Management of hydrosalpinges

The paradox of hydrosalpinges and IVF In vitro fertilization was primarily developed to treat tubal infertility, a logical rationale to circumvent abnormally functioning tubes. However, comparison of IVF success rates of patients receiving IVF for tubal subfertility with results of patients receiving IVF for other reasons, showed that women with hydrosalpinges had lower implantation rates and a two-fold risk of early pregnancy loss. As tubal disease is present in 10-30% of IVF patients, and hydrosalpinges may reduce IVF success rates up to 50% this is important in clinical practice. Approriate management of hydrosalpinges is an important key in improving IVF success rates. How hydrosalpinges affect IVF success rates Several theories explain how hydrosalpinges might have a negative effect on IVF outcome. The hydrosalpinx fluid itself seems to have a key role, exerting a possible effect at three different levels; on the oocytes, the transferred embryo, and on the implantation process. Oocytes and transferred embryos may be exposed to toxic factors, or to the lack of factors important in embryonic development, in the hydrosalpinx fluid. The fluid hinders implantation mechanically by disturbing endometrial interaction with the transferred embryo. Hydrosalpinx fluid might also simply exert a wash out effect on the newly implanted embryo; directly by leakage of fluid through the uterine cavity and indirectly by altering endometrial peristalsis.