Hydrosalpinx functional surgery or salpingectomy? The importance of hydrosalpinx fluid in assisted reproductive technologies

Impact on Fertility After Failure of Restorative Proctocolectomy in Men and Women With Ulcerative Colitis: A 17-Year Cohort Study

BACKGROUND

Impact of restorative proctocolectomy failure on fertility has not been studied and is greatly relevant.

OBJECTIVE

The purpose of this study was to evaluate the impact of restorative proctocolectomy failure on birth rate in women and men, along with in vitro fertilization incidence and success.

DESIGN

This was a retrospective registry-based cohort study over 17 years.

SETTINGS

Records for parenting a child were cross-linked with patient records. In women, in vitro fertilization records were cross-linked. All data were prospectively registered.

PATIENTS

Patients of fertile age with ulcerative colitis between 1994 and 2010 were identified in Danish national databases. Patients with restorative proctocolectomy and restorative proctocolectomy failure were identified as subgroups.

MAIN OUTCOME MEASURES

Birth rate ratios and in vitro fertilization incidence and success were measured.

RESULTS

We included 11,939 women and 13,569 men with ulcerative colitis. A total of 711 women and 730 men had restorative proctocolectomy; 114 women and 90 men had failure. Birth rate in women with failure was significantly reduced compared with women without (birth rate ratio = 0.50 (95% CI, 0.29-0.82)). In men with failure, birth rate tended to be lower compared with men without (birth rate ratio = 0.74 (95% CI, 0.51-1.05)). In vitro fertilization incidence was similar with and without failure (HRs adjusted for age at start of follow-up = 0.98 (95% CI, 0.58-1.67]). In vitro fertilization success was significantly lower with failure compared with ulcerative colitis (OR adjusted for age at start of follow-up = 0.36 (95% CI, 0.4-0.92)).

LIMITATIONS

Information on patients leading up to restorative proctocolectomy failure is lacking. Failure patients may have had children during a period with pouch function. Therefore, the impact of failure may be underestimated.

CONCLUSIONS

Restorative proctocolectomy failure impairs birth rate, primarily in women. Although in vitro fertilization incidence is similar in women with and without failure, the likelihood of giving birth after in vitro fertilization is reduced. See Video Abstract at http://links.lww.com/DCR/B202. IMPACTO SOBRE LA FERTILIDAD DESPUéS DEL FRACASO DE LA PROCTOCOLECTOMíA RESTAURADORA EN HOMBRES Y MUJERES CON COLITIS ULCEROSA: UN ESTUDIO DE COHORTE DE 17 AñOS: No se ha estudiado el impacto de la falla de la proctocolectomía restauradora en la fertilidad y es muy relevante.Evaluar el impacto del fracaso de la proctocolectomía restauradora en la tasa de natalidad en mujeres y hombres, junto con la incidencia y el éxito de la fertilización in vitro.Estudio de cohorte retrospectivo basado en el registro de más de 17 años.Los registros de crianza de un niño se cruzaron con los registros de pacientes. En las mujeres, los registros de fertilización in vitro se cruzarón. Todos los datos se regitraron de forma prospectiva.Los pacientes de edad fértil con colitis ulcerosa entre 1994-2010 fueron identificados en las bases de datos nacionales danesas. Los pacientes con proctocolectomía restauradora y fracaso de la proctocolectomía restauradora se identificaron como subgrupos.Tasas de natalidad e incidencia y éxito de la fertilización in vitro.Se incluyeron 11939 mujeres y 13569 hombres con colitis ulcerosa. 711 mujeres y 730 hombres tuvieron proctocolectomía restauradora; 114 mujeres y 90 hombres tuvieron fracaso. La tasa de natalidad en las mujeres con fracaso se redujo significativamente en comparación con las mujeres sin fracaso (tasa de natalidad: 0,50; IC del 95% [0,29; 0,82]). En los hombres con fracaso, la tasa de natalidad tendió a ser más baja en comparación con los hombres sin fracaso (tasa de natalidad: 0,74; IC del 95% [0,51; 1,05]). La incidencia de fertilización in vitro fue similar con y sin falla (aHR: 0.98, IC 95% [0.58; 1.67]). El éxito de la fertilización in vitro fue significativamente menor con el fracaso en comparación con la colitis ulcerosa (aOR: 0.36 IC 95% [0.4; 0.92]).Falta información sobre los pacientes que conducen al fracaso de la proctocolectomía restauradora. Los pacientes con fracaso pueden haber tenido hijos durante un período con función de bolsa. Por lo tanto, el impacto del fracaso puede ser subestimado.El fracaso de la proctocolectomía restauradora afecta la tasa de natalidad, principalmente en mujeres. Aunque la incidencia de la fertilización in vitro es similar en las mujeres con y sin fracaso, la probabilidad de dar a luz después de la fertilización in vitro se reduce. Consulte Video Resumen en http://links.lww.com/DCR/B202. (Traducción-Dr Gonzalo Hagerman).

Ultrasound-guided aspiration of hydrosalpinx occurring during controlled ovarian hyperstimulation could improve clinical outcome of in vitro fertilization-embryo transfer

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.

Current management of tubal infertility: from hysterosalpingography to ultrasonography and surgery

RATIONALE

The development of IVF techniques has diminished the importance of tubal infertility but recent discoveries shed a new light on reproductive tubal surgery prior to any IVF cycle.

OBJECTIVE

To adapt current state of the art recommendations concerning tubal factor infertility to actual possibilities in Romanian healthcare system and to grow the awareness of fellow fertility specialists and general practitioners to the improved outcomes of novel management and treatment modalities.

METHODS AND RESULTS

67 free full text articles centered on the subject of management in tubal infertility were identified in international databases. Four articles described general diagnosis using data from medical history, 21 works approached the diagnosis through hysterosalpingography, 14 papers introduced the use of different sonographic procedures, 8 files analyzed the importance of exploratory laparoscopy and 20 articles reviewed different treatment modalities.

DISCUSSIONS

Current data show that active implementation of the large scale use of tubal surgery prior to any IVF cycle will reduce up to 30% the costs associated with obtaining a viable pregnancy in cases with tubal factor sterility.