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Li J, Mo S, Lin Z, Mo F, Shi Q. Proximal tubal occlusion first or oocyte retrieval first for patients with hydrosalpinx? Arch Gynecol Obstet 2024; 309:1597-1608. [PMID: 38308732 DOI: 10.1007/s00404-023-07359-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/21/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Our study aimed to investigate the best time to manage hydrosalpinx to improve pregnancy outcomes during in vitro fertilization-embryo transfer (IVF-ET). METHODS Patients with hydrosalpinx who received IVF treatment were analyzed retrospectively. And two groups were included to compare the effects of different timing treatment of hydrosalpinx on IVF pregnancy outcomes, "Proximal Tubal Occlusion First Group" (Group Ligation-COH) and "Oocyte Retrieval First Group" (Group COH-Ligation). The main outcome measures included: ovarian response indexes, laboratory indexes and clinical pregnancy outcomes. Univariate and multivariate Logistic regression analysis was performed for outcome indicators, and the odds ratios (OR) and 95% confidence interval (CI) were used. RESULTS A total of 1490 patients were included (n = 976 Ligation-COH and n = 514 COH-Ligation). The Gn starting dose and MII rate in group Ligation-COH were significantly higher than those in group COH-Ligation (203.33 ± 58.20 vs. 203.33 ± 58.20, 81.58% vs. 80.28%, P < 0.05). The number of oocytes obtained and the number of available D3 embryos in group COH-Ligation were higher than those in group Ligation-COH (15.10 ± 7.58 vs. 13.45 ± 6.42, 10.92 ± 5.81 vs. 9.94 ± 5.15, P < 0.05). Although the number of ET cycles per IVF cycle in group COH-Ligation was higher than that in group Ligation-COH (1.88 ± 1.00 vs. 1.48 ± 0.70, P < 0.05), the biochemical pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, live birth rate and cumulative live birth rate in group Ligation-COH were significantly higher than those in group COH-Ligation (60.83% vs. 46.27% for biochemical pregnancy, 55.69% vs. 38.5% for clinical pregnancy, 26.18% vs. 17.74% for multiple pregnancy, 47.08% vs. 25.26% for live birth, 69.47% vs. 47.47% for cumulative live birth, P < 0.05), and the miscarriage rate in group Ligation-COH was lower than that in group COH-Ligation (10.47% vs. 17.20 for early abortion, 4.49% vs. 15.86% for late abortion, P < 0.05). In logistic regression analysis, after adjustment for age and multiple factors, the above results were still statistically significant differences (P < 0.001). For elderly patients, the clinical pregnancy rate, multiple birth rate and live birth rate in group Ligation-COH were also higher than those in group COH-Ligation (P < 0.001). No significant differences were detected for patients with diminished ovarian reserve. CONCLUSIONS For the choice of ligation operation time, we recommend that patients choose tubal ligation first and then ovulation induction and oocyte retrieval treatment.
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Affiliation(s)
- Jie Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
- Reproductive Medicine Department, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Sien Mo
- Reproductive Medicine Department, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhong Lin
- Reproductive Medicine Department, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Fuhua Mo
- Reproductive Medicine Department, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China.
- School of Public Health, Chongqing Medical University, Chongqing, China.
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Bi B, Han X, Dai W, Fang L, Shi H, Hu L. Comparisons of different treatment outcomes in IVF/ET patients with hydrosalpinx: a retrospective study. Gynecol Endocrinol 2023; 39:2249999. [PMID: 37625443 DOI: 10.1080/09513590.2023.2249999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
AIMS To explore suggestions for clinicians on the most effective treatment for hydrosalpinx undergoing IVF-ET. MATERIALS AND METHODS We reviewed 936 women with hydrosalpinx and 6715 tubal infertile women without hydrosalpinx who underwent IVF/ICSI between January 2014 and August 2019 in our center. Hydrosalpinx patients received different treatments including laparoscopic surgery (only salpingectomy and proximal tubal occlusion/ligation were included), ultrasonic-guided aspiration and hysteroscopic tubal occlusion. Outcomes were analyzed by One-way ANOVA, Chi-Square test and logistic regression. RESULTS The live birth rate (LBR) of laparoscopic surgery was significantly higher compared with hydrosalpinx aspiration (48.3% vs 39.6%, p = .024). The cumulative live birth rate (CLBR) of subsequent laparoscopic surgery was significantly higher compared with subsequent hysteroscopic occlusion (65.1% vs 34.1%, p = .001) and no subsequent treatment (65.1% vs 44.9%, p < .005). Subsequent laparoscopic surgery significantly improved the CLBR of hydrosalpinx patients who received ultrasonic-guided aspiration and didn't get clinical pregnancy in fresh cycles (Odds Ratio (OR) =1.875; 95%CI = 1.041-3.378, p = .036). CONCLUSIONS Laparoscopic surgery leads to significantly higher LBR than ultrasonic-guided aspiration and significantly higher CLBR than hysteroscopic occlusion and no treatment.
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Affiliation(s)
- Beibei Bi
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Xiao Han
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
- Reproductive Medical Center, Jiaozuo Women and Children's Hospital, Jiaozuo, P.R. China
| | - Wei Dai
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Lanlan Fang
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Hao Shi
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Linli Hu
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
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Guo H, Du T, Lyu Q, Wu L, Chai W, Zhu Q. Live birth rate and neonatal outcomes following interventional embolization of hydrosalpinx. Reprod Health 2022; 19:213. [PMID: 36457061 PMCID: PMC9713958 DOI: 10.1186/s12978-022-01522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 11/04/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Hydrosalpinx has a negative effect on the pregnancy outcomes of in vitro fertilization and embryo transfer (IVF-ET), and the pretreatment for hydrosalpinx play an important role in improving the outcomes of IVF-ET. This study aimed to investigate the impacts of interventional embolization of hydrosalpinx on the live birth rate and neonatal outcome after in-vitro fertilization. METHOD In the present retrospective study, 3351 women receiving the first frozen embryo transfer (FET) after freeze-all policy were reviewed. Patients who received interventional embolization of hydrosalpinx (n = 1268) were included in the study group and those with hydrosalpinx-free bilateral fallopian tube obstruction (n = 2083) in the control group. The primary outcome was live birth (LB) rate; the secondary endpoints included rates of implantation, clinical pregnancy (CP), multiple pregnancy, and pregnancy loss. RESULTS The LB rate was similar between embolization group (39.91%) and control group (43.21%) (P > 0.05). The rate of implantation (35.81% vs. 32.24%), CP (50.84% vs. 47%) and multiple pregnancy rate (28.71% vs. 24.16%) in the control group were significantly higher than in the embolization group (P < 0.05). The miscarriage rate (39.91%, vs 43.21%, P > 0.05), ectopic gestation rate (2.35% vs 2.83%, P > 0.05), and ongoing pregnancy rate (41.56% vs 44.89%, P > 0.05) were comparable between two groups. After adjustment for confounding factors, interventional embolization of hydrosalpinx was found to have no influence on the LB rate. The thicker endometrium, more embryos transferred, and transfer of blastocyst stage embryos significantly increased the LB rate and CP rate. CONCLUSION The interventional embolization of hydrosalpinx can achieve the LB rate similar to that of hydrosalpinx-free obstruction patients with less risk, less pain and reduced medical cost. Thus, embolization of hydrosalpinx is one of the preferable clinical treatments for patients with hydrosalpinx.
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Affiliation(s)
- Haiyan Guo
- grid.16821.3c0000 0004 0368 8293Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai, Jiao Tong University China Hospital Development Institute, Shanghai, 200011 China
| | - Tong Du
- grid.16821.3c0000 0004 0368 8293Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai, Jiao Tong University China Hospital Development Institute, Shanghai, 200011 China
| | - Qifeng Lyu
- grid.16821.3c0000 0004 0368 8293Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai, Jiao Tong University China Hospital Development Institute, Shanghai, 200011 China
| | - Ling Wu
- grid.16821.3c0000 0004 0368 8293Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai, Jiao Tong University China Hospital Development Institute, Shanghai, 200011 China
| | - Weiran Chai
- grid.16821.3c0000 0004 0368 8293Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai, Jiao Tong University China Hospital Development Institute, Shanghai, 200011 China
| | - Qianqian Zhu
- grid.16821.3c0000 0004 0368 8293Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai, Jiao Tong University China Hospital Development Institute, Shanghai, 200011 China
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Cao Z, Xu B, Wu Y, Luan K, Du X. A comprehensive analysis of miRNA/isomiRs profile of hydrosalpinx patients with interventional ultrasound sclerotherapy. PLoS One 2022; 17:e0268328. [PMID: 35969523 PMCID: PMC9377599 DOI: 10.1371/journal.pone.0268328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 04/28/2022] [Indexed: 11/18/2022] Open
Abstract
Hydrosalpinx is a chronic inflammatory condition with high recurrence rate, and it is reported among female population having fallopian tubal factor infertility. Previously, we have reported that interventional ultrasound sclerotherapy improves endometrial receptivity and pregnancy rate with negligible adverse effects in patients suffering from hydrosalpinx. During present investigation, we have used next generation sequencing (NGS) to characterize the isomiR profiles from the endometrium of patients suffering from hydrosalpinx before and after interventional ultrasound sclerotherapy. Our results indicated that miRNA arm shift and switch remained unaffected when compared in patients before and after interventional ultrasound sclerotherapy. We observed that isomiRs with trimming at 3’ and isomiRs with canonical sequences were lower in post-treatment than in pre-treatment group. Gene ontology (GO) annotation and KEGG pathway analysis revealed that the expression of mature mir-30 was significantly lower in the pre-treatment as compared to post treatment group while the expression of mir-30 isomiR was 4.26-fold higher in pre-treatment when compared with the post-treatment group. These different expression patterns of mir-30 mature miRNA and mir-30 isomiRs in two groups are affecting the physiological function of the endometrium. Our results suggested that differential isomiR distribution in hydrosalpinx patients before and after treatment plays an important role in hydrosalpinx incidence and can help in designing novel strategy for the treatment of hydrosalpinx in female population.
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Affiliation(s)
- Zhengyi Cao
- Reproductive Medicine Center, Hefei, Anhui, P.R. China
| | - Bo Xu
- Division of Life Sciences and Medicine, Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Yan Wu
- Reproductive Medicine Center, Hefei, Anhui, P.R. China
| | - Kang Luan
- Reproductive Medicine Center, Hefei, Anhui, P.R. China
| | - Xin Du
- Reproductive Medicine Center, Hefei, Anhui, P.R. China
- * E-mail:
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Recurrence Rate and Morbidity after Ultrasound-guided Transvaginal Aspiration of Ultrasound Benign-appearing Adnexal Cystic Masses with and without Sclerotherapy: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2021; 29:204-212. [PMID: 34571216 DOI: 10.1016/j.jmig.2021.09.708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the pooled recurrence rate of benign adnexal masses/cysts (namely simple cyst, endometrioma, hydrosalpinx, peritoneal cyst) after transvaginal ultrasound-guided aspiration, with or without sclerotherapy. DATA SOURCES Search of studies published in PubMed and Web of Science databases between January 1990 and December 2020. METHODS OF STUDY SELECTION A systematic search strategy was done using Medical Subject Heading terms. Only randomized trials and prospective studies published in English language were included. TABULATION, INTEGRATION, AND RESULTS A total of 395 articles were screened. After applying inclusion and exclusion criteria, 20 studies were included in this review comprising data from 1386 patients with a mean follow-up of 11.4 months (range 0.5-26.5 months). The overall pooled rate of recurrence of adnexal masses was 27%, (95% confidence interval [CI], 18%-39%). Recurrence rate was significantly higher after only aspiration than after sclerotherapy (53%; 95% CI, 46%-60% vs 14%; 95% CI, 8%-22%; p <.001). However, a high heterogeneity across the studies was found. A total of 10 major complications were recorded in the different publications. CONCLUSION In a selected population, aspiration with sclerotherapy had a lower recurrence rate than aspiration without sclerotherapy. However, these results should be interpreted with caution given the heterogeneity of the studies and the paucity of randomized controlled trials. Regarding the adoption of this procedure in routine clinical practice, we believe that aspiration should be considered an experimental procedure as there are few studies addressing long-term recurrence rate, and data comparing this technique with surgical cystectomy are lacking.
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Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertil Steril 2021; 115:1143-1150. [PMID: 33642065 DOI: 10.1016/j.fertnstert.2021.01.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
This document reviews surgical options for reparative tubal surgery and the factors that must be considered when deciding between surgical repair and in vitro fertilization. This document replaces the document of the same name, last published in 2012 (Fertil Steril 2015;103:e37-43). This document reviews surgical options for reparative tubal surgery and the factors that must be considered when deciding between surgical repair and in vitro fertilization.
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, Alabama
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Melo P, Georgiou EX, Johnson N, van Voorst SF, Strandell A, Mol BWJ, Becker C, Granne IE. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev 2020; 10:CD002125. [PMID: 33091963 PMCID: PMC8094448 DOI: 10.1002/14651858.cd002125.pub4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Tubal disease accounts for 20% of infertility cases. Hydrosalpinx, caused by distal tubal occlusion leading to fluid accumulation in the tube(s), is a particularly severe form of tubal disease negatively affecting the outcomes of assisted reproductive technology (ART). It is thought that tubal surgery may improve the outcome of ART in women with hydrosalpinges. OBJECTIVES To assess the effectiveness and safety of tubal surgery in women with hydrosalpinges prior to undergoing conventional in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, DARE, and two trial registers on 8 January 2020, together with reference checking and contact with study authors and experts in the field to identify additional trials. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing surgical treatment versus no surgical treatment, or comparing surgical interventions head-to-head, in women with tubal disease prior to undergoing IVF. DATA COLLECTION AND ANALYSIS We used Cochrane's standard methodological procedures. The primary outcomes were live birth rate (LBR) and surgical complication rate per woman randomised. Secondary outcomes included clinical, multiple and ectopic pregnancy rates, miscarriage rates and mean numbers of oocytes retrieved and of embryos obtained. MAIN RESULTS We included 11 parallel-design RCTs, involving a total of 1386 participants. The included trials compared different types of tubal surgery (salpingectomy, tubal occlusion or transvaginal aspiration of hydrosalpingeal fluid) to no tubal surgery, or individual interventions to one another. We assessed no studies as being at low risk of bias across all domains, with the main limitations being lack of blinding, wide confidence intervals and low event and sample sizes. We used GRADE methodology to rate the quality of the evidence. Apart from one moderate-quality result in one review comparison, the evidence provided by these 11 trials ranged between very low- to low-quality. Salpingectomy versus no tubal surgery No included study reported on LBR for this comparison. We are uncertain of the effect of salpingectomy on surgical complications such as the rate of conversion to laparotomy (Peto odds ratio (OR) 5.80, 95% confidence interval (CI) 0.11 to 303.69; one RCT; n = 204; very low-quality evidence) and pelvic infection (Peto OR 5.80, 95% CI 0.11 to 303.69; one RCT; n = 204; very low-quality evidence). Salpingectomy probably increases clinical pregnancy rate (CPR) versus no surgery (risk ratio (RR) 2.02, 95% CI 1.44 to 2.82; four RCTs; n = 455; I2 = 42.5%; moderate-quality evidence). This suggests that in women with a CPR of approximately 19% without tubal surgery, the rate with salpingectomy lies between 27% and 52%. Proximal tubal occlusion versus no surgery No study reported on LBR and surgical complication rate for this comparison. Tubal occlusion may increase CPR compared to no tubal surgery (RR 3.21, 95% CI 1.72 to 5.99; two RCTs; n = 209; I2 = 0%; low-quality evidence). This suggests that with a CPR of approximately 12% without tubal surgery, the rate with tubal occlusion lies between 21% and 74%. Transvaginal aspiration of hydrosalpingeal fluid versus no surgery No study reported on LBR for this comparison, and there was insufficient evidence to identify a difference in surgical complication rate between groups (Peto OR not estimable; one RCT; n = 176). We are uncertain whether transvaginal aspiration of hydrosalpingeal fluid increases CPR compared to no tubal surgery (RR 1.67, 95% CI 1.10 to 2.55; three RCTs; n = 311; I2 = 0%; very low-quality evidence). Laparoscopic proximal tubal occlusion versus laparoscopic salpingectomy We are uncertain of the effect of laparoscopic proximal tubal occlusion versus laparoscopic salpingectomy on LBR (RR 1.21, 95% CI 0.76 to 1.95; one RCT; n = 165; very low-quality evidence) and CPR (RR 0.81, 95% CI 0.62 to 1.07; three RCTs; n = 347; I2 = 77%; very low-quality evidence). No study reported on surgical complication rate for this comparison. Transvaginal aspiration of hydrosalpingeal fluid versus laparoscopic salpingectomy No study reported on LBR for this comparison, and there was insufficient evidence to identify a difference in surgical complication rate between groups (Peto OR not estimable; one RCT; n = 160). We are uncertain of the effect of transvaginal aspiration of hydrosalpingeal fluid versus laparoscopic salpingectomy on CPR (RR 0.69, 95% CI 0.44 to 1.07; one RCT; n = 160; very low-quality evidence). AUTHORS' CONCLUSIONS We found moderate-quality evidence that salpingectomy prior to ART probably increases the CPR compared to no surgery in women with hydrosalpinges. When comparing tubal occlusion to no intervention, we found that tubal occlusion may increase CPR, although the evidence was of low quality. We found insufficient evidence of any effect on procedure- or pregnancy-related adverse events when comparing tubal surgery to no intervention. Importantly, none of the studies reported on long term fertility outcomes. Further high-quality trials are required to definitely determine the impact of tubal surgery on IVF and pregnancy outcomes of women with hydrosalpinges, particularly for LBR and surgical complications; and to investigate the relative efficacy and safety of the different surgical modalities in the treatment of hydrosalpinges prior to ART.
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Affiliation(s)
- Pedro Melo
- Buckinghamshire Hospitals NHS Trust, Aylesbury, UK
| | | | - Neil Johnson
- Discipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | | | - Annika Strandell
- Obstetrics and Gynecology, University of Gothenburg, Gothenburg, Sweden
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Christian Becker
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Ingrid E Granne
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
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Capmas P, Suarthana E, Tulandi T. Management of Hydrosalpinx in the Era of Assisted Reproductive Technology: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:418-441. [PMID: 32853797 DOI: 10.1016/j.jmig.2020.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis evaluating the effect of hydrosalpinx on pregnancy outcomes, to compare different types of management of hydrosalpinx and their impact on pregnancy rates as well as on the ovarian reserve. DATA SOURCES Electronic search using Pubmed, EMBASE, Ovid MEDLINE, Google Scholar, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials and including all published studies that examined tubal infertility and its management (assisted reproductive technology or surgery) as well as the effects on ovarian reserve. The following medical subject headings (Mesh) terms combinations were used: "fallopian tube disease," hydrosalpinx," "tubal or salpinx occlusion or obstruction," "in vitro fertilization," "fallopian tube surgery," "salpingectomy," "salpingostomy," "infertility," "subfertility," "sterility" and "ovarian reserve." METHODS OF STUDY SELECTION All randomized trials, cohort, and case controls studies were included. We excluded review articles, meeting abstracts, case series and case reports, and abstracts without access to full texts. The search was limited to trials in humans and published in English. TABULATION, INTEGRATION, AND RESULTS Our electronic search initially retrieved 6354 articles. Finally, 19 studies were included in the quantitative evaluation of the effects of hydrosalpinx: 23 in the qualitative evaluation and 5 in the quantitative evaluation of different types of hydrosalpinx treatments; and 17 in the quantitative evaluation of ovarian reserve. The presence of a hydrosalpinx was associated with decreased rates of implantation and clinical pregnancy, and increased rates of ectopic pregnancy and miscarriage. Management of hydrosalpinx with salpingectomy, tubal occlusion, or hydrosalpinx aspiration led to better in vitro fertilization pregnancy rates. We found no difference in ovarian response to stimulation after salpingectomy except a decrease in antimüllerian hormone compared to no surgery. CONCLUSIONS The presence of hydrosalpinx is associated with decreased pregnancy rate and increased rates of ectopic pregnancy and miscarriage. Management of hydrosalpinx, regardless of the type of treatment, leads to an increased chance of pregnancy.
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Affiliation(s)
- Perrine Capmas
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors); Inserm, Centre of Research in Epidemiology and Population Health, U1018, and Faculty of Medicine, University Paris Sud, Le Kremlin Bicêtre, France (Dr. Capmas)
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors)
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors).
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D’Angelo A, Panayotidis C, Amso N, Marci R, Matorras R, Onofriescu M, Turp AB, Vandekerckhove F, Veleva Z, Vermeulen N, Vlaisavljevic V. Recommendations for good practice in ultrasound: oocyte pick up †. Hum Reprod Open 2019; 2019:hoz025. [PMID: 31844683 PMCID: PMC6903452 DOI: 10.1093/hropen/hoz025] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 06/22/2019] [Accepted: 07/29/2019] [Indexed: 01/13/2023] Open
Abstract
STUDY QUESTION What is good practice in ultrasound (US), and more specifically during the different stages of transvaginal oocyte retrieval, based on evidence in the literature and expert opinion on US practice in ART? SUMMARY ANSWER This document provides good practice recommendations covering technical aspects of US-guided transvaginal oocyte retrieval (oocyte pick up: OPU) formulated by a group of experts after considering the published data, and including the preparatory stage of OPU, the actual procedure and post-procedure care. WHAT IS KNOWN ALREADY US-guided transvaginal OPU is a widely performed procedure, but standards for best practice are not available. STUDY DESIGN SIZE DURATION A working group (WG) collaborated on writing recommendations on the practical aspects of transvaginal OPU. A literature search for evidence of the key aspects of the procedure was carried out. Selected papers (n = 190) relevant to the topic were analyzed by the WG. PARTICIPANTS/MATERIALS SETTING METHODS The WG members considered the following key points in the papers: whether US practice standards were explained; to what extent the OPU technique was described and whether complications or incidents and how to prevent such events were reported. In the end, only 108 papers could be used to support the recommendations in this document, which focused on transvaginal OPU. Laparoscopic OPU, transabdominal OPU and OPU for IVM were outside the scope of the study. MAIN RESULTS AND THE ROLE OF CHANCE There was a scarcity of studies on the actual procedural OPU technique. The document presents general recommendations for transvaginal OPU, and specific recommendations for its different stages, including prior to, during and after the procedure. Most evidence focussed on comparing different equipment (needles) and on complications and risks, including the risk of infection. For these topics, the recommendations were largely based on the results of the studies. Recommendations are provided on equipment and materials, possible risks and complications, audit and training. One of the major research gaps was training and competence. This paper has also outlined a list of research priorities (including clarification on the value or full blood count, antibiotic prophylaxis and flushing, and the need for training and proficiency). LIMITATIONS REASONS FOR CAUTION The recommendations of this paper were mostly based on clinical expertise, as at present, only a few clinical trials have focused on the oocyte retrieval techniques, and almost all available data are observational. In addition, studies focusing on OPU were heterogeneous with significant difference in techniques used, which made drafting conclusions and recommendations based on these studies even more challenging. WIDER IMPLICATIONS OF THE FINDINGS These recommendations complement previous guidelines on the management of good laboratory practice in ART. Some useful troubleshooting/checklist recommendations are given for easy implementation in clinical practice. These recommendations aim to contribute to the standardization of a rather common procedure that is still performed with great heterogeneity. STUDY FUNDING/COMPETING INTERESTS The meetings of the WG were funded by ESHRE. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER NA.ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.
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Affiliation(s)
| | - Arianna D’Angelo
- Wales Fertility Institute, University Hospital of Wales, Cardiff University, Cardiff, UK
| | | | - Nazar Amso
- Cardiff University, Cardiff, South Glamorgan, UK
| | - Roberto Marci
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Roberto Matorras
- Instituto Valenciano de Infertilidad, IVI Bilbao, Bilbao, Spain; Human Reproduction Unit, Cruces University Hospital, Bilbao, Spain; Department of Obstetrics and Gynecology, Basque Country University, Spain; BioCruces Research Center Bilbao, Bilbao, Spain
| | - Mircea Onofriescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr.T.Popa”, Iasie, Romania
| | - Ahmet Berkiz Turp
- Department of Obstetrics and Gynecology, IVF Unit, Harran University, Sanliurfa 63300, Turkey
| | | | - Zdravka Veleva
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
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10
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Van Voorhis BJ, Mejia RB, Schlaff WD, Hurst BS. Is removal of hydrosalpinges prior to in vitro fertilization the standard of care? Fertil Steril 2019; 111:652-656. [PMID: 30929723 DOI: 10.1016/j.fertnstert.2019.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Bradley J Van Voorhis
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Rachel B Mejia
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - William D Schlaff
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Bradley S Hurst
- Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina
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11
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Ultrasound guidance in reproductive surgery. Best Pract Res Clin Obstet Gynaecol 2019; 59:12-24. [PMID: 31279764 DOI: 10.1016/j.bpobgyn.2019.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 11/22/2022]
Abstract
Ultrasound plays a key role in diagnosis and guidance in reproductive medicine and surgery. In the field of reproductive surgery, some of the interventions, especially intrauterine procedures, are regularly conducted without imaging guidance but instead performed based on clinical skills and experience alone. Operative real-time US provides concurrent visualisation of the structures, contents and planes and operating instruments and, therefore, has the potential to improve efficacy and safety of the operative interventions. Ultrasound should be used in our operating theatres more often to guide various intrauterine procedures to reduce the intra-operative risks and complications including uterine perforations and visceral injury. The use of ultrasound necessitates an additional assistant experienced in ultrasound in the theatre, but regular use of ultrasound improves the training opportunities of the trainees and clinicians.
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12
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Yohannes E, Kazanjian AA, Lindsay ME, Fujii DT, Ieronimakis N, Chow GE, Beesley RD, Heitmann RJ, Burney RO. The human tubal lavage proteome reveals biological processes that may govern the pathology of hydrosalpinx. Sci Rep 2019; 9:8980. [PMID: 31222072 PMCID: PMC6586608 DOI: 10.1038/s41598-019-44962-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 05/24/2019] [Indexed: 12/12/2022] Open
Abstract
Hydrosalpinx, the blockage of fallopian tubes, can result from pelvic inflammatory disease. Hydrosalpinx is a cause of infertility and negatively impacts in vitro fertilization. To better understand the pathobiology of hydrosalpinx, we compared the proteome of lavages from disease vs. healthy fallopian tubes. Results indicate a disruption of redox homeostasis and activation of the complement system, immune cell infiltration, and phagocytosis; pathways that may drive tubal injury. To our surprise among the most prominent proteins with hydrosalpinx was mesothelin (MSLN), which until now has only been associated with epithelial malignancies. Analogous to mesothelioma and ovarian carcinoma, a significant increase of MSLN was detected in plasma from patients with hydrosalpinx. This finding suggests MSLN may provide clinical diagnosis in lieu of the current approaches that require invasive imaging. Importantly, these findings implicate MSLN in a benign disease, indicating that the activation and role of MSLN is not restricted to cancer.
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Affiliation(s)
- Elizabeth Yohannes
- Department of Clinical Investigation, Division of Graduate Medical Education, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA.
| | - Avedis A Kazanjian
- Department of Clinical Investigation, Division of Graduate Medical Education, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Morgan E Lindsay
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Dennis T Fujii
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Nicholas Ieronimakis
- Department of Clinical Investigation, Division of Graduate Medical Education, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Gregory E Chow
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Ronald D Beesley
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Ryan J Heitmann
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Richard O Burney
- Department of Clinical Investigation, Division of Graduate Medical Education, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA.,Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
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13
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Volodarsky-Perel A, Buckett W, Tulandi T. Treatment of hydrosalpinx in relation to IVF outcome: a systematic review and meta-analysis. Reprod Biomed Online 2019; 39:413-432. [PMID: 31324437 DOI: 10.1016/j.rbmo.2019.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/21/2019] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
Salpingectomy is the most widely used treatment for hydrosalpinx. The effect of salpingectomy on the stimulation response during subsequent IVF treatment, however, remains unclear. The aim of this systematic review was to evaluate the ovarian response and pregnancy outcome of IVF treatment carried out after salpingectomy compared with other pre-IVF treatment options for hydrosalpinx. We conducted a literature search using PubMed, Ovid MEDLINE, Google Scholar, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials. Five randomized studies and nine observational studies were included in the systematic review and evaluated using Cochrane Collaboration's tool for randomized, Newcastle-Ottawa scale for observational studies and GRADE guidelines for certainty of evidence assessment. The mean number of retrieved oocytes was similar between the groups in randomized (mean difference [MD] = -0.03, 95% CI -0.75 to 0.70) and observational studies (MD = -0.15, 95% CI -2.32 to 2.02). Live birth (RR 1.59, 95% CI 1.17 to 2.16), clinical pregnancy (RR 1.27, 95% CI 1.02 to 1.57) and implantation rates (RR 1.55, 95% CI 1.16 to 2.08) were higher in the salpingectomy group in randomized studies. The present systematic review and meta-analysis showed that salpingectomy does not impair the ovarian response during subsequent IVF treatment.
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Affiliation(s)
- Alexander Volodarsky-Perel
- Department of Obstetrics and Gynecology, McGill University Health Centre, 1001 Decarie Blvd, Montreal QC, H4A 3J1, Canada.
| | - William Buckett
- Department of Obstetrics and Gynecology, McGill University Health Centre, 1001 Decarie Blvd, Montreal QC, H4A 3J1, Canada
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University Health Centre, 1001 Decarie Blvd, Montreal QC, H4A 3J1, Canada
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14
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Harb H, Al-Rshoud F, Karunakaran B, Gallos ID, Coomarasamy A. Hydrosalpinx and pregnancy loss: a systematic review and meta-analysis. Reprod Biomed Online 2019; 38:427-441. [DOI: 10.1016/j.rbmo.2018.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/07/2018] [Accepted: 12/10/2018] [Indexed: 11/24/2022]
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15
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Cohen A, Almog B, Tulandi T. Hydrosalpinx Sclerotherapy Before In Vitro Fertilization: Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2018; 25:600-607. [DOI: 10.1016/j.jmig.2017.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/21/2017] [Accepted: 12/07/2017] [Indexed: 10/18/2022]
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16
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Abstract
Ultrasonography, especially 3D, is essential in the diagnosis and preoperative evaluation of gynecologic surgeries and is important in surgical planning and counseling of patients. In addition, it is useful during hysteroscopic procedures, particularly difficult Asherman syndrome cases, resection of transverse vaginal septum, and treatment of hematometria. 3D ultrasound is especially helpful for fibroid mapping as the simultaneous visualization of the endometrium and myometrium with the coronal view is possible, it can be done by the gynecologist and at a lower cost than an magnetic resonance imaging. The ability to visualize with ultrasound during surgery may reduce complications and eliminate the use of laparoscopy.
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17
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Popović J, Radović-Janošević D, Kutlešić R, Pop-Trajković-Dinić S, Trenkić M, Krtinić D. LAPAROSCOPIC SURGERY IN THE DIAGNOSIS AND MANAGEMENT OF HYDROSALPINX IN THE PREPARATION FOR IN VITRO FERTILIZATION PROCEDURE. ACTA MEDICA MEDIANAE 2017. [DOI: 10.5633/amm.2017.0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Pregnancy outcome of in vitro fertilization after Essure and laparoscopic management of hydrosalpinx: a systematic review and meta-analysis. Fertil Steril 2017; 108:84-95.e5. [DOI: 10.1016/j.fertnstert.2017.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/23/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022]
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19
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Daniilidis A, Balaouras D, Chitzios D, Theodoridis T, Assimakopoulos E. Hydrosalpinx: Tubal surgery or in vitro fertilisation? An everlasting dilemma nowadays; a narrative review. J OBSTET GYNAECOL 2017; 37:550-556. [PMID: 28325120 DOI: 10.1080/01443615.2017.1287685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The decision on how to treat tubal diseases, specifically hydrosalpinx, is a difficult one. Ιt involves surgical, medical, social, emotional and economic factors. This narrative review aims to increase awareness of tubal disease diagnosis and treatment, to compare between tubal surgery and in vitro fertilisation (IVF) for tubal factor infertility, and to investigate the effect of the combination of both. This way, we can be more effective, safe and provide our patients with better treatment results. The review analysed randomised studies, trials and meta-analysis, which give new aspects on the treatment methods for tubal pathology before IVF. Recent papers published in English have been studied, alongside guidelines and committee opinions from previous years. Tubal surgery and IVF aim to exploit a woman's reproductive potential. IVF and endoscopic tubal surgery must be thought of as complementary, rather than competing techniques in tubal disease cases, in order to improve fertility outcome. The first-line treatment for young women less than 35 years old with minor tubal pathology, is tubal surgery. IVF should be offered if there are other factors in a couple's subfertility, if the patient is >38 years old, if moderate to severe tubal disease is present, and if it has been more than 12 months post-surgery.
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Affiliation(s)
- A Daniilidis
- a 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki , Greece
| | - D Balaouras
- a 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki , Greece
| | - D Chitzios
- a 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki , Greece
| | - T Theodoridis
- b 1st University Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki , Greece
| | - E Assimakopoulos
- a 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki , Greece
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20
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Tubal Disease and Impersonators/Masqueraders. Clin Obstet Gynecol 2017; 60:46-57. [DOI: 10.1097/grf.0000000000000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Barbosa MW, Sotiriadis A, Papatheodorou SI, Mijatovic V, Nastri CO, Martins WP. High miscarriage rate in women treated with Essure® for hydrosalpinx before embryo transfer: a systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:556-565. [PMID: 27854386 DOI: 10.1002/uog.15960] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Essure® has been tested as an alternative treatment for hydrosalpinx before embryo transfer (ET) in women undergoing assisted reproduction techniques. However, the persistence of a foreign body inside the uterine cavity might have a negative impact on the outcome of pregnancy. The present systematic review aimed at identifying, appraising and summarizing the available evidence regarding the effectiveness and safety of using Essure prior to ET for women with hydrosalpinx. METHODS We searched for studies in PubMed, Scopus, CENTRAL, Web of Science and ClinicalTrials.gov and the reference lists of eligible studies. All studies including at least 10 women with hydrosalpinx who received Essure, any other intervention or no treatment prior to ET were considered eligible. Study selection, data extraction and evaluation of the risk of bias were performed independently by two authors. Study outcomes were miscarriage per clinical pregnancy, singleton preterm birth per singleton live birth and live birth/ongoing pregnancy and clinical pregnancy per ET. The pooled results for each outcome and intervention were summarized as proportions with their respective 95% CIs, using a random-effects model. RESULTS Our electronic search of databases was performed on 7 November 2015, and 26 studies with 43 study arms were considered eligible: eight study arms evaluating Essure; seven assessing tubal aspiration; seven appraising effects of no treatment; 12 evaluating salpingectomy; two assessing tubal division; and seven evaluating tubal occlusion. When compared with women who had no intervention, women with Essure had a higher clinical pregnancy rate per ET (36% (95% CI, 0-43%) vs 13% (95% CI, 9-17%)). When compared with women who had other interventions, women with Essure had a higher miscarriage rate per clinical pregnancy (38% (95% CI, 27-49%) vs 15% (95% CI, 10-19%)). CONCLUSIONS The available evidence suggests that, although Essure prior to ET in women with hydrosalpinx improves the chance of achieving a clinical pregnancy compared with no intervention, it is associated with a higher rate of miscarriage when compared with the other interventions. Although this evidence is based on observational studies, we believe that salpingectomy should be the first option for women who are eligible for videolaparoscopy. However, it is still premature to make recommendations for women who are not eligible for surgery, and randomized controlled trials are needed to clarify which is the best treatment alternative in such a scenario. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M W Barbosa
- University of Sao Paulo, Department of Obstetrics and Gynecology, Ribeirao Preto Medical School (FMRP-USP), Ribeirao Preto, Brazil
| | - A Sotiriadis
- Aristotle University of Thessaloniki, 2nd Department of Obstetrics and Gynecology, Thessaloniki, Greece
| | - S I Papatheodorou
- Department of Health Sciences, Cyprus Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - V Mijatovic
- Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - C O Nastri
- SEMEAR Fertilidade, Human Reproduction, Ribeirao Preto, Brazil
| | - W P Martins
- University of Sao Paulo, Department of Obstetrics and Gynecology, Ribeirao Preto Medical School (FMRP-USP), Ribeirao Preto, Brazil
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22
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Song XM, Jiang H, Zhang WX, Zhou Y, Ni F, Wang XM. Ultrasound sclerotherapy pretreatment could obtain a similar effect to surgical intervention on improving the outcomes of in vitro fertilization for patients with hydrosalpinx. J Obstet Gynaecol Res 2016; 43:122-127. [PMID: 27762465 DOI: 10.1111/jog.13152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/19/2016] [Accepted: 08/07/2016] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to compare the clinical outcomes of in vitro fertilization (IVF) for patients with hydrosalpinx between ultrasound sclerotherapy and surgical intervention. METHODS The data of 482 IVF/intracytoplasmic sperm injection (ICSI) cycles were divided into three groups according to different intervention protocols before IVF/ICSI. Group A included 265 cycles in which ultrasound sclerotherapy pretreatment was carried out before controlled ovarian hyperstimulation. Group B included 109 cycles in which hydrosalpinx aspiration was carried out under ultrasound guidance on the day of oocyte retrieval. Croup C included 108 cycles in which bilateral salpingectomy was carried out before IVF/ICSI. RESULTS The rates of embryo implantation, biochemical pregnancy, clinical pregnancy, multiple pregnancy, and early abortion showed no significant differences between groups A and C (P > 0.05); whereas the rates of embryo implantation, biochemical pregnancy, and clinical pregnancy in group B were significantly lower than those in groups A and C (P < 0.05), and that of early abortion in group B was significantly higher than that in groups A and C (P < 0.05). CONCLUSION Ultrasound sclerotherapy on patients with hydrosalpinx before IVF-embryo transfer could obtain a similar clinical outcome to surgical intervention.
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Affiliation(s)
- Xiao-Min Song
- The Reproductive Medicine Center, Clinical College of People's Liberation Army Affiliated to Anhui Medical University, Hefei, Anhui, China.,105 Hospital of People's Liberation Army, Hefei, Anhui, China
| | - Hong Jiang
- The Reproductive Medicine Center, Clinical College of People's Liberation Army Affiliated to Anhui Medical University, Hefei, Anhui, China.,105 Hospital of People's Liberation Army, Hefei, Anhui, China
| | - Wen-Xiang Zhang
- The Reproductive Medicine Center, Clinical College of People's Liberation Army Affiliated to Anhui Medical University, Hefei, Anhui, China.,105 Hospital of People's Liberation Army, Hefei, Anhui, China
| | - Yun Zhou
- The Reproductive Medicine Center, Clinical College of People's Liberation Army Affiliated to Anhui Medical University, Hefei, Anhui, China.,105 Hospital of People's Liberation Army, Hefei, Anhui, China
| | - Feng Ni
- The Reproductive Medicine Center, Clinical College of People's Liberation Army Affiliated to Anhui Medical University, Hefei, Anhui, China.,105 Hospital of People's Liberation Army, Hefei, Anhui, China
| | - Xue-Mei Wang
- The Reproductive Medicine Center, Clinical College of People's Liberation Army Affiliated to Anhui Medical University, Hefei, Anhui, China
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23
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Tsiami A, Chaimani A, Mavridis D, Siskou M, Assimakopoulos E, Sotiriadis A. Surgical treatment for hydrosalpinx prior to in-vitro fertilization embryo transfer: a network meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:434-445. [PMID: 26922863 DOI: 10.1002/uog.15900] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/11/2016] [Accepted: 02/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The presence of hydrosalpinx impairs the outcome of in-vitro fertilization embryo transfer (IVF-ET). Surgical methods to either aspirate the fluid or isolate the affected Fallopian tubes have been attempted as a means of improving outcome. The aim of this network meta-analysis was to compare the effectiveness of surgical treatments for hydrosalpinx before IVF-ET. METHODS An electronic search of MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (Central) and the US Registry of clinical trials for articles published from inception to July 2015 was performed. Eligibility criteria included randomized controlled trials of women with hydrosalpinx before IVF-ET comparing ultrasound-guided aspiration of the fluid, tubal occlusion, salpingectomy or no intervention. Ongoing pregnancy was the primary outcome and clinical pregnancy, ectopic pregnancy and miscarriage were secondary outcomes. A random-effects network meta-analysis synthesizing direct and indirect evidence from the included trials was carried out. We estimated the relative effect sizes as risk ratios (RRs) and obtained the relative ranking of the interventions using cumulative ranking curves. The quality of evidence according to GRADE guidelines, adapted for network meta-analysis, was assessed. RESULTS Proximal tubal occlusion (RR, 3.22 (95% CI, 1.27-8.14)) and salpingectomy (RR, 2.24 (95% CI, 1.27-3.95)) for treatment of hydrosalpinx were superior to no intervention for ongoing pregnancy. For an outcome of clinical pregnancy, all three interventions appeared to be superior to no intervention. No superiority could be ascertained between the three surgical methods for any of the outcomes. In terms of relative ranking, tubal occlusion was the best surgical treatment followed by salpingectomy for ongoing and clinical pregnancy rates. No significant statistical inconsistency was detected; however, the point estimates for some inconsistency factors and their CIs were relatively large. The small study number and sizes were the main limitations. The quality of evidence was commonly low/very low, especially when aspiration was involved, indicating that the results were not conclusive and should be interpreted with caution. CONCLUSIONS Proximal tubal occlusion, salpingectomy and aspiration for treatment of hydrosalpinx scored consistently better than did no intervention for the outcome of IVF-ET. In terms of relative ranking, proximal tubal occlusion appeared to be the most effective intervention, followed by salpingectomy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Tsiami
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Chaimani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - D Mavridis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Primary Education, University of Ioannina School of Education, Ioannina, Greece
| | - M Siskou
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Assimakopoulos
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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24
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Dreyer K, Lier M, Emanuel M, Twisk J, Mol B, Schats R, Hompes P, Mijatovic V. Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT. Hum Reprod 2016; 31:2005-16. [DOI: 10.1093/humrep/dew050] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/19/2016] [Indexed: 11/13/2022] Open
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25
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Zhou Y, Jiang H, Zhang WX, Ni F, Wang XM, Song XM. Ultrasound-guided aspiration of hydrosalpinx occurring during controlled ovarian hyperstimulation could improve clinical outcome of in vitro fertilization-embryo transfer. J Obstet Gynaecol Res 2016; 42:960-5. [PMID: 27079131 DOI: 10.1111/jog.13013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/02/2016] [Accepted: 02/26/2016] [Indexed: 11/29/2022]
Abstract
AIM To investigate whether aspiration of hydrosalpinx during oocyte retrieval could improve the clinical outcome of in vitro fertilization-embryo transfer (IVF-ET). METHODS The clinical data of 598 IVF-ET cycles with tubal factor infertility at Reproductive Medical Center, 105 Hospital of People's Liberation Army, Anhui, China, between March 2011 and July 2015 were analyzed in this retrospective study. Among them, 71 cycles with unilateral or bilateral hydrosalpinx confirmed on both hysterosalpingography (HSG) and ultrasonography before controlled ovarian hyperstimulation (COH) were assigned to group A. A total of 51 cycles with unilateral or bilateral hydrosalpinx occurring during COH and confirmed on ultrasonography were assigned to group B. In both group A and group B, ultrasound-guided hydrosalpinx aspiration was performed in all patients when oocyte retrieval was finished. A further 35 cycles with unilateral or bilateral hydrosalpinx during COH received no intervention and were assigned to group C. A total of 441 cycles without hydrosalpinx on HSG or on ultrasonography before or during COH served as the control (group D). The IVF-ET outcomes of the four groups were analyzed and compared. RESULTS The embryo implantation rate and clinical pregnancy rate in group A and group C were significantly lower than those in group B and group D. The ongoing pregnancy rate in group A was significantly lower than that in group B and group D, and the ongoing pregnancy rate in group C was significantly lower than that in group D. CONCLUSION Aspiration of hydrosalpinx occurring during COH could significantly improve the clinical outcomes of IVF-ET, but not for the hydrosalpinx occurring before COH.
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Affiliation(s)
- Yun Zhou
- Reproductive Medicine Center, Clinical College of People's Liberation Army Affiliated to Anhui Medical University, Hefei, Anhui, China.,Reproductive Medicine Center, 105 Hospital of People's Liberation Army, Hefei, Anhui, China
| | - Hong Jiang
- Reproductive Medicine Center, Clinical College of People's Liberation Army Affiliated to Anhui Medical University, Hefei, Anhui, China.,Reproductive Medicine Center, 105 Hospital of People's Liberation Army, Hefei, Anhui, China
| | - Wen-Xiang Zhang
- Reproductive Medicine Center, Clinical College of People's Liberation Army Affiliated to Anhui Medical University, Hefei, Anhui, China.,Reproductive Medicine Center, 105 Hospital of People's Liberation Army, Hefei, Anhui, China
| | - Feng Ni
- Reproductive Medicine Center, Clinical College of People's Liberation Army Affiliated to Anhui Medical University, Hefei, Anhui, China.,Reproductive Medicine Center, 105 Hospital of People's Liberation Army, Hefei, Anhui, China
| | - Xue-Mei Wang
- Reproductive Medicine Center, Clinical College of People's Liberation Army Affiliated to Anhui Medical University, Hefei, Anhui, China.,Reproductive Medicine Center, 105 Hospital of People's Liberation Army, Hefei, Anhui, China
| | - Xiao-Min Song
- Reproductive Medicine Center, Clinical College of People's Liberation Army Affiliated to Anhui Medical University, Hefei, Anhui, China.,Reproductive Medicine Center, 105 Hospital of People's Liberation Army, Hefei, Anhui, China
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de Ziegler D, Pirtea P, Galliano D, Cicinelli E, Meldrum D. Optimal uterine anatomy and physiology necessary for normal implantation and placentation. Fertil Steril 2016; 105:844-54. [PMID: 26926252 DOI: 10.1016/j.fertnstert.2016.02.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/02/2016] [Accepted: 02/11/2016] [Indexed: 12/11/2022]
Abstract
The authors review aberrations of uterine anatomy and physiology affecting pregnancy outcomes with IVF. In the case of endometriosis and hydrosalpinx, pathologies outside of the uterus alter the uterine endometrium. In the case of endometriosis, Dominique de Ziegler outlines the numerous changes in gene expression and the central role of inflammation in causing progesterone resistance. With endometriosis, the absence of ovarian function inherent in deferred transfer, with or without a more lengthy suppression of ovarian function, appears to be sufficient to restore normal function of eutopic endometrium. Because laparoscopy is no longer routine in the evaluation of infertility, unrecognized endometriosis then becomes irrelevant in the context of assisted reproductive technology. With hydrosalpinx and submucus myomas, the implantation factor HOXA-10 is suppressed in the endometrium and, with myomas, even in areas of the uterus not directly affected. Daniela Galliano reviews various uterine pathologies, the most enigmatic being adenomyosis, where the endometrium also manifests many of the changes seen in endometriosis and deferred transfer with extended suppression appears to provide the best outcomes. Ettore Cicinelli's group has extensively studied the diagnosis and treatment of endometritis, and although more definitive diagnosis and care of this covert disorder may await techniques such as sequencing of the endometrial microbiome, it undoubtedly is an important factor in implantation failure, deserving our attention and treatment.
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Affiliation(s)
- Dominique de Ziegler
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Université Paris Descartes, Paris Sorbonne Cité-Assistance Publique Hôpitaux de Paris, CHU Cochin, Paris, France.
| | - Paul Pirtea
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Université Paris Descartes, Paris Sorbonne Cité-Assistance Publique Hôpitaux de Paris, CHU Cochin, Paris, France
| | - Daniela Galliano
- Instituto Valenciano de Infertilidad (IVI), Rome, Italy and Barcelona, Spain; IVI Foundation, Valencia, Spain
| | - Ettore Cicinelli
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Bari, Italy
| | - David Meldrum
- Reproductive Partners San Diego, Division of Reproductive Endocrinology, University of California, San Diego, California
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Lorente González J, Ríos Castillo JE, Pomares Toro E, Romero Nieto MI, Castelo-Branco C, Arjona Berral JE. Essure a novel option for the treatment of hydrosalpinx: a case series and literature review. Gynecol Endocrinol 2016; 32:166-70. [PMID: 26513546 DOI: 10.3109/09513590.2015.1103221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the use of hysteroscopic Essure device placement for the treatment of hydrosalpinx (HS)-related infertility in patients with laparoscopic contraindications and compared their pregnancy outcomes following IVF-ICSI treatment with those patients having had laparoscopic tubal occlusion (LTO). PATIENTS From 2008 to 2014 a total of 50 patients were diagnosed with unilateral or bilateral hydrosalpinges: 29 patients had laparoscopic contraindications and were treated hysteroscopically and 21 patients were treated with laparoscopical salpingectomy. RESULTS Of the 29 patients who underwent treatment with Essure(®), 21 began a cycle of in vitro fertilization (IVF), and 13 finished in embryo transfer that resulted in seven clinical pregnancies. Furthermore, in the group of women treated with salpingectomy, 17 started an IVF cycle that resulted in 12 clinical pregnancies. The clinical pregnancy rate per patient with an IVF cycle started was 33.3% and 70.6%, the live-birth rate per patient was 14.3% and 52.9%, the miscarriage rate was 57.1% and 18.2%, and the implantation rate was 16.3% and 34.1% for hysteroscopy and laparoscopy, respectively. CONCLUSION Essure(®) placement is an alternative method for occlusion of hydrosalpinges before IVF. Monitoring the live-birth rate confirms that this option may be considered when laparoscopy is impossible or contraindicated.
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Affiliation(s)
- Juan Lorente González
- a Department of Obstetrics and Gynecology , ''Reina Sofia'' University Hospital , Cordoba , Spain and
| | | | - Elvira Pomares Toro
- a Department of Obstetrics and Gynecology , ''Reina Sofia'' University Hospital , Cordoba , Spain and
| | | | - Camil Castelo-Branco
- b Faculty of Medicine , Institut Clinic of Gynecology, Obstetrics and Neonatology, University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
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Liu S, Shi L, Shi J. Impact of endometrial cavity fluid on assisted reproductive technology outcomes. Int J Gynaecol Obstet 2015; 132:278-83. [PMID: 26792140 DOI: 10.1016/j.ijgo.2015.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 07/12/2015] [Accepted: 11/20/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The impact of endometrial cavity fluid (ECF) on assisted reproductive technology (ART) outcomes has not been evaluated in a meta-analysis. OBJECTIVES To evaluate the impact of ECF on the outcome of ART cycles. SEARCH STRATEGY PubMed, China Academic Journals Full-text Database, and China Doctoral/Masters Dissertations Full-text Databases were searched for reports published in any language before January 1, 2015, using relevant keywords. SELECTION CRITERIA Studies were included if they compared the outcome of ART in women with and without ECF. DATA COLLECTION AND ANALYSIS Background information, participants' characteristics, and study outcomes were recorded. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method. MAIN RESULTS Six studies evaluating 5928 ART cycles were included. The pregnancy rate was significantly lower in the group with ECF than in the group without ECF (OR 0.74, 95% CI 0.55-0.98; P=0.03). The same association was observed if the analysis included only patients with hydrosalpinx (OR 0.36, 95% CI 0.15-0.86; P=0.02). CONCLUSIONS The clinical pregnancy rate after ART is significantly lower among patients with ECF than among those without ECF. In addition, if ECF is found in patients with hydrosalpinx, ART cycles should be cancelled after oocyte retrieval.
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Affiliation(s)
- Shan Liu
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Lin Shi
- Department of Immunology and Microbiology, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China.
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Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertil Steril 2015; 103:e37-43. [DOI: 10.1016/j.fertnstert.2015.03.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 01/03/2023]
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Veersema S. Hysteroscopy and contraception. Best Pract Res Clin Obstet Gynaecol 2015; 29:940-50. [PMID: 26013880 DOI: 10.1016/j.bpobgyn.2015.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
The Essure method is the only available hysteroscopic sterilisation method. A 4-cm device is placed in the fallopian tubes, which then induces an inflammatory reaction that causes occlusion. The method has a high successful placement rate and high effectiveness, and it can be performed in an office setting without anaesthesia. Three months after the procedure, a confirmation test has to be conducted to assure a correct position of the micro-inserts and tubal occlusion. This test can be performed by hysterosalpingography (HSG), plain X-ray or ultrasound. Pregnancies reported after Essure sterilisation are, in a majority, related to non-adherence to the follow-up protocol or misreading of the confirmation test. A majority of the pregnancies occurred after HSGs that were determined to have been misinterpreted, including missed expulsion or perforation of the micro-insert. Other complications such as ectopic pregnancy and allergic reaction to the micro-inserts seem to have been described to be of low incidence.
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Affiliation(s)
- Sebastiaan Veersema
- Department of Obstetrics & Gynaecology, St Antonius Hospital, Nieuwegein, The Netherlands.
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Fouda UM, Sayed AM, Abdelmoty HI, Elsetohy KA. Ultrasound guided aspiration of hydrosalpinx fluid versus salpingectomy in the management of patients with ultrasound visible hydrosalpinx undergoing IVF-ET: a randomized controlled trial. BMC WOMENS HEALTH 2015; 15:21. [PMID: 25783650 PMCID: PMC4364312 DOI: 10.1186/s12905-015-0177-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/04/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this study was to compare the efficacy of ultrasound guided aspiration of hydrosalpinx fluid at the time of oocyte retrieval with salpingectomy in the management of patients with ultrasound visible hydrosalpinx undergoing IVF-ET. METHODS One hundred and sixty patients with ultrasound visible hydrosalpinx were randomized into salpingectomy group and aspiration group using computer generated randomization list and sequentially numbered sealed envelopes containing allocation information written on a card. RESULTS The clinical pregnancy rate per started cycle and the implantation rate were non- significantly higher in the salpingectomy group compared with the aspiration group [40% vs. 27.5% (p value = 0.132) and 18.95% vs. 12.82% (p value =0.124), respectively]. In the aspiration group, 34.21% of patients had rapid re-accumulation of the hydrosalpinx fluid (i.e. within first two weeks after embryo transfer). Whereas, the clinical pregnancy rate per transfer cycle and the implantation rate were significantly higher in salpingectomy group compared with the subgroup of patients with rapid re-accumulation of hydrosalpinx fluid [42.67% vs. 19.23% (p value = 0.036) and 18.95% vs. 7.58% (p value = 0.032), respectively], no significant differences were detected between the salpingectomy group and the subgroup of patients with no re-accumulation of hydrosalpinx fluid (42.67% vs. 34% (p value = 0.356) and 18.95% vs. 15.5% (p value = 0.457), respectively). CONCLUSION The small sample size could be the cause of failure of detecting significant increase in implantation and pregnancy rates in salpingectomy group compared with aspiration group. Further larger randomized controlled trials are needed to determine whether salpingectomy is more effective than aspiration of hydrosalpinx fluid or not. Moreover, the data presented in this study suggested that rapid re-accumulation of hydrosalpinx fluid is an obstacle against successful implantation and the cause of lower success rate with ultrasound guided aspiration of hydrosalpinx fluid compared with salpingectomy. TRIAL REGISTRATION Clinical trials.gov ( NCT02008240 ), registered 8 December 2013.
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Affiliation(s)
- Usama M Fouda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt,
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D'Arpe S, Franceschetti S, Caccetta J, Pietrangeli D, Muzii L, Panici PB. Management of hydrosalpinx before IVF: a literature review. J OBSTET GYNAECOL 2014; 35:547-50. [PMID: 25436898 DOI: 10.3109/01443615.2014.985768] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hydrosalpinx has a detrimental effect on the outcome of in vitro fertilization (IVF). Surgical intervention such as salpingectomy or tubal occlusion before IVF improves the outcome of IVF, but these procedures are often contraindicated in women with dense pelvic adhesions. Thus, it is worthwhile to search minimally invasive alternative therapies. The main objective of this review is to assess and compare the value of all the therapeutic options for hydrosalpinx before IVF. The results of the following procedures were compared: the laparoscopic treatments (salpingectomy/proximal tubal occlusion), the hysteroscopic insertion of device achieving tubal occlusion, the tuberous sclerosis and the aspiration of hydrosalpingeal fluid at the time of IVF procedure. Laparoscopic surgical treatment should be considered for all women with hydrosalpinx before IVF. Whenever laparoscopy is not recommended, hysteroscopic insertion of device seems the most effective option for management of hydrosalpinx before IVF.
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Affiliation(s)
- S D'Arpe
- a Department of Gynecology , Obstetrics and Urology, Policlinico Umberto I, University "Sapienza" , Rome , Italy
| | - S Franceschetti
- a Department of Gynecology , Obstetrics and Urology, Policlinico Umberto I, University "Sapienza" , Rome , Italy
| | - J Caccetta
- a Department of Gynecology , Obstetrics and Urology, Policlinico Umberto I, University "Sapienza" , Rome , Italy
| | - D Pietrangeli
- a Department of Gynecology , Obstetrics and Urology, Policlinico Umberto I, University "Sapienza" , Rome , Italy
| | - L Muzii
- a Department of Gynecology , Obstetrics and Urology, Policlinico Umberto I, University "Sapienza" , Rome , Italy
| | - P B Panici
- a Department of Gynecology , Obstetrics and Urology, Policlinico Umberto I, University "Sapienza" , Rome , Italy
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Legendre G, Moulin J, Vialard J, Ziegler DD, Fanchin R, Pouly JL, Watrelot A, BELAISCH Allart J, Massin N, Fernandez H. Proximal occlusion of hydrosalpinges by Essure® before assisted reproduction techniques: a French survey. Eur J Obstet Gynecol Reprod Biol 2014; 181:300-4. [DOI: 10.1016/j.ejogrb.2014.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/15/2014] [Accepted: 07/20/2014] [Indexed: 01/18/2023]
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Reda HA, Naeem K, Seshadri S, El-Toukhy T. Surgical Interventions to Improve In Vitro Fertilization Outcomes: A Systematic Review of the Literature. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2012.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Houssam Abdel Reda
- Assisted Conception Unit, Guy's and St. Thomas' Foundation Trust, King's College London, London, United Kingdom
| | - Komal Naeem
- Assisted Conception Unit, Guy's and St. Thomas' Foundation Trust, King's College London, London, United Kingdom
| | - Srividya Seshadri
- Assisted Conception Unit, Guy's and St. Thomas' Foundation Trust, King's College London, London, United Kingdom
| | - Tarek El-Toukhy
- Assisted Conception Unit, Guy's and St. Thomas' Foundation Trust, King's College London, London, United Kingdom
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Veersema S, Mijatovic V, Dreyer K, Schouten H, Schoot D, Emanuel MH, Hompes P, Brölmann H. Outcomes of Pregnancies in Women With Hysteroscopically Placed Micro-Inserts In Situ. J Minim Invasive Gynecol 2014; 21:492-7. [DOI: 10.1016/j.jmig.2013.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 11/26/2022]
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Zhang WX, Jiang H, Wang XM, Wang L. Pregnancy and perinatal outcomes of interventional ultrasound sclerotherapy with 98% ethanol on women with hydrosalpinx before in vitro fertilization and embryo transfer. Am J Obstet Gynecol 2014; 210:250.e1-5. [PMID: 24246526 DOI: 10.1016/j.ajog.2013.11.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 10/21/2013] [Accepted: 11/12/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the pregnancy and perinatal outcomes of ultrasound sclerotherapy with 98% ethanol on women with hydrosalpinx before in vitro fertilization and embryo transfer. STUDY DESIGN A total of 339 women were divided into 4 groups. Group A without a recurrent hydrosalpinx after sclerotherapy (n = 123, 130 cycles), group B having a recurrence of hydrosalpinx after sclerotherapy (n = 34, 39 cycles), group C (n = 47, 50 cycles) with no prophylactic intervention for hydrosalpinx, whereas group D with nonhydrosalpinx tubal factor infertility was served as control group (n = 135, 145 cycles). Pulsatility index, resistance index, the ratio between peak systolic flow and lowest diastolic flow of the uterine arcuate artery on the day of human chorionic gonadotropin administration, and pregnancy and perinatal outcomes were assessed. RESULTS Thirty-four women (21.7%) experienced hydrosalpinx recurrence after sclerotherapy. The rates of embryo implantation (8.8%), clinical pregnancy (16.0%), and live birth (10.0%) in group C were significantly lower than those in group A (26.4%, 43.1%, 33.8%), group B (24.5%, 38.5%, 28.2%), and group D (30.0%, 50.3%, 39.3%), respectively. The pulsatility index, resistance index, and the ratio between peak systolic flow and lowest diastolic flow of the uterine arcuate artery in group C were significantly higher than those in the other 3 groups. No significant differences in the rate of preterm birth, the rate of low birthweight newborns, and birth defects were found among the 4 groups. CONCLUSION Ultrasound sclerotherapy on women with hydrosalpinx could improve the outcomes of in vitro fertilization embryo transfer by improving the blood flow of the uterine arcuate artery. Interventional ultrasound sclerotherapy has no adverse effect on perinatal outcomes.
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Coughlan C, Ledger W, Wang Q, Liu F, Demirol A, Gurgan T, Cutting R, Ong K, Sallam H, Li T. Recurrent implantation failure: definition and management. Reprod Biomed Online 2014; 28:14-38. [DOI: 10.1016/j.rbmo.2013.08.011] [Citation(s) in RCA: 331] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 05/05/2013] [Accepted: 08/06/2013] [Indexed: 12/29/2022]
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Matorras R, Rabanal A, Prieto B, Diez S, Brouard I, Mendoza R, Exposito A. Hysteroscopic hydrosalpinx occlusion with Essure device in IVF patients when salpingectomy or laparoscopy is contraindicated. Eur J Obstet Gynecol Reprod Biol 2013; 169:54-9. [DOI: 10.1016/j.ejogrb.2013.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 01/10/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
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Tubal factor infertility: diagnosis and management in the era of assisted reproductive technology. Obstet Gynecol Clin North Am 2013. [PMID: 23182560 DOI: 10.1016/j.ogc.2012.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tubal factor infertility accounts for a large portion of female factor infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. The diagnosis of tubal occlusion can be established by a combination of clinical suspicion based on patient history and diagnostic tests, such as hysterosalpingogram, sonohysterosalpingography, and laparoscopy with chromopertubation. Depending on several patient factors, tubal microsurgery or more commonly in vitro fertilization with its improving success rates are the recommended treatment options.
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Sonigo C, Collinet P, Rubod C, Catteau-Jonard S. Place actuelle des micro-implants Essure® dans la prise en charge des hydrosalpinx avant fécondation in vitro. ACTA ACUST UNITED AC 2013; 41:133-8. [DOI: 10.1016/j.gyobfe.2012.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Indexed: 10/27/2022]
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Na ED, Cha DH, Cho JH, Kim MK. Comparison of IVF-ET outcomes in patients with hydrosalpinx pretreated with either sclerotherapy or laparoscopic salpingectomy. Clin Exp Reprod Med 2012; 39:182-6. [PMID: 23346530 PMCID: PMC3548078 DOI: 10.5653/cerm.2012.39.4.182] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/09/2012] [Accepted: 11/23/2012] [Indexed: 12/22/2022] Open
Abstract
Objective Many studies have demonstrated that hydrosalpinx has a detrimental effect on the outcome of IVF. Treating hydrosalpinges prior to the IVF procedure in women with hydrosalpinges is thought to improve the likelihood of successful IVF outcome. Vaginal ultrasound-guided aspiration of hydrosalpinx fluid (HSF) with injection of the sclerosing agent in situ might be simpler than invasive procedures like salpingectomy. Therefore, we carried out a retrospective study on the effects of ultrasound-guided HSF aspiration and injection of the sclerosing agent of ultrasonically diagnosed hydrosalpinx on IVF outcome. Methods In our retrospective study, 97 tubal factor infertile female patients that underwent IVF treatment between January 2005 and December 2012 at the Reproductive Medicine Center of CHA Hospital were divided into two study groups. Fifty-six patients underwent interventional ultrasound sclerotherapy (group 1), and the remaining 41 patients received laparoscopic salpingectomy (group 2) before IVF. We compared the IVF outcomes of the two groups. Results The results showed that ultrasound-guided HSF aspiration and sclerotherapy have IVF outcomes comparable to laparoscopic salpingectomy. Conclusion Interventional ultrasound guided sclerotherapy before IVF is an effective and less invasive prophylactic intervention alternative to salpingectomy with hydrosalpinx.
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Affiliation(s)
- Eun Duc Na
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
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Ultrasound-guided hydrosalpinx aspiration during oocyte retrieval and a mouse embryo assay of hydrosalpinx fluid in a woman with hydrosalpinx and hydrometra during in vitro fertilization treatment. Taiwan J Obstet Gynecol 2012; 51:106-8. [DOI: 10.1016/j.tjog.2012.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2011] [Indexed: 11/21/2022] Open
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43
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Committee opinion: role of tubal surgery in the era of assisted reproductive technology. Fertil Steril 2012; 97:539-45. [DOI: 10.1016/j.fertnstert.2011.12.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 12/19/2011] [Indexed: 11/23/2022]
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Kotrotsou M, Strandell A, Trew G. The current place of tubal surgery in the management of subfertility. HUM FERTIL 2012; 15:75-81. [PMID: 22339337 DOI: 10.3109/14647273.2012.659004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Treatment of tubal disease can be challenging and complex. It requires accurate assessment of the extent of disease and evaluation of all fertility parameters. Although traditionally treatment involved salpingectomy or IVF or a combination of the two, less invasive treatment options may prove beneficial. We evaluated the various diagnostic tools for disease assessment and the treatment options available.
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Affiliation(s)
- Maria Kotrotsou
- Division of Reproductive Medicine, Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK
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45
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Efficacy of surgical treatment for successful pregnancy in infertile patients with hydrosalpinx. ACTA ACUST UNITED AC 2012. [DOI: 10.5468/kjog.2012.55.12.929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chanelles O, Ducarme G, Sifer C, Hugues JN, Touboul C, Poncelet C. Hydrosalpinx and infertility: what about conservative surgical management? Eur J Obstet Gynecol Reprod Biol 2011; 159:122-6. [DOI: 10.1016/j.ejogrb.2011.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 06/10/2011] [Accepted: 07/11/2011] [Indexed: 11/16/2022]
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Fouda UM, Sayed AM. Effect of ultrasound-guided aspiration of hydrosalpingeal fluid during oocyte retrieval on the outcomes of in vitro fertilisation-embryo transfer: a randomised controlled trial (NCT01040351). Gynecol Endocrinol 2011; 27:562-7. [PMID: 20672903 DOI: 10.3109/09513590.2010.507290] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine whether the ultrasound-guided aspiration of hydrosalpingeal fluid at the time of oocyte retrieval can improve the outcomes of in vitro fertilisation-embryo transfer (IVF-ET). PATIENTS One hundred and ten women with ultrasound-visible hydrosalpinges were randomised to two groups based on computer generated randomisation list. Fifty-four women underwent ultrasound-guided aspiration of hydrosalpingeal fluid prior to IVF-ET and 53 women underwent IVF-ET without any prior intervention. RESULTS Patients who underwent aspiration of hydrosalpinges demonstrated a significantly increased implantation, clinical pregnancy rates. Among the patients in the aspiration group, the implantation rate and pregnancy rates were higher in the subgroup of patients with no reaccumulation of hydrosalpingeal fluid within the first 2 weeks after aspiration compared to patients with reaccumulation of hydrosalpingeal fluid within the first 2 weeks after aspiration, but this difference failed to reach statistical significance. Furthermore, no pregnancies occurred in the four patients with uterine fluid collection detected during IVF-ET cycles. CONCLUSION The aspiration of hydrosalpingeal fluid at the time of oocyte retrieval is simple, safe and effective procedure for treatment of patients with ultrasound-visible hydrosalpinges particularly those without rapid reaccumulation of hydrosalpingeal fluid after aspiration or uterine fluid collection during the IVF-ET cycles.
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Affiliation(s)
- Usama M Fouda
- Obstetrics and Gynaecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Amar-Hoffet A, Hédon B, Belaisch-Allart J. [Assisted reproductive technologies place]. J Gynecol Obstet Hum Reprod 2010; 39:S88-S99. [PMID: 21185490 DOI: 10.1016/s0368-2315(10)70034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There are three kinds of infertility treatment: medical treatment, surgical treatment and assisted reproductive technology (ART). ART includes intra uterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). ART technologies made a lot of progress last years and their field of applications extended. Through literature reviews, IUI is recommended for unexplained infertility and discussed for male or cervical infertility. IVF is recommended for tubal and unexplained infertility. Limits between IVF and ICSI in case of male infertility remains unclear. In non mal infertility ICSI is not recommended.
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Affiliation(s)
- A Amar-Hoffet
- Hôpital Saint Joseph, Unité de médecine de la reproduction, 26 bd de Louvain, 13008 Marseille, France
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Abstract
Endometriosis and infertility are associated clinically. Medical and surgical treatments for endometriosis have different effects on a woman's chances of conception, either spontaneously or via assisted reproductive technologies (ART). Medical treatments for endometriosis are contraceptive. Data, mostly uncontrolled, indicate that surgery at any stage of endometriosis enhances the chances of natural conception. Criteria for non-removal of endometriomas are: bilateral cysts, history of past surgery, and altered ovarian reserve. Fears that surgery can alter ovarian function that is already compromised sparked a rule of no surgery before ART. Exceptions to this guidance are pain, hydrosalpinges, and very large endometriomas. Medical treatment-eg, 3-6 months of gonadotropin-releasing hormone analogues-improves the outcome of ART. When age, ovarian reserve, and male and tubal status permit, surgery should be considered immediately so that time is dedicated to attempts to conceive naturally. In other cases, the preference is for administration of gonadotropin-releasing hormone analogues before ART, and no surgery beforehand. The strategy of early surgery, however, seems counterintuitive because of beliefs that milder non-surgical options should be offered first and surgery last (only if initial treatment attempts fail). Weighing up the relative advantages of surgery, medical treatment and ART are the foundations for a global approach to infertility associated with endometriosis.
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Affiliation(s)
- Dominique de Ziegler
- Université Paris Descartes, Centre Hospitalier Universitaire Cochin, Service de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France.
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Jiang H, Pei H, Zhang WX, Wang XM. A prospective clinical study of interventional ultrasound sclerotherapy on women with hydrosalpinx before in vitro fertilization and embryo transfer. Fertil Steril 2010; 94:2854-6. [PMID: 20674895 DOI: 10.1016/j.fertnstert.2010.06.065] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 06/21/2010] [Accepted: 06/22/2010] [Indexed: 11/18/2022]
Abstract
In this prospective clinical study, ultrasound-guided transvaginal aspiration and sclerotherapy with 98% ethanol was performed before the IVF cycle in 33 patients with hydrosalpinx. The results showed that ultrasound aspiration and sclerotherapy could improve the endometrial receptivity and outcomes of IVF, with no recurring sign of the hydrosalpinx and no adverse effect on ovarian reserve or responsiveness during the IVF procedure.
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Affiliation(s)
- Hong Jiang
- Reproductive Medicine Center, Huangshan Hospital, Hefei, People's Republic of China.
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