Hum. Reprod. Advance Access published online on March 13, 2008
Human Reproduction, doi:10.1093/humrep/den071
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Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves pregnancy outcome in IVF: a randomized controlled trial
1 Centre for Reproductive Medicine and Surgery, John Webster House, 6 Lawrence Drive, Nottingham Business Park, Nottingham NG8 6PZ, UK 2 Assisted Conception Unit, Guy’s Hospital, St Thomas Street, London SE1 9RT, UK 3 Department of Reproductive Medicine and Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK 4 Department of Obstetrics and Gynaecology, Birmingham Heartlands Hospital, Birmingham, UK 5 Assisted Conception Unit, Birmingham Women’s Hospital, Metchley Park Road, Edgbaston, Birmingham B15 2TG, UK
6 Correspondence address: Tel: +44-1158528100; E-mail: nahed{at}doctors.org.uk
BACKGROUND: Hydrosalpinges have adverse effects on IVF outcomes. Salpingectomy is effective in improving outcomes, but it is not always practical or safe. Ultrasound-guided aspiration of hydrosalpinges at oocyte collection is an option for those who develop hydrosalpinges during controlled ovarian stimulation; however, there is no randomized evidence to show whether this practice is effective.
METHODS: Between October 1999 and June 2003, consenting women of age 
39 years with an ultrasound diagnosis of hydrosalpinx were randomized before oocyte collection to transvaginal aspiration of hydrosalpinx under antibiotics cover or no aspiration. Third-party randomization was performed using a computer algorithm, and allocation concealment was achieved with opaque sealed envelopes. Outcomes were biochemical and clinical pregnancies, implantation, spontaneous abortion, ectopic pregnancy and pelvic infection rates. Analysis was by intention to treat.
RESULTS: Sixty-six women were recruited to the trial, 32 to the aspiration group and 34 to the no-aspiration group. Aspiration resulted in a greater biochemical pregnancy rate [14/32 (43.8%) versus 7/34 (20.6%), relative risk (RR) = 2.1 (1.02, 4.6), P = 0.04]. Clinical pregnancy rates for aspiration versus control groups were 31.3% (10/32) and 17.6% (6/34), respectively [RR = 1.8 (0.8, 4.3), P = 0.20]. There were no changes in implantation rate or spontaneous abortion risk with aspiration and no differences between the groups in infection or ectopic pregnancy rates.
CONCLUSIONS: In women who are identified to have hydrosalpinges during controlled ovarian stimulation during IVF, aspiration of hydrosalpinges during oocyte collection may be effective in improving pregnancy rates (Trial Registration Number: NCT00566956 [ClinicalTrials.gov] ).
Key words: IVF/hydrosalpinx/aspiration/oocyte collection/pregnancy
Submitted on December 5, 2007; resubmitted on January 22, 2008; accepted on January 26, 2008.
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  F. I. Sharara Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves outcome in IVF Hum. Reprod., March 1, 2009; 24(3): 756 - 756. [Full Text] [PDF]
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N. Hammadieh, A. Coomarasamy, B. Ola, S. Papaioannou, M. Afnan, and K. Sharif Reply: Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves outcome in IVF Hum. Reprod., March 1, 2009; 24(3): 756 - 757. [Full Text] [PDF]
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