Hydrosalpinges 输卵管积液

分类:医学文献 52 0

Evidence accumulated previously suggests that either unilateral or bilateral hydrosalpinges may exert deleterious effects on IVF cycle outcome (1).


A meta-analysis encompassing 1004 patients with hydrosalpinges and 4588 control patients with tubal factor infertility but without hydrosalpinges in 14 studies showed significant decreases in pregnancy, implantation, and delivery rates in the hydrosalpinx groups (OR 0.64, 0.63, 0.58, respectively) (2).


A variety of hypotheses have been proposed to explain the effect. The accumulation of fluid of any source within the endometrial cavity has been shown to impair embryonic implantation (3). In addition, hydrosalpinx fluid may have a direct embryotoxic effect and may also inhibit fertilization (4). This deleterious effect may be mediated by the presence of inflammatory cytokines present with hydrosalpinx fluid (5). Others have shown that the endometrial of women with hydrosalpinges expressed significantly less αvβ3 integrin, a presumptive marker of endometrial receptivity, than fertile controls (6). Implantation may also be inhibited by diminished endometrial expression of HOXA-10, purported to be a regulator of endometrial receptivity, in the presence of hydrosalpinx fluid (7).


If retrograde flow of hydrosalpinx fluid is the cause of this deleterious effect, then prophylactic salpingectomy or tubal occlusion performed prior to embryo transfer should enhance outcomes. On the other hand, if damage from this fluid to the uterine environment is irreversible, then such surgery would have no beneficial effect. Strandell and colleagues published the results of a prospective randomized trial of 192 patients with hydrosalpinges who underwent salpingectomy or no intervention prior to embryo transfer and also began an actual treatment cycle (8). The salpingectomy group experienced significantly increased delivery rates with a trend towards increased clinical pregnancy rates.


The way in which salpingectomy acts to improve IVF outcome has not been shown conclusively. Bildirici et al. proposed that salpingectomy may restore αvβ3 integrin expression, thus enhancing endometrial receptivity (9). Others have demonstrated a reduction of endometrial lymphocyte clusters after salpingectomy, purportedly reflecting suppression of natural killer cell activation (10). Seli and coworkers reported that endometrial leukemia inhibitory factor expression, a proposed marker for endometrial receptivity, is suppressed in the presence of a hydrosalpinx but increased after tubal resection (11).




1. Murray D, Sagoskin A, Widra E, Levy M. The adverse effect of hydrosalpinges on in vitro fertilization pregnancy rate and the benefit of surgical correction. Fertil Steril 1998;69:41-5.

2. Camus E, Poncelet C, Goffinet F, et al. Pregnancy rates after in vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies Hum Reprod 1999;14:1243-9.

3. Mansour R, Aboulghar M, Serour G, Raafat R. Fluid accumulation of the uterine cavity before embryo transfer: a possible hinderance for implantation. J In Vitro Fertil Embryo Transf 1991;8:157-9.

4. Arrighi C, Lucas H, El-Mowafi D, Campana A, Chardonnens D. Effects of human hydrosalpinx fluid on in-vitro murine fertilization. Hum Reprod 2001;16:676-82.

5. Strandell A, Twinburn J, Wallin A. The presence of cytokines and growth factors in hydrosalpingeal fliud. J Assist Reprod Genet 2004;21:241-7.

6. Meyer W, Castelbaum A, Somkuti S, et al. Hydrosalpinges adversely affect markers of endometrial receptivity. Hum Reprod 1997;12:1393-8.

7. Daftary G, Taylor H. Hydrosalpinx fluid diminishes endometrial HOXA 10 expression. Fertil Steril 2002;78:577-80.

8. Strandell A, Lindhard A, Waldenstrom U, et al. Hydrosalpinx and IVF outcome: a prospective randomized multicentre trial in Scandinavia on salpingectomy prior to IVF. Hum Reprod 1999;14:2762-9.

9. Bildirici I, Bukulmez O, Ensari A, YaralI H, Guregan T. A prospective evaluation of the effect of salpingectomy on endometrial receptivity in cases of women with communication hydrosalpinges. Hum Reprod 2001;96:2422-6.

10. Ito C, Ito M, Itakura A, et al. A prospective evaluation of the effect of salpingectomy on endometrial lymphocyte clusters in patients with hydrosalpinges. Fertil Steril 2004;80:149-53.

11. Seli E, Kagiski U, Lakniak H, et al. Removal of hydrosalpinges increases endometrial leukemia inhibitory factor expression at the time of the implantation window. Hum Reprod 2005;20:3012-17.

上一篇: 下一篇: