How to treat hydrosalpinges: IVF as the treatment of choice.

Two treatment options are available for patients suffering from tubal infertility due to hydrosalpinges. Surgical distal tubal repair is appropriate only for patients with preserved tubal mucosa, otherwise the subsequent intrauterine pregnancy rate is unacceptably low and the ectopic pregnancy rate too high. The alternative treatment, IVF, has also demonstrated low success rate in patients with untreated hydrosalpinges, possibly due to leakage of fluid into the uterus. Salpingectomy has been suggested as a method to overcome the negative influence of the hydrosalpingeal fluid on implantation and embryo development. A randomized controlled trial in Scandinavia has demonstrated a benefit of salpingectomy in patients with hydrosalpinges that were large enough to be visible on ultrasound. If only the first cycle was considered, patients having undergone salpingectomy expressed significantly higher clinical pregnancy (46% versus 22%) and birth (40% versus 17%) rates. It is concluded that patients with large hydrosalpinges and without prospect of spontaneous conception should be recommended salpingectomy, which truly increases their chances of a successful IVF treatment.