Monday, 14 May 2012

Hydrosalpinx Prior to Doing IVF

Is there any need to remove a hydrosalpinx prior to doing IVF?

Many women with blocked tubes go in for IVF treatment. Some of them have a hydrosalpinx, in which the blocked tube is filled with fluid. It has now become standard advice to remove the hydrosalpinx or to clip the blocked tube prior to IVF. This needs to be done by performing an operative laparoscopy; and this procedure is supposed to improve IVF pregnancy rates (because the hydrosalpinx fluid is toxic and can prevent the embryos from implanting.)

Most gynecologists are happy to advise this surgery before referring the patient for IVF, because this is an additional surgical procedure for which they can charge the patient. In reality, however, this unnecessary surgery can actually end up causing harm.

For one, it leads to overtreatment. In many IVF clinics, all blocked tubes are surgically removed prior to IVF, even if the hydrosapinx is very small! This has never been proven to be of any benefit ( the original study only selected patients with a large hydrosalpinx) , but sadly patients are not well informed enough to ask questions and most are quite happy to sign on the dotted line. However, as is true of all surgical procedures, even this "minimally invasive surgery" carries a risk. This surgery can impair ovarian blood flow and reduce ovarian reserve.

In reality, there is a much easier way of ensuring that the hydrosalpinx fluid will not affect the embryos when they are being transferred. At the time of egg collection, the hydrosalpinx can be aspirated under vaginal ultrasound guidance. This means that when the embryos are being transferred into the uterus 3-5 days later, there is no toxic fluid in the hydrosalpinx to harm the embryos. This is a simple, zero-cost, non-surgical solution which ensures that the hydrosalpinx fluid will not affect embryo implantation or IVF success rates!

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