Low implantation rate after in-vitro fertilization in patients with hydrosalpinges diagnosed by ultrasonography

Deleterious effect of the presence of hydrosalpinx on implantation and pregnancy rates with in vitro fertilization

OBJECTIVE

To determine the effect of the presence of a unilateral or bilateral hydrosalpinx on the outcome with IVF-ET.

DESIGN

Retrospective analysis of clinical and laboratory data.

SETTING

Hospital-based private IVF center.

PATIENTS

Eight hundred forty-six patients with tubal disease younger than age 40 years undergoing 1,766 stimulation cycles. In 118 cycles, a hydrosalpinx was noted sonographically (group I) whereas, in 1,648 cycles, no such image was documented.

MAIN OUTCOME MEASURES

Pregnancy and implantation rates.

RESULTS

Group I displayed a significantly lower pregnancy rate per transfer than group II (16.84% versus 36.83%) and a lower implantation rate (3.92% versus 11.53%).

CONCLUSION

The presence of hydrosalpinx adversely affects the outcome of IVF.

The uterus and endometrium

Transvaginal sonography is useful for the identification of physiologic and pathologic changes within the myometrium and endometrium. Endometrial ultrasonography is simple to learn because of the reliable identification of the uterus. It is useful for monitoring fertility treatment, evaluation of abnormal bleeding and monitoring patients in the menopause.

Impaired implantation after in vitro fertilisation treatment associated with hydrosalpinx

OBJECTIVE

To study whether the presence of hydrosalpinx affected success after in vitro fertilisation (IVF) in women with inflammatory tubal damage.

DESIGN

Retrospective, nonrandomised study.

SETTING

University private IVF clinic with complete fertility services.

PARTICIPANTS

Two study groups (79 women with hydrosalpinges and 198 women with inflammatory tubal damage but no hydrosalpinx) and a third group (22 sterilised, previously fertile women) for comparison.

MAIN OUTCOME MEASURES

Clinical pregnancy and livebirth rates per embryo transfer cycle; implantation and live baby rates per individual embryo transferred.

RESULTS

The hydrosalpinx group had a significantly lower implantation rate per embryo (8.2%) and chance of a live baby per embryo transferred (5.6%), compared with the nonhydrosalpinx group (14.9% and 11.2%, respectively). The hydrosalpinx group also had a lower clinical pregnancy rate (23%) and live birth rate per transfer cycle (17%) compared with the nonhydrosalpinx group (30% and 26%), but these differences were not significant.

CONCLUSIONS

The presence of a hydrosalpinx halves the chance of an embryo implanting, probably due to physical or toxic chemical effects of fluid draining from the hydrosalpinx into the uterine cavity. Women with hydrosalpinges may benefit from distal salpingostomy or salpingectomy as a drainage procedure before in vitro fertilisation treatment, even though such surgery may not increase the chances of natural conception.