Implantation: Low implantation rate after in-vitro fertilization in patients with hydrosalpinges diagnosed by ultrasonography

Abstract

The purpose of this study was to assess whether patients with tubal infertility and a hydrosalpinx have a reduced implantation rate after in-vitro fertilization. The study included 741 patients who had 1190 consecutive oocyte aspirations. The presence or absence of hydrosalpinges was assessed by transvaginal ultrasonography on day 2 of all cycles. In 62 patients treated in 104 cycles a hydrosalpinx was diagnosed, whereas 493 patients treated in 813 cycles had no hydrosalpinx and eight patients treated in 16 cycles had uncertain hydrosalpinx. The results show that the presence of a hydrosalpinx is associated with a reduced pregnancy rate per aspiration (19.2 versus 32.6%; P < 0.01), reduced implantation rate (2.9 versus 10.3%, P < 0.0005), reduced delivery rate per aspiration (5.8 versus 20.9%, P < 0.0005), reduced delivery rate per embryo transfer (6.6 versus 22.8%, P < 0.0005) and increased early pregnancy loss (70 versus 36%, P < 0.005). Among 178 patients with unexplained infertility or other infertility factors treated with 257 aspirations the results were similar to those in patients with tubal infertility without a hydrosalpinx. In conclusion, the presence of a hydrosalpinx does not impair the number of embryos transferred but seems to impair the implantation process. We hypothesize that this may be due to leakage of fluid into the uterine cavity which may disturb the receptivity of the endometrium and/or the developing embryos.

Effect of endometrial cavity fluid on clinical pregnancy rate in tubal embryo transfer (TET)

“…ECF was occasionally found during IVF among patients diagnosed as hydrosalpinx (8,(14)(15)(16)(17)(18). It was thought to have negative effect on embryo implantation, the lower clinical pregnancy rate, and even lead to abortion (1,9,10).…”

“…It was thought to have negative effect on embryo implantation, the lower clinical pregnancy rate, and even lead to abortion (1,9,10). These include embryotoxic effects of hydrosalpinx fluid, reduced endometrial receptivity (8,16) and mechanical factors or flushing effects from the reflux of hydrosalpinx fluid into the endometrial cavity to interfere the embryo implantation (14,16,17,19). However, Strandell et al (20) found that hydrosalpinx fluid did not adversely affect the normal development of human embryos and implantation, but they ignored the long-term effect of hydrosalpingeal fluid to embryos.…”

“…Most studies showed that the ECF usually developed after receiving HCG injection (8,14,16,17). If fluid accumulation reached a diameter of over 3 mm either before or after HCG was given, it usually persisted until the time of the peri-implantation period and affected embryo implantation (8).…”

“…If fluid accumulation reached a diameter of over 3 mm either before or after HCG was given, it usually persisted until the time of the peri-implantation period and affected embryo implantation (8). Aspiration of the hydrosalpinx fluid prior to an IVF procedure slightly increased implantation rates (21).…”

“…Mechanisms which had been suggested were either direct or systemic influenced by inflammatory mediations on the developing embryo in uterus or on the endometrium prior to or during implantation. It was suspected to have toxic effect on embryo development and interfere the implantation of embryos, and resulted in decreaseing pregnancy rate (8)(9)(10)(11). Most relative studies which revealed ECF with hydrosalpinges will have negative effect on pregnancy rate (9)(10)(11).…”