Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies

Abstract

This meta-analysis was intended to evaluate differences in pregnancy rates after in-vitro fertilization (IVF) in tubal fertility with and without hydrosalpinx. It examined nine published retrospective comparative series and five series published as abstracts for which additional information was obtained. In all, these studies involved 5592 patients (1004 with hydrosalpinx and 4588 with tubal infertility without hydrosalpinx). The main outcome measures were rates of pregnancy, implantation, live delivery, and early pregnancy loss. Pregnancy rates were significantly lower in the presence of hydrosalpinx: 31.2% for the tubal sterility group without hydrosalpinx and 19.7% for the group with hydrosalpinx (odds ratio: 0.64; 95% confidence interval: 0.56, 0.74). Similarly, the implantation rate and the delivery rate per transfer in the hydrosalpinx group were only slightly more than half those of the non-hydrosalpinx group (implantation: 8.5 and 13.7%, respectively; delivery: 13.4 and 23.4%). The incidence of early pregnancy loss was also higher in the hydrosalpinx group (43.7%) than in the control group (31.1%). This meta-analysis makes it clear that hydrosalpinx present during IVF-embryo transfer has negative consequences on the rates of pregnancy, implantation, live delivery, and early pregnancy loss. It would be premature, nonetheless, to conclude that routine salpingectomy should be performed on all patients with hydrosalpinx.

The Role ofHoxGenes in Female Reproductive Tract Development, Adult Function, and Fertility

“…Women with hydrosalpinges have decreased implantation rates in IVF, and their pregnancy rates can be improved with salpingectomy before IVF. The hydrosalpinx generates an inflammatory fluid that may interfere with endometrial receptivity and embryonic implantation mechanically or chemically (Zeyneloglu et al 1998;Camus et al 1999). Although a study has shown that culturing mice embryos in the medium containing hydrosalpinx fluid can suppress embryo maturation and promote degeneration, this toxic effect does not affect human embryos.…”

Previous tubal ectopic pregnancy raises the incidence of repeated ectopic pregnancies in In Vitro fertilization-embryo transfer patients

“…Hydrosalpinx [1,2,3], pelvic inflammatory disease, and bacterial infection [4], as well as smoking habits [5,6], are known to be negative influencing factors. Furthermore, a previous (tubal) ectopic pregnancy (TEP) [7,8] and surgery [5] affect the fertility of women.…”

Effect of endometrial cavity fluid on clinical pregnancy rate in tubal embryo transfer (TET)

“…Mechanisms which had been suggested were either direct or systemic influenced by inflammatory mediations on the developing embryo in uterus or on the endometrium prior to or during implantation. It was suspected to have toxic effect on embryo development and interfere the implantation of embryos, and resulted in decreaseing pregnancy rate (8)(9)(10)(11). Most relative studies which revealed ECF with hydrosalpinges will have negative effect on pregnancy rate (9)(10)(11).…”

“…It was suspected to have toxic effect on embryo development and interfere the implantation of embryos, and resulted in decreaseing pregnancy rate (8)(9)(10)(11). Most relative studies which revealed ECF with hydrosalpinges will have negative effect on pregnancy rate (9)(10)(11). The more extensive the hydrosalpinx, the lower the implantation rates (12).…”