Hydrosalpinx Management Before Intracytoplasmic Sperm Injection
Condition: Hydrosalpinx
Study type: Observational

Summary: 
      ICSI pregnancy outcomes following hysteroscopic tubal electrocoagulation versus laparoscopic
      tubal disconnection for patients with hydrosalpinges
    

Detailed description: 
      Tubal factor of infertility resulting from various forms of tuboperitoneal damage remains an
      extremely common cause of female infertility, accounting for more than 35% of all cases of
      female infertility. Probably the most severe form of tubal pathology is hydrosalpinx.
      Hydrosalpinx is a Greek word that means a Fallopian tube filled with water or fluid. Patients
      with hydrosalpinges have been identified as a subgroup with significantly lower implantation
      and pregnancy rates than patients with other tubal pathologies. An increased risk for early
      pregnancy loss and increased risk for ectopic pregnancies was reported, and many studies
      confirmed that the presence of hydrosalpinx significantly impairs in vitro fertilization
      (IVF) outcome as well.

      Patients with a hydrosalpinx have been found to have significantly poorer outcomes of IVF
      than do patients with tubal factor infertility but no hydrosalpinx .

      Hydrosalpinges in infertile women reduce the success of IVF by 50 % .

      The harmful effect of a hydrosalpinx on pregnancy rates after IVF has been attributed to
      mechanical washout of the transferred embryos by tubal-uterine reflux of the hydrosalpinx
      fluid .

      Additionally, a hydrosalpinx might disturb endometrial receptivity: integrins, the best
      endometrial markers, show decreased expression in cases of hydrosalpinx .

      Altered endometrial blood flow has also been proposed as a possible factor causing decreased
      rates of implantation.

      Any surgical interventions that disrupt tubal-uterine communication in affected tubes might
      improve pregnancy rates .

      Laparoscopic salpingectomy was the most popular treatment option offered by the clinicians,
      followed by open salpingectomy, salpingostomy, proximal tubal occlusion and transvaginal
      ultrasonographic guided hydrosalpinx aspiration either before or during oocyte retrieval.The
      latest treatment option introduced was proximal occlusion of the hydrosalpinx by
      hysteroscopic placement of microinserts. Clinicians would still perform open salpingectomy.
      The possible explanation for this could be the lack of training in endoscopic surgery and/or
      that patients with tubal disease may have significant pelvic adhesions necessitating open
      surgery.

      Laparoscopic salpingectomy or tubal ligation has been shown to improve IVF outcomes for
      patients with a hydrosalpinx.

      However, this procedure has many drawbacks, including its invasiveness, the possibility of
      surgical injury (e.g. visceral injury, vascular damage, or unintended laparotomy), the
      potential risks from general anesthesia, and technical difficulty if there are pelvic
      adhesions .

      The proximal occlusion of a hydrosalpinx by hysteroscopy might offer a feasible therapeutic
      alternative when laparoscopy is technically difficult or contraindicated,with the advantage
      of hysteroscopic procedures of faster recovery, less hospitalization and rapid return to
      work, and in the future it might be done in the outpatient clinic as an office procedure.
    

Intervention name(s): Hysteroscopic tubal electrocoagulation
Intervention type(s): Procedure
Intervention description(s): Unilateral or bilateral electrocoagulation of the cornual end of the tube and the surrounding part of the uterine horn was performed using a hysteroscopicelectrocoagulating roller ball.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        50 patients who have unilateral or bilateral hydrosalpinges identified on
        hysterosalpingography and vaginal ultrasonography, and who are undergoing IVF.