Effects of hydrosalpinx on IVF outcome: the search goes on.

I read with interest the manuscript by Meyer et al. (1997) on the adverse effects of hydrosalpinges (HSPX) on markers of uterine receptivity. Of 103 women with unilateral or bilateral HSPX undergoing in-vitro fertilization (IVF), 38.8% had normal α v ,β 3 integrin expression compared with 65.4 and 68.1% for infertile and fertile controls, a statistically significant difference. In addition, of 20 women with HSPX and low α v ,β 3 expression who subsequently underwent surgical correction (13 had salpingectomy, three had salpingostomy, three had proximal tubal interruption, and one had transvaginal aspiration of the HSPX), 15/20 had their α v ,β 3 normalized on a repeat endometrial biopsy ~3 months after surgical correction. Of the five that failed to correct their integrin expression, three had their HSPX reaccumulate. Of the 103 women with HSPX, no information was given about the outcome of their IVF cycles, most likely because multiple centres with potentially different pregnancy rates were involved in collecting the patients from July 1991 to October 1996, and therefore comparisons may be flawed. The reader is very interested to know how many of these patients had their HSPX visualized on a baseline ultrasound prior to initiation of medications. Of more importance, how many had endometrial fluid collections in their endometrial lining on a baseline scan, on the day of oocyte aspiration or day of embryo transfer. This information may potentially be much more critical than integrin assessment for implantation. Recent data suggest that patients with HSPX constitute a heterogeneous population with potentially different outcomes, especially if a history of hydorrhoea is elicited or endometrial fluid collections are noted on ultrasound (Mansour et al. It would be nearly impossible for implantation to physically occur if embryonal apposition cannot take place secondary to endometrial fluid. Recent data also seem to suggest that HSPX fluid is not embryotoxic (Murray et al. As shown by Meyer et al. (1997), nearly 40% of women with HSPX had normal α v ,β 3 integrin expression, a result which does not explain the poor pregnancy rates (PR) and implantation rates (IR) noted in most studies, fuelling the debate that women with HSPX indeed constitute a heterogeneous group. Women with endometrial fluid collections visualized on ultrasound may potentially have abnormal integrin expression, while those with no collections have normal expression and can potentially easily conceive with IVF. We currently offer surgical correction only to those women with …