Finally pregnant with hydrosalpinx

Affected by various factors, lesions of female reproductive organs such as the uterus, fallopian tubes, and ovaries can lead to female infertility. Among them, hydrosalpinx is an obstruction of the fallopian tube fimbria caused by fallopian tube inflammation. Due to bacterial infection, the fallopian tube epithelial cells fall off and block the fallopian tube, resulting in fallopian tube obstruction and sperm being unable to enter the ovaries. It is difficult for women to conceive, and even after surgical treatment, it is still difficult for patients to conceive.

1. Effect of hydrosalpinx on endometrial receptivity

The retained fluid of hydrosalpinx flows into the uterine cavity, ① causing hydrosalpinx, which can mechanically interfere with the contact between the embryo and the endometrium. During superovulation, the hydrosalpinx may increase, and the amount of fluid flowing into the uterine cavity will increase accordingly; ② hydrosalpinx contains microorganisms, debris and toxic substances that can directly enter the uterine cavity. The presence of hydrosalpinx causes the tissue to release cytokines, prostaglandins, leukocyte chemotactic factors and other inflammatory complexes, which act on the endometrium directly or through blood and lymphatic transport. These substances participate in regulating the movement of the fallopian tube and uterus and affect embryo implantation; in addition, the level of endometrial β-integrin decreases during the implantation window of patients with hydrosalpinx, which can also affect endometrial receptivity; ③ hydrosalpinx is often caused by infection, and most of them are ascending infections, which cause endometrial damage and leave a permanent impact on embryo implantation receptivity.

2. Toxic effects of hydrosalpinx on embryos

Embryo implantation also depends on the quality of the embryo. Sachdev et al. cultured mouse embryos in a control group and under three different hydrosalpinx concentrations. The results showed that hydrosalpinx could affect the formation of mouse blastocysts and block embryonic development. Its toxic effects were related to the amount and concentration of hydrosalpinx. Toxic substances from hydrosalpinx flow into the uterine cavity during embryo transfer, producing toxic effects on the embryos transferred into the uterine cavity, affecting their development, reducing their implantation ability, lowering embryo implantation rate and pregnancy rate, and increasing miscarriage rate.

In addition, during superovulation, B-ultrasound monitoring can reveal that a small number of hydrosalpinxes are progressively enlarged, which may be mistaken for developing follicles. During in vitro fertilization, this phenomenon may lead to misleading medication and premature administration of HCG, resulting in a decrease in the ratio of mature oocytes during egg retrieval. On the other hand, during the transvaginal egg retrieval under ultrasound monitoring, hydrosalpinx may be accidentally punctured, which can directly contaminate the oocytes and affect the fertilization of the oocytes and the development of the fertilized eggs.

Scholars' opinions

Hydrosalpinx can cause infertility. The treatment of infertility caused by hydrosalpinx varies:

1. IVF–ET treatment

Some scholars consider that the fallopian tubes are blocked and perform IVF-ET treatment, but the implantation rate and pregnancy rate are not high and the miscarriage rate is high for the reasons mentioned above.

2. Partial resection

Some scholars believe that since hydrosalpinx reduces the pregnancy rate of IVF-ET, hydrosalpinx resection should be performed before IVF-ET to eliminate the toxic effects of hydrosalpinx on eggs and embryos, remove the damage of hydrosalpinx to endometrial receptivity, eliminate potential tubal inflammation and possible toxins, thereby improving embryo quality and the embryo implantation environment, and increasing the pregnancy rate of IVF-ET. This is a last resort for patients with severe hydrops in the fallopian tubes, complete loss of tubal function, and those who have not responded to conservative fallopian tube surgery. However, salpingectomy may affect ovarian function. Mc-Comb et al. ligated the intraovarian mesentery vessels in the rabbit fallopian tube and found that the number of ovulations in the ipsilateral ovary was significantly reduced. Zackrisson et al. found that if the blood flow to the mouse ovary is rapidly reduced, the ovulation function of the mouse ovary will be significantly inhibited.

A et al. found that although the volume of the ovary on the operated side did not decrease significantly, the number of follicles that developed and the number of eggs retrieved during IVF-ET were significantly reduced. The surgery may affect the blood supply to the ovary and the development of follicles. The results of this study also showed that hydrosalpingectomy before IVF-ET could improve the implantation rate and clinical pregnancy rate of IVF-ET, but the number of oocytes obtained would be reduced. It is suggested that removing the hydropsy fallopian tube is not the best option, as it may damage the blood supply and nerves between the fallopian tube and the ovarian mesentery on the same side, thus affecting the hormone secretion and follicle development of the ovary on that side. When removing the fallopian tube, it should be kept close to the bottom and the mesentery should be preserved as much as possible.

3. Conservative treatment

Some scholars advocate that if the hydrosalpinx is not serious and its function can be restored, the fallopian tube should be preserved as much as possible, and a fallopian tube fimbria or ampulla ostomy should be performed during laparoscopic or laparotomy microsurgery. The advantage of this operation is that it preserves the fallopian tube and avoids affecting the blood flow of the ipsilateral ovary; it can drain the hydrosalpinx into the abdominal cavity and reduce the amount of fluid flowing into the uterine cavity. After surgical treatment, anti-infection treatment can be performed, and some fallopian tubes can restore their function, and natural pregnancy may occur. The intrauterine pregnancy rate is about 20%; if the hydrosalpinx is severe and its function has been severely damaged, hydrosalpinx ostomy treatment is ineffective, and the pregnancy rate can be improved by IVF-ET; its disadvantage is a higher rate of ectopic pregnancy, and some patients with hydrosalpinx will relapse. It is reported that hydrosalpingostomy before IVF-ET can improve the implantation rate and clinical pregnancy rate of IVF-ET, but attention should be paid to monitoring the occurrence of ectopic pregnancy.

Overview

In summary, the implantation rate and clinical pregnancy rate of patients with untreated hydrosalpinx undergoing IVF-ET are low, and the miscarriage rate is high. Removal of the hydrosalpinx or salpingostomy before IVF-ET can improve the implantation rate and clinical pregnancy rate of IVF-ET and reduce the miscarriage rate. Hydrosalpinx ostomy has little effect on ovarian function, and strengthening anti-infection after surgery may restore its function, but individual patients may relapse, and attention should be paid to the occurrence of ectopic pregnancy. Removal of the hydrosalpinx can avoid the occurrence of ectopic pregnancy, but it may affect the ipsilateral ovarian reserve function and should be carefully considered. Therefore, for patients with bilateral hydrosalpinx or only one fallopian tube with hydrosalpinx, whether to undergo hydrosalpinx ostomy or in vitro fertilization should be decided by the patients themselves based on their own financial situation and specific condition.