title: Hydrosalpinx and infertility: what about conservative surgical management?
abstract: OBJECTIVE
  The aim of this study was to assess and validate a management protocol for infertile patients affected by at least one hydrosalpinx.
  
  
  METHODS
  Eighty-one consecutive infertile normo-ovulatory patients with uni or bilateral hydrosalpinx planed to be surgically managed were included in the protocol from November 2003 to May 2007. During laparoscopy, a systematic evaluation of the tubes was firstly conducted and the local management protocol based on validated tubal prognostic scores was applied. Surgery for hydrosalpinx was either conservative by neosalpingostomy or radical by salpingectomy. The primary end-point was the cumulative clinical pregnancy rate.
  
  
  RESULTS
  115 hydrosalpinges out of 153 present tubes were confirmed during laparoscopy. Neosalpingostomy was possible in 35 patients featuring 50 hydrosalpinges (43.2% and 43.5%, respectively). Salpingectomy was necessary for the others (46 patients representing 65 hydrosalpinges). The mean follow-up period was 31.8 ± 12.4 months. The overall cumulative pregnancy rate was 61% per couple who completed the protocol (33/54 patients). The cumulative pregnancy rate was 50% after IVF in patients who underwent bilateral salpingectomy. Among patients with at least one functional tube, the overall cumulative pregnancy rate was 63.3%, with a spontaneous pregnancy rate of 30.4%.
  
  
  CONCLUSIONS
  Hydrosalpinx management can be conservative with a tubal conservative of 43.5% and fair chances for spontaneous conception. An integrated management of hydrosalpinx including ART actually leads to a cumulative pregnancy rate of 61% per patient.
authors.affiliation: Department of Obstetrics and Gynecology, Jean Verdier Hospital, AP-HP, avenue du 14 Juillet, Bondy 93143, University Paris XIII, Bobigny, France. ochanelles@gmail.com
authors.forename: Olivier
authors.initials: O
authors.lastname: Chanelles
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ducarme
authors.forename: Christophe
authors.initials: C
authors.lastname: Sifer
authors.forename: Jean-Noel
authors.initials: JN
authors.lastname: Hugues
authors.forename: Cyril
authors.initials: C
authors.lastname: Touboul
authors.forename: Christophe
authors.initials: C
authors.lastname: Poncelet
mesh_terms: D000328:Adult; D001826:Body Fluids; D003663:Decision Trees; D005184:Fallopian Tube Diseases / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005187:Fallopian Tubes / Q000473:pathology* / Q000601:surgery; D005260:Female; D005306:Fertilization; D005307:Fertilization in Vitro; D018495:Fluid Shifts; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007247:Infertility, Female / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects; D059351:Organ Sparing Treatments / Q000009:adverse effects; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D012189:Retrospective Studies; D058994:Salpingectomy / Q000009:adverse effects; D012720:Severity of Illness Index