Effects of Hydrosalpinx on Endometrial Implantation Failures: Evaluating Salpingectomy in Women Undergoing in vitro fertilization

Abstract

Hydrosalpinx is a disease characterized by the obstruction of the salpinx, with progressive accumulation in the shape of a fluid-filled sac at the distal part of the tuba uterina, and closed to the ovary. Women with hydrosalpinges have lower implantation and pregnancy rates due to a combination of mechanical and chemical factors thought to disrupt the endometrial environment. Evidence suggests that the presence of hydrosalpinx reduces the rate of pregnancy with assisted reproductive technology. The main aim of the present is review to make an overview of the possible effects of hydrosalpinx on in vitro fertilization (IVF). We conducted a literature search on the PubMed, Ovid MEDLINE, and Google Scholar data bases regarding hydrosalpinx and IVF outcomes. Hydrosalpinx probably has a direct toxic effect on sperm motility and on the embryos. In addition, the increasing liquid inside the salpinges could alter the mechanisms of endometrial receptivity. The window of endometrial receptivity is essential in the implantation of blastocysts, and it triggers multiple reactions arising from the endometrium as well as the blastocysts. Hydrosalpinx could influence the expression of homeobox A10 (HOXA10) gene, which plays an essential role in directing embryonic development and implantation. Salpingectomy restores the endometrial expression of HOXA10; therefore, it may be one mechanism by which tubal removal could result in improved implantation rates in IVF. In addition, salpingectomy does not affect the ovarian response, nor reduces the antral follicle count. Further studies are needed to establish the therapeutic value of fluid aspiration under ultrasonographic guidance, during or after oocyte retrieval, in terms of pregnancy rate and ongoing pregnancy.

Recurrent Implantation Failure: The Role of Anatomical Causes

“…The hydrosalpinx removal with salpingectomy leads to an improvement of in vitro fertilization outcomes in comparison with no treatment, which turns it into a golden standard management before IVF. This evidence is replicated in other studies, such as Palagiano et al, where the pregnancy rates in patients with hydrosalpinx is lower than the control group [69]. There were negative effects either in fresh or frozen embryo transfers.…”

“…It is a common condition among infertile women with 10-13% diagnosis rate after ultrasound scan. These numbers can be increased when other diagnostic methods such as hysterosalpingography or laparoscopy are used [69].…”

Inflammation-Related Molecules at the Maternal–Fetal Interface during Pregnancy and in Pathologically Altered Endometrium

“…Another disease that can also cause chronic endometritis is hydrosalpinx. Fluid from the fallopian tubes entering the uterine cavity may have a direct embryotoxic effect [ 173 , 174 ]. This fluid contains inflammatory mediators such as cytokines, PGs, mucosa debris and toxins, impairing blood flow through the uterine spiral arteries [ 175 , 176 , 177 ].…”

“…This fluid contains inflammatory mediators such as cytokines, PGs, mucosa debris and toxins, impairing blood flow through the uterine spiral arteries [ 175 , 176 , 177 ]. Moreover, hydrosalpinx mechanically disturbs the contact between the embryo and the endometrial surface [ 173 , 174 ]. The effect of hydrosalpinx on the endometrium is chronic endometritis, which negatively affects endometrial receptivity [ 178 , 179 ].…”