Controversies in the modern management of hydrosalpinx

The management of hydrosalpinx is a difficult clinical problem. Surgical tr eatment includes fimbrioplasty for patients with fimbrial obstruction and s alpingostomy to fashion a stoma in the distal Fallopian tube in patients wi th a damaged fimbrial end. Surgery is only suitable for a small thin-walled hydrosalpinx with healthy mucosa. These operations can be performed via la paroscopy or open microsurgery. The proper selection of patients for surgic al treatment and of the type of surgical technique are essential to achieve good results. The results of open microsurgery and laparoscopic surgery ar e summarized, in general, the prognosis of surgery is poor; however, in wel l selected cases, good results can be achieved by an experienced surgeon. I n-vitro fertilization (IVF) is the main line of treatment for infertility c aused by hydrosalpinx. In 1991, our group was the first to report on fluid accumulation in the uterine cavity before embryo transfer as a possible hin drance for implantation. Later, several publications reported an associatio n between patients with hydrosalpinx and a reduced pregnancy rate when trea ted by IVF, The cause of a low pregnancy rate could be due to mechanical, c hemical or toxic effects of the tubal fluid on the endometrium preventing i mplantation. All these mechanisms are reviewed in detail. The literature is controversial concerning the effect of transvaginal aspiration of hydrosal pinx on the outcome of IVF. Several reports suggest that surgical correctio n of the hydrosalpinx may improve the outcome of IVF. Further studies are r equired to verify this assumption and to find out the most suitable surgica l procedure and if there is a subgroup of patients who could benefit most f rom salpingectomy.