Human Reproduction, Vol. 14, No. 3, 578,
March 1999
© 1999 European Society of Human Reproduction and Embryology
Debate |
What is a hydrosalpinx? A plea for the use of a proper terminology in scientific discussion
Gemeinschaftspraxis im Lutzow Center, Wichmannstraße 5, D 10787 Berlin, Germany
I read with great interest the study of De Wit et al. (1998), where they could clearly demonstrate that hydrosalpinges exert a negative effect on implantation and pregnancy rates in patients undergoing in-vitro fertilization (IVF) and embryo transfer. However, the terminology they use is misleading and may be the cause of the conflicting results reported in the literature (Anderson et al., 1994
; Strandell et al., 1994; Vandromme et al., 1995; Akman et al., 1996; Sharara et al., 1996; Ng and Po, 1997).
Hydrosalpinx is a Greek word and means a Fallopian tube filled with water or fluid. Using ultrasound, hydrosalpinges are documented as cystic elongated masses in the adnexa, sometimes these cystic masses are tortured around the ovaries. As a tube filled with fluid should be recognized as a cystic mass, all hydrosalpinges should be visible by ultrasound. Distally occluded tubes which are not filled with fluid are, by definition, not hydrosalpinges. Why is this discrimination important?
In the discussion of the negative effects of hydrosalpinges on pregnancy rates after IVF/embryo transfer treatment, the tubal fluid plays a crucial role. Due to a leakage of tubal fluid into the uterine cavity: (i) a direct toxic effect on the embryos transferred is postulated (Mukherjee et al., 1996); (ii) a negative effect of endometrial integrin expression has been found (Lessey et al., 1994; Meyer et al., 1997); (iii) a mechanical problem, i.e. disturbed contact between endometrial surface and embryo or even washing out the embryo through the cervical channel is discussed (Mansour et al., 1991; Bloechle et al., 1997).
To resolve these problems, tubal surgery, reconstruction or removal, have been intensively debated (Anderson et al., 1996; Puttemans and Brosens, 1996). To obtain more information on patients with hydrosalpinges undergoing IVF/embryo transfer treatment, we need more and prospective data. We have to learn to discern those patients who may profit from surgery and those who will not but, first of all, we must use clear and proper terms, since distally occluded tubes and hydosalpinges are different entities, as De Wit et al. (1998) have clearly demonstrated by their study.
Notes
This debate was previously published on Webtrack 49, January 15, 1999
References
Akman, M.A., Garcia J.E., Damewood M.D. et al. (1996) Hydrosalpinx affects the implantation of previously cryopreserved embryos. Hum. Reprod., 11, 1013–1014.
Anderson, A.N., Yue, Z., Meng, F.J. and Peterson, K. (1994) Low implantation rate after in-vitro fertilization in patients with hydrosalpinges diagnosed by ultrasonography. Hum. Reprod., 9, 1935–1938.
Anderson, A.N., Lindhard, A., Loft, A. et al. (1996) The infertile patient with hydrosalpinges – IVF with or without salpingectomy ? Hum. Reprod., 11, 2081–2084.
Bloechle, M., Schreiner, Th. and Lisse, K. (1997) Recurrence of hydrosalpinges after transvaginal aspiration of tubal fluid in an IVF cycle with development of a serometra. Hum. Reprod., 12, 703–705.
De Wit, W., Gowrising, C.J., Kuik, D.J. et al. (1998) Only hydrosalpinges visible on ultrasound are associated with reduced implantation and pregnancy rates after IVF, Hum. Reprod., 13, 1696–1701.
Lessey, B.A., Castelbaum, A.J., Riben, M. et al. (1994) Effect of hydrosalpinges on markers of uterine receptivity and success in IVF. [Abstr.] The American Fertility Society, San Antonio, Texas, November 5 – 10, 1994.
Mansour, RT., Aboulghar, M.A., Serrour, G.I. and Riad, R. (1991) Fluid accumulation of the uterine cavity before embryo transfer: a possible hindrance for implantation. J. Vitro Fertil. Embryo Transfer, 8, 157–159.
Meyer W.R., Castelbaum, A.J., Somkuti, S. et al. (1997) Hydrosalpinges adversely affect markers of endometrial receptivity. Hum. Reprod., 12, 1393–1398.
Mukherjee, T., Copperman, A.B., McCaffrey, C. et al. (1996) Hydrosalpinx fluid has embryotoxic effects on murine embryogenesis: a case for prophylactic salpingetomy. Fertil. Steril., 66, 851–853.[Web of Science][Medline]
Ng, E.H.Y. and Po, P.C. (1997) Hydrosalpinx may not impair the success of IVF treatment. [Abstr.] Hum. Reprod., 12, (Abstr. Book 1), 144.
Puttemans, P.J. and Brosens, I.A. (1996) Salpingectomy improves in-vitro fertilization outcome in patients with a hydrosalpinx: a blind victimization of the Fallopian tube? Hum. Reprod., 11, 2079–2081.
Sharara, F.I., Scott, R.T., Marut, E.L. and Queenan, J.T. (1996) In-vitro fertilization outcome in women with hydrosalpinx. Hum. Reprod., 11, 526–530.
Strandell, A., Waldenstrom U., Nilsson, L. and Hamberger, L. (1994) Hydrosalpinx reduces in-vitro fertilization/embryo transfer pregnancy rates. Hum. Reprod., 9, 861–863.
Vandromme, J., Chasse E., Lejeune, B. et al. (1995) Hydrosalpinges in in-vitro fertilization: an unfavourable prognostic feature. Hum. Reprod., 10, 576–579.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. de Vantery Arrighi, H. Lucas, D. El-Mowafi, A. Campana, and D. Chardonnens Effects of human hydrosalpinx fluid on in-vitro murine fertilization Hum. Reprod., April 1, 2001; 16(4): 676 - 682. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Balasch Investigation of the infertile couple: Investigation of the infertile couple in the era of assisted reproductive technology: a time for reappraisal Hum. Reprod., November 1, 2000; 15(11): 2251 - 2257. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Guerriero, S. Ajossa, M.P. Lai, V. Mais, A.M. Paoletti, and G.B. Melis Transvaginal ultrasonography associated with colour Doppler energy in the diagnosis of hydrosalpinx Hum. Reprod., July 1, 2000; 15(7): 1568 - 1572. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||