Published for the European Society of Human Reproduction and Embryology by IRL Press
Human Reproduction vol:10 issue:5 pages:1075-1078
The relationship of abnormalities of the Fallopian tubes in patients with tubal infertility due to hydrosalpinges and fertility outcome after salpingoneostomy was studied in a prospective multicentric project. Hydrosalpinges of infertile patients were evaluated macroscopically and microscopically at the time of salpingoneostomy and the results were analysed with regard to the fertility outcome. Peritubal adhesions, the diameter and the quality of the mucosa were scored at the time of surgery and biopsies from representative areas were evaluated by scanning electron and light microscopy in 50 patients with bilateral hydrosalpinges or a hydrosalpinx of a single tube. Analysis of the different factors for fertility outcome was performed using the Cox proportional hazards model. No intrauterine pregnancy occurred in the thick-walled hydrosalpinges group (n = 13). In the thin-walled hydrosalpinx group (n = 37), 15 intrauterine and two tubal pregnancies occurred. The aspect of the mucosa as evaluated by an operating microscope was the most important factor in determining the fertility outcome; >50% abnormal mucosa was associated with an intrauterine pregnancy rate of 7% which increased significantly to 50 and 69% when the mucosa was >50 and 75% normal respectively. The pregnancy rate was not influenced by the presence or extent of peritubal adhesions but small sized (<1 cm) hydrosalpinx had a better prognosis than medium (1-2 cm) and large sized (>2 cm) hydrosalpinx. When mucosal adhesions were present (n = 19), the intrauterine pregnancy rate was 22% which increased significantly to 58% when adhesions were absent (n = 18), Both tubal pregnancies occurred in tubes with mucosal adhesions. These data indicate that the evaluation of the tubal mucosa, and for practical endoscopic purposes the presence of mucosal adhesions, is the most important factor for the proper selection of patients in the choice between reconstructive surgery and in-vitro fertilization.