A 2019 meta-analysis published in Reproductive Biomedicine Online (RBMO) reports a 74 percent higher risk for pregnancy loss among women with hydrosalpinx, which is widely associated with lower implantation and pregnancy rates.
Fortunately, hydrosalpinx treatment may reduce this risk and improve outcomes with in vitro fertilization for any patients who are looking to start or expand their families. Promoting thoughtful, shared decision-making can help your patients better navigate their next steps.
Hydrosalpinx and Fertility
Hydrosalpinx, which occurs when fluid builds up in the fallopian tube, is a severe form of tubal disease that can affect fertility. A separate 2019 systematic review in Reproductive Biomedicine Online indicates the condition appears in 10 to 30 percent of heterosexual cisgender couples facing infertility. Multiple studies have shown evidence of the damaging effect of hydrosalpinges on IVF outcomes, which may reduce live birth rates by approximately half. Notably, even hydrosalpinx in one tube may lead to lower pregnancy rates with IVF, according to A 2021 opinion from the Practice Committee of the American Society for Reproductive Medicine (ASRM).
Although the precise mechanism of damage is not well understood, Fertility and Sterility suggests the presence of debris, toxins, cytokines, prostaglandins and cellular components may trigger an inflammatory, immunological or infectious reaction. This response, in turn, may render the endometrium hostile to embryo development. Other potential rationales include low endometrial blood flow and mechanical flushing of the embryo as fluid leaks into the uterus from the fallopian tube.
Swift diagnosis — whether by hydrosalpinx ultrasound, hysterosalpingogram, laparoscopy surgery or pelvic MRI scan — can help patients receive timely treatment and improve their chances for a healthy pregnancy.
Next Steps with Hydrosalpinx
Several avenues of treatment may prove fruitful for patients with this condition seeking better fertility odds. Research published in the Reproductive Biomedicine Online meta-analysis found the risk of miscarriage drops by half following hydrosalpinx treatment by salpingectomy or tubal reconstructive techniques in patients undergoing IVF.
Pioneered more than a century ago, salpingectomy — surgical removal of the fallopian tube — is today the most widely used intervention for hydrosalpinx. The ASRM regards salpingectomy as the gold standard for enhancing reproductive options in hydrosalpinx patients before IVF.
Similarly, according to the RBMO's systematic review, 67.6 percent of registered IVF centers in France also reported managing hydrosalpinx via laparoscopic salpingectomy. In terms of other surgical approaches, close to 22 percent opted for salpingostomy, while 12.9 percent relied on ultrasound-guided aspiration.
Salpingectomy
The latest ASRM surgical practice guideline recommends a minimally invasive approach with salpingectomy except among patients with complex surgical histories. This tends to produce fewer complications, shorter recovery times, less blood loss and similar completion rates to open tubal surgery. Depending on the condition of the fallopian tubes, the procedure may remove one or both tubes.
As with other laparoscopic interventions, the laparoscope is inserted through a tiny abdominal incision, and the cavity is inflated for better viewing. Other instruments are introduced through additional incisions as needed. Then, depending on whether it is a unilateral or bilateral procedure, the tube or tubes are excised and removed.
IVF Success with Hydrosalpinx Treatment
When a patient's fertility is in doubt, they may be comforted to hear of evidence suggesting that salpingectomy may nearly double embryo implantation and pregnancy rates during IVF, according to a trial in Human Reproduction. The research team randomly assigned women to either a salpingectomy treatment group or a nontreatment group before undergoing IVF. The salpingectomy group experienced implantation and pregnancy rates of 10 percent and 34 percent, respectively, compared with rates of just 5 percent and 19 percent in the nontreatment group.
The review in RBMO associated salpingectomy with higher implantation, clinical pregnancy and live birth rates after IVF than other hydrosalpinx treatment alternatives.
In cases of hydrosalpinx in a single tube, the ASRM cites research published in Fertility and Sterility, which further adds that unilateral salpingectomy may significantly improve IVF pregnancy rates in these patients. Interestingly, spontaneous pregnancy has been reported after salpingectomy for a unilateral hydrosalpinx, but the largest of these case reports included just 25 patients. Thus, more evidence is required on this front.
Although some literature has raised concerns about the possible negative effects of salpingectomy on ovarian reserve and on the stimulation response during subsequent IVF cycles, current evidence does not support these findings, concludes the review from RBO. When questions remain about ovarian reserve, 3D ultrasound may aid in follicular assessment in the IVF process.
Evidence-based counselling about hydrosalpinx treatment options can help comfort your patient as they navigate this condition and reassure them that, with the appropriate care, their fertility goals may remain within reach.
