I-25: Management of Hydrosalpinx in ART

Hydrosalpinx, is one of the severe manifestations of tubal disease, is associated with significantly lower implantation and pregnancy rates, increased spontaneous abortion and ectopic pregnancy.This condition is usually due to PID but may also result from peritonitis of any cause or tubal damage from previous surgery.The mechanism for poor outcome in patients undergoing IVF is not yet clear. Many theories have been reported, including the embryotoxic effect, endometrial hostility, mechanical washout of embryos. several methods for treatment of hydrosalpinx Such as neosalpingostomy, salpingostomy, proximal tubal ligation, ultrasound-guided transvaginal aspiration of hydrosalpinx, hysteroscopic placement of an Essure and ultrasound-guided transvaginal aspiration and sclerotherapy have been used in practice. The decision to repair or remove fallopian tubes usually made intraoperatively based on the severity and prognosis for an intrauterine pregnancy. IVF is preferred for older women and for those with male factor or other infertility factors. Patients with poor-prognosis hydrosalpinges are better served by salpingectomy followed by IVF. laparoscopic salpingectomy prior to IVF showed an increase pregnancy, and live birth rates. Laparoscopic tubal occlusion is an alternative to laparoscopic salpingectomy in improving IVF pregnancy rates. Proximal occlusion of a hydrosalpinx by hysteroscopic placement of an Essure device may offer an alternative to laparoscopic surgery in patients with severe pelvic adhesion. A clinician may also be faced with the situation of identifying a hydrosalpinx for the first time during stimulation in ART cycle. In these situations aspiration of hydrosalpinges during oocyte collection may be effective in improving pregnancy rates. Finally in a prospective clinical study, ultrasound-guided transvaginal aspiration and sclerotherapy with 98% ethanol was performed before the IVF cycle. The results showed that sclerotherapy could improve outcomes of IVF, with no recurring sign of the hydrosalpinx and no adverse effect on ovarian reserve or responsiveness during the IVF procedure.