Efectividad de los tratamientos del hidrosálpinx en pacientes que deben recurrir a técnicas de reproducción asistida

  • Jaime Saavedra-Saavedra

Resumen

Introducción: las teorías detrás de los mecanismos que explican los malos resultados de la fertilización in vitro (FIV) en pacientes con hidrosálpinx se han enfocado en la toxicidad del fluido del hidrosálpinx, el daño en la receptividad endometrial y el obstáculo mecánico a la implantación por la posible interfase que puede producir el fluido en la superficie endometrial.

Objetivo: evaluar las diferentes opciones de tratamiento que eliminan el fluido del hidrosálpinxantes de realizar una fertilización in vitro (FIV).

Metodología: se realizó una selección y evaluación de la literatura relacionada con el tema, obtenida de las bases de datos de MEDLINE y EMBASE de enero de 1997 a septiembre de 2007. Se utilizaron las siguientes palabras clave para la búsqueda: hidrosálpinx, enfermedad tubárica, FIV, ICSI, resultado, tratamiento, cirugía, salpingectomía, salpingostomía, embarazo antes de, embarazo siguiente a y embarazo después de, profilaxis, implantación, tóxico, embrión, cultivo. Todas las palabras clave fueron usadas en combinación con  "hidrosálpinx", y los artículos fueron evaluados con relación a su objetivo, su metodología, tipo de estudio y tipo de revisiones.

Resultados: la salpingectomía previa a la fertilización in vitro (FIV) es el único método que ha probado ser efectivo en restaurar las tasas de nacimientos en pacientes con hidrosálpinx. La ligadura proximal de la tuba uterina también puede ser efectiva, de acuerdo con un estudio controlado aleatorizado. Por el contrario, otros tratamientos sugeridos, como el drenaje transvaginal del hidrosálpinx, no ofrecen ningún beneficio. Además, el mecanismo fundamental que explique las bajas tasas de implantación y mal desarrollo embrionario aún no está definido.

Conclusión: la salpingectomía laparoscópica pre-FIV se recomienda en pacientes con hidrosálpinx visible al examen ecográfico. Otros tratamientos sugeridos necesitan ser evaluados en estudios controlados aleatorizados.

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Biografía del autor/a

Jaime Saavedra-Saavedra
Profesor titular. Jefe del Departamento de Ginecología y Obstetricia de la Universidad del Valle. Maestro de la especialidad de Ginecología y Obstetricia del Valle del Cauca. Director general del Centro de Biomedicina Reproductiva del Valle del Cauca S.A. - FECUNDAR. Director del Centro de Entrenamiento en Cirugía Endoscópica Ginecológica, Universidad del Valle, Cali (Colombia).

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Publicado
2009-06-30
Cómo citar
1.
Saavedra-Saavedra J. Efectividad de los tratamientos del hidrosálpinx en pacientes que deben recurrir a técnicas de reproducción asistida. Rev. Colomb. Obstet. Ginecol. [Internet]. 30 de junio de 2009 [citado 21 de octubre de 2021];60(2):171-8. Disponible en: https://revista.fecolsog.org/index.php/rcog/article/view/343
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Artículo de Revisión