Salpingectomy Versus Aspiration of Hydrosalpingeal Fluid Prior to IVF-ET
Condition: Infertility
MeSH terms: Infertility
Study type: Interventional
Phase: Phase 2

Summary: 
      The aim of this randomized controlled trial is to compare the efficacy of ultrasound guided
      aspiration of hydrosalpingeal fluid with salpingectomy in the management patients with
      ultrasound visible hydrosalpinges undergoing IVF-ET.
    

Detailed description: 
      The adverse impact of hydrosalpinx on in vitro fertilisation embryo transfer (IVF-ET)
      outcomes has been confirmed by several retrospective and prospective studies .

      Cochrane review of prospective randomised trials of laparoscopic salpingectomy confirmed the
      beneficial effect of laparoscopic salpingectomy on IVF-ET outcomes in patients with
      hydrosalpinges.

      Surgery is not usually safe especially in patients with extensive adhesions, morbid obesity
      or previous multiple laparotomies. Furthermore, many infertile couples refuse to undergo
      bilateral salpingectomy or proximal tubal occlusion because these procedures remove any hope
      of spontaneous pregnancy. Other less invasive options for patients with hydrosalpinges as
      ultrasound-guided aspiration of hydrosalpingeal fluid, antibiotics (alone or combined with
      aspiration) and hysteroscopic occlusion of fallopian tube were studied in order to find an
      alternative to salpingectomy . Although these methods are simple and getting popular, current
      data are inadequate to recommend these treatment options instead of salpingectomy because
      most of the supporting evidences for these methods come from small retrospective studies.

      A recent randomized controlled trial revealed that the aspiration of hydrosalpingeal fluid at
      the time of oocyte retrieval was associated with improved implantation rate and pregnancy
      rates.

      The aim of this randomized controlled trial is to compare the efficacy of ultrasound guided
      aspiration of hydrosalpingeal fluid with salpingectomy in the management patients with
      ultrasound visible hydrosalpinges undergoing IVF-ET
    

Intervention name(s): Needle aspiration of hydrosalpinx; Salpingectomy
Intervention type(s): Procedure; Procedure
Intervention description(s): Under deep sedation, the retrieval of oocytes is done and then an aspiration needle is inserted into the hydrosalpinx under ultrasonographic guidance and suction is applied to aspirate the hydrosalpingeal fluid completely . If there are bilateral hydrosalpinges, the process is repeated on the opposite side.; laparoscopic surgical removal of affected tube is done with bipolar electrocoagulation for hemostasis. The mesosalpinx is coagulated as close a possible to the fallopian tube to avoid any compromise in the ovarian blood supply . In cases with marked adhesion, proximal ligation and a distal fenestration is done .
Other intervention name(s): ultrasound guidance aspiration of hydrosalpingeal fluid; surgical removal of hydrosalpinx
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Infertility; Hydrosalpinx; IVF-ET; Salpingectomy