalpinx, IVF 1. INTRODUCTION Hydrosalpingel fluid may contain inflammatory mediators such as cytokines, prostaglandins, and Tubal factor infertility accounts for up to 35% mucosal debris that may be toxic to the of female infertility, and was one of the original motivations for the development of in-vitro implanting embryo [6]. fertilization (IVF) [1]. The presence of hydrosalpingel fluid in the Hydrosalpinx is defined as fluid collection in a endometrial cavity physically inhibits blocked fallopian tube, and is found in about 10- implantation and impairs the expression of 30% of women with tubal factor infertility, factors essential for the development and corresponding to approximately 5% of infertile differentiation of the endometrium, such as women [2]. integrins (the best endometrial receptivity markers) [7]. Hydrosalpinx is associated with a large redu ction in pregnancy rates following IVF Hydrosalpinx may be also associated with impaired endometrial and ovarian blood flows (about 40-50%), and an increased risk of miscarriage and ectopic pregnancy [3]. which may adversely affect endometrial receptivity and oocyte quality [8]. This review discusses the effect of hydrosalpinx on IVF and the lines of management of 2.2. Management of Hydrosalpinx before IVF hydrosalpinx before IVF. The rationale behind treatment of hydrosalpinx 2. DISCUSSION prior to IVF is to eliminate the detrimental effect of hydrosalpingel fluid either by 2.1. Effect of Hydrosalpinx on IVF removing the fallopian tube (salpingectomy) or Patients with a hydrosalpinx have been found to by isolating it from the uterine cavity have significantly poorer IVF outcome than do (laparoscopic or hysteroscopic occlusion, or patients with tubal factor infertility but no Essure insert), or by aspirating the hydrosalpinx [4]. hydrosalpingel fluid (ultrasound-guided) [9]. The exact mechanism by which hydrosalpingial Laparoscopic surgery, including salpingectomy fluid impacts implantation and pregnancy is not or tubal occlusion, has been shown to improve clear; however, many theories exist. IVF outcome for patients with a hydrosalpinx The harmful effect of a hydrosalpinx on [10]. However, this procedure has many pregnancy after IVF has been attributed to drawbacks, including its invasiveness, technical mechanical washout of the transferred embryos difficulty if there are pelvic adhesions, the by tubal-uterine reflux of the hydrosalpingel possibility of surgical injury (e.g. visceral fluid [5]. injury, vascular damage, or unintended ARC Journal of Gynecology and Obstetrics Page | 21 Hydrosalpinx and IVF: Effect and Management laparotomy), and the potential risks from ─ Evidence is insufficient to allow assessment general anesthesia [11]. of the value of aspiration of hydrosalpinges before or during IVF procedures (very low- There are also some concerns about quality evidence) or the value of tubal salpingectomy, including its potentially negative restorative surgery as an alternative (or as effect on the ovarian blood flow and subsequent apreliminary) to IVF. reduction of ovarian response to gonadotropin stimulation, and its permanent nature, which REFERENCES precludes any possibility of spontaneous [1] Strandell A, Lindhard A,WaldenströmU, conception in the future in cases of bilateral Thorburn J. 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