How To Choose The Management Of Hydrosalpinges Before In-vitro Fertilization And Embryo Transfer

In virtro fertilization and embryo transfer (IVF-ET) is an assisted reproductive technology which is mainly for treating patients with tubal factor infertility.According to the data of our center, there are about 20%of women who were treated by IVF-ET had visible hydrosalpinges detected by ultrasound. Many retrospective studies have shown that hydrosalpinx is associated with poor outcome of IVF. Thus it is very important to properly deal with hydrosalpinges before the IVF cycle. My research is about how to analyze, diagnose and then choose the most beneficial management of hydrosalpinges before applying IVF to patients.Because of various factors it's hard to propose a very specific management to a hydrosalpinges patient. Our center currently uses two ways in managing hydrosalpinges: occlusion of bilateral proximal tube with laparoscopic clips before IVF cycle, and transvaginal aspiration of hydrosalpinges on oocytes retrieval day. The first chapter of this paper compare the reproductive outcome of these two ways and get the conclusion that laparoscopic bilateral proximal tubal occlusion with clips is better than transvaginal aspiration on assisting reproduction. It seems that laparoscopic bilateral proximal tubal occlusion with clips should be the prior management to hydrosalpinges according to the comparison of different management.But must all hydrosalpinges patients have to go through surgical procedure to get better assisted reproductive outcome? Many patients would rather choose transvaginal aspiration on oocytes retrieval day due to cultural and economic consideration—they think this management is more acceptable because it is comparatively less painful and costs less. In the second chapter of this paperâ… will try to find an evaluation standard to classify hydrosalpinges patients, thus to specify who must go through surgical procedure and who could also get high chance of pregnancy with transvaginal aspiration management. This aim can be realized by logistic regression analysis. In this chapter,â… suggest six factors which are closely associated with the IVF outcome.â… propose to use these six factors to evaluate hydrosalpinges, thus further classify patients and take different management.Part 1:Subject: To evaluate the effect of transvaginal aspiration or laparoscopic proximal tubal occlusion with clips for hydrosalpinx on ovarian response and outcome of In vitro fertilization and embryo transfer (IVF-ET).Methods: 514 cases of patients were retrospectively analyzed which were infertile with oviduct blockage and had IVF-ET from June to November 2005 in our center, divide them into 3 groups:Group A (n=70),had transvaginal aspirationat at the time of oocyte retrieval; group B(n=16), had laparoscopic bilateral proximal tubal occlusion with clips had been performed before the IVF. Groups C(n=428), as a control group. There are no differences in the age, period of infertility,the number of embryo transfered among three groups.Compare each group on the doses of gonadotropin ,the number of oocytes retrieved and good embryos, the fertilization rate, cleavage rate, implantation rate, clinical pregnancy rate, ectopic pregnancy rate and abortion rate.Results: There are no differences in the doses of gonadotropin, the number of good embryos, ectopic pregnancy rate and abortion rate. There are differences in the number of oocytes retrieved and clinical pregnancy rate as follows respectively: Group A (10.31±4.89;35.17%), Group B (12±7.12,73.33%) , Group C (11.73±5.88,46.73%),Group A is less than group C, P＜0.05,Group B and group C having't significant difference. Implantation rate respectively as Group A (18.67%), Group B(50%), GroupC (27.13%),P＜0.05,Group A is the lowest.Conclusion: Hydrosalpinx still has harmful effects on clinical pregnancy rates and implantation rates of IVF-ET, even the patients having transvaginal aspirationat at the time of oocyte retrieval. The laparoscopic bilateral proximal tubal occlusion with clips will be effectual pretreatment methods for the patients undergoing IVF-ET andyield statistically similar responses to controlled ovarian hyperstimulation and IVF-ET cycle with controlling group/ does not impair the ovarian response in IVF treatment outcome. Part 2:Subject:The aim of this part of study was to find some index that cound objectively evaluated women with hydrosalpinx.We cound use these index to classify patients and determined whether they should accept transvaginal aspiration or proximal tubal occlusion with clips.Methods:91 cases which had accepted transvaginal aspiration at the time of oocyte retrieval were retrospectively analyzed.To determine whether difference in cytokine concentrations,chemical composition, color and volume of hydrosalpinx fluid exist between women with hydrosalpinx who achieved (n=31) and did not achieve (n=60) pregnancy. Constructing a logistic regression model with some sense variables,and getting some index that close related with outcome of IVF-ET.Results: There are differences in the radius of hydrosalpinx in ultrasound,back-flow history, communicating hydrosalpinges,total volume aspirated,and the concentration of potassium,chloride. Logistic regression demonstrated that back-flow history X₅, total volume aspirated X₇,and the color X₉,sodium/potassium ratio X₁₁,Ph X₁₆ and specific density X₁₇ of hydrosalpinx fluid were independent predictors of IVF outcome.The logistic regress model was shown as the following: logitP＝3.103＋1.22X₅＋1.578X₇＋2.435X₉＋2.232X₁₁－1.008X₁₆－1.191X₁₇.The exactitude of predictor was 80.2% for 91 cases.Conclusion: The back-flow history, total volume aspirated, and the color, sodium/potassium ratio,PH and specific density of hydrosalpinx fluid were closely related with outcome of IVF-ET. We cound classify patients according to these index and advise them to choose either transvaginal aspiration or proximal tubal occlusion with clips.