Recurrence of hydrosalpinges after transvaginal aspiration of tubal fluid in an IVF cycle with development of a serometra

Abstract

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.

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).…”

Controversies in the modern management of hydrosalpinx

“…Mansour et al (1991) was the first to report on aspiration through the cervix of fluid which accumulated in the uterine cavity before embryo transfer; however, pregnancy was not achieved in this series. Transvaginal aspiration of the tubal fluid was not successful as the tubes refilled within 2 days (Bloechle et al, 1997). The uterine cavity was evacuated via an embryo transfer catheter and three embryos were transferred.…”

Cirugía Endoscópica Para La Enfermedad Tubárica en Mujeres Referidas a Centros De Fertilización in Vitro

“…Las experiencias de Andersen y cols (10) y de Zeyneloglu y cols (48), sugirieron que las pérdidas de embarazos en FIV eran más comunes en mujeres con hidrosalpinx. Otros autores realizan aspiración de los hidrosalpinx durante la obtención del huevo (49,50), no obstante la rápida reacumulación de líquido al transcurso del tercer día de la aspiración y que podría comprometer el éxito de la interven-ción (51). Finalmente, Stadtmauer y cols (52), encontraron significativamente menos embarazos en mujeres a las que no se les realizo cirugía por hidrosalpinx, comparadas con aquellas a las que se les realizó salpingectomía laparoscópica o cauterización tubárica bilateral.…”