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.
Highlights
Hydrosalpinx is the accumulation of fluid within the ampullar lumen as a result of occlusion of the infundibulum
Effects of Hydrosalpinx on Reproductive Outcome The hydrosalpinges are associated with the presence of fluid in the uterine cavity, modifications in endometrial blood flow, the leukemia inhibitory factor, the inflammatory response, and homeobox A10 (HOXA10) expression,[8,9] in the joint, which could explain the mechanism leading to decreasing pregnancy rates (PRs) and increasing miscarriage rates in women undergoing assisted reproductive technology (ART)
The PR in most cases of in vitro fertilization (IVF) is below 40%; undiscovered pathologies in the uterus, endometrium and fallopian tubes could play a crucial role in implantation failure
Summary
Hydrosalpinx is the accumulation of fluid within the ampullar lumen as a result of occlusion of the infundibulum. It is a common condition among women of reproductive age, and it is related to diminished pregnancy rates (PRs)[1,2,3] with assisted reproductive technology (ART). Hydrosalpinx fluid (HF) is known to be embryotoxic, and contains growth-factor inhibitors. It seems that the liquid contained in the hydrosalpinx could reduce sperm motility and the velocity of motile spermatozoa following 24 hours of incubation.[7]
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