The presence of hydrosalpinges has been shown to be deleterious in infertility treatment. Pregnancy rates after in-vitro fertilization (IVF) with embryo transfer decline considerably. This study concerns a patient who developed bilateral hydrosalpinges during controlled ovarian stimulation in preparation for IVF treatment. Transvaginal aspiration of the tubal fluid was unsuccessful as the tubes refilled within 2 days. Additionally, on the day of embryo transfer a serometra developed which could not be seen on the day of oocyte retrieval. The uterine cavity was evacuated via an embryo transfer catheter and three embryos were transferred. The serometra reappeared 3 days after embryo transfer. A pregnancy could not be achieved. The accumulation of fluid in the uterine cavity during an IVF/embryo transfer cycle is a rare complication of hydrosalpinges. However, the retrograde flow of tubal fluid may disturb intrauterine embryo development. This study suggests that the aspiration of hydrosalpinges and intrauterine fluid accumulation during an IVF cycle is not beneficial, as the underlying pathology is not cured. Cancellation of the treatment cycle or cryopreservation of oocytes in the pronucleate stage and transfer of the cryopreserved oocytes after surgical correction of the tubes may be better options.

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The purpose of the present study was to evaluate the use of colour Doppler sonography of ascendent uterine artery perfusion in 91 patients undergoing in-vitro fertilization (IVF)-embryo transfer treatment after ovarian stimulation with a depot formulation of goserelin and recombinant human follicle stimulating hormone according to the long protocol. Resistance index (RI), pulsatility index (PI), maximum peak velocity (Vmax) and minimum diastolic velocity (Vmin) were assessed for the left and right ascending uterine artery on day 1 of ovarian stimulation, on day -2 [the day of human chorionic gonadotrophin (HCG) application] and on day +14 (12 days after embryo transfer). The data of 75 patients who had at least two cleaved preimplantation embryos available for transfer were analysed: 21 patients became pregnant resulting in a pregnancy rate of 28% (21/75). After exclusion of biochemical, ectopic and abortive pregnancies (n = 5), the data from 54 non-pregnant patients and 16 pregnant patients were analysed. No differences with respect to patient age, current cycle number, indication for IVF treatment, endometrial thickness at day -2 and serum oestradiol and serum progesterone concentrations at day -2 were found between the pregnant and non-pregnant groups. Compared to the non-pregnant patients the ascendent uterine artery flow of the pregnant patients showed significantly lower RI (P < 0.009) and PI (P < 0.03) values at the beginning of ovarian stimulation. Vmax and Vmin did not differ between the two groups. On day -2 no differences in RI, PI, Vmax and Vmin were found between pregnant and non-pregnant patients. On day +14 the flow in the ascendent uterine arteries of the pregnant patients showed significantly lower RI (P < 0.008) and PI (P < 0.03) values and significantly higher Vmax (P < 0.003) and Vmin (P < 0.0001) values. RI (P < 0.009) and PI (P < 0.003) values had decreased significantly and Vmax (P < 0.0002) and Vmin (P < 0.0001) had increased significantly on day +14 compared to the previous observation times in both the pregnant and non-pregnant groups. A significant correlation between the increase of serum progesterone concentrations and the decrease of RI (r = 0.68, P < 0.009), and the increase of Vmin (r = 0.67, P < 0.01) was only detected in the pregnant group. In conclusion, the differences found in RI and PI values at the beginning of ovarian stimulation were not clinically helpful as there was a wide overlap between non-pregnant and pregnant patients. The parameters currently used in colour Doppler assessment of uterine artery perfusion are not clinically helpful in discriminating prospectively which patients will and will not become pregnant in an IVF programme. In pregnant patients, increasing progesterone concentration is correlated with a significant decrease in impedance to uterine perfusion in the late luteal phase.

This study describes the conduct and results of a recently developed technique for transvaginal catheterization of the Fallopian tube in order to transfer gametes or early embryos. Transvaginal gamete intra-Fallopian transfer (TV-GIFT) was performed in 46 patients after stimulation with human menopausal gonadotrophin (HMG) and human chorionic gonadotrophin (HCG) and transvaginal oocyte retrieval. This resulted in 11 (23.9%) pregnancies. Eight patients delivered healthy children, including one set of twins. Two patients had abortions at 8 and 11 weeks of gestation and one had an ectopic pregnancy. In a first series of 11 women, oocytes were fertilized in vitro and a maximum of three embryos at the 2- to 8-cell stages were transferred into one tube. Three of the 11 cycles with tubal embryo-stage transfer' (TV-TEST) resulted in clinical pregnancy.