Impaction Of Hydrosalpinx On The Outcome Of In Vitro Fertilization And Embryo Transfer

Objective:To investigate the reproduction-assisting effects of laparoscopic 'core-pulling'salpingectomy for patients with hydrosalpinx on ovarian reserve, responsiveness to stimuli and outcomes of in vitro fertilization and embryo transfer (IVF-ET).Methods:Infertile females receiving treatment in our center due to fallopian tube disorders (n=653) were enrolled from July2006to December2009and further divided into three groups.'Core-pulling'procedure group (GroupA) consisted of patients receiving pretreatment with'core-pulling'salpingectomy due to hydrosalpinx in our center (n=125). Conventional procedure group (GroupB) consisted of patients receiving conventional salpingectomy for hydrosalpinx or ectopic pregnancy in our center or other institutes prior to IVF-ET (n=104). Control group (Group C) consisted of patients receiving IVF-ET without the history of previous hydrosalpinx or salpingectomy (n=424).Results:At baseline, the antral follicle count of GroupB was significantly less than those of GroupA and C (8.8±2.7vs7.3±2.3vs10.1±2.5). The mature oocytes retrieved numbered less than the other two groups, in a statistically significant manner compared to Group C (14±6vs10±5vs13±6). Patients of GroupA and B received more gonadotropin while the dosage of Group B differed significantly from Group C (2350±450vs2150±375vs2850±600). E2level on HCG day was slightly lower in Group B than in the other two groups, statistically significant compared to that of Group C but not compared to that of Group A.Conclusions:Compared to the conventional procedure, laparoscopic'core-pulling' salpingectomy should be recommended for patients with hydrosalpinx intending to receive IVF-ET, which did not interfere with the ovarian reserve or responsiveness but improve the conception rate in clinical practice. Objective:The aim of this study was to compare the difference of chemical composition and cytokines between different colored hydrosalpingeal fluid and colorless hydrosalpingeal fluid to explore the effect of hydrosalpinx fluid(HSF) on development of human early embryo.Methods:33cases of women with hydrosalpinx were enrolled and hydrosalpinx fluid was collected undergoing laparoscopic salpingectomy for presence of hydrosalpinx. Aspiration of hydrosalpinx fluid was performed as the first intra-abdominal procedure during surgery. Great care was taken to avoid blood contamination in the aspirates. The hydrosalpinx fluids were immediately divided into three parts and aliquotted into tubes, two parts for detection of microorganism and chemical composition, the third part were frozen and stored at-70℃for detection of TNF-a/IL-2and human embryo culture in vitro.Results:1.Between the two groups of HSF, the colored HSF has higher level of glucose, but the other chemical composition was not different(P>0.05).Compared with those of blastocyst culture medium, statistically significant differences of chemical composition were found in all HSF2. The fluid samples were subjected to assay employing a quantitative sandwich enzyme immunosorbent assay (ELISA) for detection of the following cytokines: TNF-a and IL-2, we found significant differences in the two groups (p<0.05). 3,The bacteria culture of all HSF was negative, but the detection of Chlamydia Trachomatis (CT) was62.5%and70.6%positive in colored HSF and colorless HSF, respectively, and there was no difference between the two groups(P>0.05).4. After cultured the3PN embryos in different concentrations of HSF, we found that there was no difference of the the rates of blastocyst formation,blastocyst expansion, and good blastocyst between the two groups(P>0.05); Lower concentrations of HSF(bellow50%) had no effect on the development of embryos, but higher concentrations of HSF(above75%) had significantly negative effect on the development of embryos with reducing the the rates of blastocyst formation,blastocyst expansion, and good blastocyst (P<0.05)Conclusions:1.Hydrosalpinx is perhaps correlated with infection of Chlamydia Trachomatis, further investigation is worthy to determine whether antibiotics should be applied before IVF-ET.2. Higher concentrations of HSF may influence human blastocyst development, this maybe due to the lower concentrations of glucose, total protein and other aberrant chemical compositions.3. The levels of TNF-a and IL-2between the two groups of HSF were significantly different, but the two cytokines are not embryotoxic. Objective:The aim of this study was to investigate the effect of different colored hydrosalpinx fluid (HSF) and colorless hydrosalpinx fluid on human endometrium.Methods:One group of161patients with hydrosalpinx were performed laparoscopic salpingectomy and hysteroscopy, and among the161cases,19cases had colored HSF and142cases had colorless HSF. The endometrial biopsy of the19cases with colored HSF and20cases with colorless HSF was taken for detection of TNF-a/IL-2using semi-quatitative transcriptional-polymerase chain reaction(RT-PCR) technique and immunohistochemistry. Meanwhile, the other group of110infertile patients without hydrosalpinx were performed hysteroscopy before IVF-ET. The endometrial biopsy was taken from30cases among the110patients for detection of TNF-a/IL-2.Results:1.19patients with colored HSF,142with colorless HSF and110without hydrosalpinx were performed hysteroscopy and endometritis was diagnosed by hysteroscopy. The Incidence of endometritis among three groups was63.2%(12/19),22.5%(32/142)and20.9%(23/110),respectively. The patients with colored HSF had significantly higher incidence of endometritis (P<0.05).2. The endometrial biopsy from21cases with endometritis and48cases with normal endometrium was performed the detection of TNF-a/IL-2using semi-quatitative transcriptional-polymerase chain reaction(RT-PCR) technique and immunohistochemistry. We observed that the intensity of the immunohistochemistry signal of TNF-a in inflammatory endometrium was substantially higher than that in normal endometrium (P<0.01). Meanwhile, the intensity of the immunohistochemistry signal of IL-2in inflammatory endometrium was substantially higher than that in normal endometrium (P<0.01). They were mainly localized in the luminal epithelium and glandular epithelium and weak in stroma. As for the results of RT-PCR, TNF-a mRNA levels of the two groups of patients were75.25±11.95and23.05±9.72, respectively, and statistically significant difference was found between the two groups (p<0.01). IL-2mRNA levels of the two groups of patients was79.56±13.36and33.12±8.32, respectively, and statistically significant difference was also found between the two groups (p<0.01).Conclusions:1. The Incidence of endometritis varies from person to person, and colored HSF maybe induces endometritis more easily, which may negatively influence endometrial receptivity2. Perhaps colorless HSF is not associated with endometritis and does not play a negative role on endometrial receptivity.