Controversies in the surgical management of hydrosalpinx

The surgical management of hydrosalpinges is a controversial subject. Chron ic pathology of the fallopian tube with distal obstruction leads to the for mation of a hydrosalpinx, and is associated with very poor pregnancy rates after surgery. In these cases, in-vitro fertilization has proved to be a mu ch better alternative. However, several studies have shown that patients wi th hydrosalpinges have significantly lower pregnancy and implantation rates after in-vitro fertilization compared with patients with other forms of tu bal damage. The exact mechanism by which the hydrosalpinx adversely affects in-vitro fertilization results is not yet fully understood. The value of p erforming a salpingectomy before in-vitro fertilization has been studied ex tensively. Currently. a clear benefit in salpingectomies has been proved fo r patients with ultrasonically visible hydrosalpinges. (C) 2000 Lippincott Williams & Wilkins.