Abstract
Purpose: To determine if previous exposure to chlamydia, as evidenced by positive serology, is associated with a greater degree of detectable hydrosalpinges, and to determine if positive serology is more associated with bilateral than unilateral hydrosalpinges. Materials and Methods: Retrospective study evaluating all patients who had either a unilateral or bilateral hydrosalpinges detected by laparoscopy. The group was further defined by these women in this group who had serum chlamydia antibody tests and transvaginal pelvic sonography (TVS). Results: Prior exposure to chlamydia infection as evidenced by positive serology was detected in 31 of 39 (79.4%) women . All eight women with negative serology had a unilateral hydrosalpinx, of which only one could be detected by TVS. Whereas 29.4% of 17 women with unilateral hydrosalpinges and positive serology were detectable by TVS, 35.7% of the 25 hydrosalpinges of the 14 women with positive serology and bilateral hydrosalpinges could be detected by TVS. TVS correctly identified 16 of the 53 (30.2%) hydrosalpinges seen by laparoscopy. TVS identified 15 of the 39 (38.5%) women who had at least one hydrosalpinges. Conclusions: Ultrasound alone will detect less than 50% of hydrosalpinges, since women negative for chlamydia exposure are more likely to have smaller unilateral hydrosalpinges not detected by ultrasound. Future studies are needed to determine if salpingectomy may not be needed to improve fecundity.
Highlights
There have been many reports that found a hydrosalpinx can have a negative effect on development and/or implantation of embryos with in vitro fertilization embryo transfer (IVF-ET) [1-3]
Some studies have suggested that only the large hydrosalpinges seen by sonography are the ones most likely associated with lower pregnancy rates with IVF-ET and would benefit from surgical intervention [4, 5]
All eight women with negative IgG Chlamydia antibodies had a unilateral hydrosalpinx; only one of these was large enough to be seen on Transvaginal sonography (TVS)
Summary
Tubal infection with the gonococcus or chlamydia will frequently damage the fallopian tubes and cause a hydrosalpinx. Hysterosalpingography has been found to be highly specific in the diagnosis of tubal occlusion but is less sensitive because a higher rate of spasm at the cornual junction. Transvaginal sonography (TVS) has been found to be highly specific in diagnosing a hydrosalpinx, but with a very low sensitivity because of failure to identify small hydrosalpinges. There have been many reports that found a hydrosalpinx can have a negative effect on development and/or implantation of embryos with in vitro fertilization embryo transfer (IVF-ET) [1-3]. Some studies have suggested that only the large hydrosalpinges seen by sonography are the ones most likely associated with lower pregnancy rates with IVF-ET and would benefit from surgical intervention [4, 5]. The objective of the present study was to determine if a larger size and/or bilateral presence of hydrosalpinges are more likely in women with previous exposure to Chlamydia
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