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

Autores/as

  • Jaime Saavedra-Saavedra

DOI:

https://doi.org/10.18597/rcog.343

Palabras clave:

hidrosálpinx, salpingectomía, fertilización in vitro (FIV)

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.

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).

Referencias bibliográficas

Zeyneloglu HB, Arici A, Olive DL. Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization and embryo transfer. Fertil Steril 1998;70:492-9.

Camus E, Poncelet C, Goffinet F, Wainer B, Merlet F, Nisand I, et al. Pregnancy rates after in vitro fertilization in cases of tubal fertility with and without hydrosalpinx: meta-analysis of published comparative studies. Hum Reprod 1999;14:1243-9.

Andersen AN, Yue Z, Meng FJ, Petersen K. Low implantation rate after in-vitro fertilization in patients with hidrosalpinges diagnosed by ultrasonography. Hum Reprod 1994;9:1935-8.

Cohen MA, Lindheim SR, Sauer MV. Hydrosalpinges adversely effect implantation in donor oocyte cycles. Hum Reprod 1999;14:1087-9.

Strandell A, Lindhard A, Waldenström U, Thorburn J, Janson PO, Hamberger L, et al. Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpinguectomy prior to IVF. Hum Reprod 1999;14:2762-9.

Strandell A. How to treat hydrosalpinges: IVF as the treatment of choice. Reprod Biomed Online 2002;4 Suppl 3:37-9.

Meyer WR, Castelbaum AJ, Somkuti S, Sagoskin AW, Doyle M, Harris JE, et al. Hydrosalpinges adversely affect markers of endometrial receptivity. Hum Reprod 1997;12:1393-8.

Daftary GS, Taylor HS. Hydrosalpinx fluid diminishes endometrial cell HOXA10 expression. Fertil Steril 2002;78:577-80.

Sawin SW, Loret de Mola JR, Monzon-Bordonaba F, Wang CL, Feinberg RF. Hydrosalpinx fluid enhances human trophoblast viability and function in-vitro: implications for embryonic implantation in assisted reproduction. Fertil Steril 1997;68:65-71.

Freeman MR, Whitworth CM, Hill GA. Permanent impairment of embryo development by hydrosalpinges. Hum Reprod 1998;13:983-6.

Jun JH, Koong MK, Song SJ, Han MH, Kim JW, Kang IS. Hydrosalpingeal fluid inhibits the attachment of blastocyst and the growth of trophoblast: an in-vitro assessment in a murine model. Hum Reprod 1999;14:112.

Strandell A, Lindhard A. Salpingectomy prior to IVF can be recommended to a well defined, subgroup of patients. Hum Reprod 2000;15:2072-4.

Fleming C, Hull MG. Impaired implantation after in vitro fertilization treatment associated with hydrosalpinx. Br J Obstet Gynecol 1996;103:268-72.

Mansour RT, Aboulghar MA, Serour GI, Riad R. Fluid accumulation of the uterine cavity before embryo transfer: a possible hindrance of implantation. J In Vitro Fert Embryo Transf 1991;8:157-9.

Andersen AN, Linhard A, Loft A, Ziebe S, Andersen CY, et al. The infertile patient with hidrosalpinges-IVF with or without salpinguectomy? Hum Reprod 1996;11:2081-4.

Bloechle M, Schreiner T, Lisse K. Recurrence of hydrosalpinges after transvaginal aspiration of tubal fluid in an IVF cycle with development of serometra. Hum Reprod 1997;12:703-5.

Sharara FI, McClamrock HD. Endometrial fluid collection in women with hydrosalpinx after human chorionic gonadotrophine administration: a report of two cases and implications for management. Hum Reprod 1997;12: 2816-9.

Levi AJ, Segaes JH, Miller BT, Leondires MP. Endometrial cavity fluid is associated with poor ovarian response and increased cancellation rates in ART cycles. Hum Reprod 2001;16:2610-5.

Ng EH, Chan CC, Tang OS, Ho PC. Comparison of endometrial and subendometrial blood flows among patients with and without hydrosalpinx shown on scanning during in vitro fertilization treatment. Fertil Steril 2006; 85:333-8.

Murray CA, Clarke HJ, Tulandi T, Tan SL. Inhibitory effect of human hidrosalpingueal fluid on mouse preimplantation embryonic development is significantly reduced by addition of lactate. Hum Reprod 1997;12:2504-7.

Granot I, Dekel N, Segal I, Fieldust S, Shoham Z, Barash A. Is hydrosalpinx fluid cytotoxic? Hum Reprod 1998;13:1620-4.

Strandell A, Sjogren A, Bentin-Ley U, Thorburn J, Hamberger L, Brännström M. Hydrosalpinx fluid does not adversely affect the normal development of human embryos and implantation in vitro. Hum Reprod 1998;13:2921-5.

Strandell A, Lindhard A.Why does hydrosalpinx reduce fertility? The importance of hydrosalpinx fluid. Hum Reprod 2002;17:1141-5.

Ajonuma LC, Ng EH, Chan LN, Chow PH, Kung LS, Cheung AN, et al. Ultrastructural characterization of whole hydrosalpinx from infertile Chinese women. Cell Biol Inter 2005;29:849-56.

BeylerSA, James KP, Fritz MA, Meyer WR. Hydrosalpingeal fluid inhibits in vitro embryonic development in murine model. Hum Reprod 1997;12:2724-8.

AjonumaLC, Chan LN, Ng EH, Chow PH, Kung LS, Cheung AN, et al. Characterization of epithelial cell culture from human hydrosalpinges and effects of its conditioned medium on embryo development and sperm motility. Hum Reprod 2003;18:291-8.

Mukherjee T, Copperman AB, McCaffrey C, Cook CA, Bustillo M, Obasaju MF. Hydrosalpinx fluid has embryotoxic effects on murine embryogenesis: a case for prophylactic salpinguectomy. Fertil Steril 1996;66:851-3.

Rawe VJ, Liu J, Shaffer S, Compton MG, García JE, Katz E. Effect of human hydrosalpinx fluid on murine embryo development and implantation. Fertil Steril 1997;68:668-70.

Sachdev R, Kemmann E, Bohrer MK, El-Danasouri I. Detrimental effect of hydrosalpinx fluid on the development and blastulation of mouse embryos in vitro. Fertil Steril 1997;68:531-3.

Spandorfer SD, Liu HC, Neuer A, Barmat LI, Davis O, Rosenwaks Z.The embryo toxicity of hydrosalpinx fluid is only apparent at high concentrations: an in vitro model that simulates in vivo events. Fertil Steril 1999;71:619-26.

de VantéryArrighi C, Lucas H, El-Mowafi D, Chardonnens D. Effects of human hydrosalpinx fluid on in-vitro murine fertilization. Hum Reprod 2001;16:676-82.

Koong MK, Jun JH, Song SJ, Lee HJ, Song IO, Kang IS. A second look at the embryotoxicity of hydrosalpingueal fluid: an in-vitro assessment in a marine model. Hum Reprod 1998;13:2852-6.

Strandell A, Waldesntröm U, Nilson L, Hamberguer L. Hydrosalpinx reduces in-vitro fertilization / embryo transfer pregnancy rates. Hum Reprod 1994;9:861-3.

Freeman MR, Whitworth CM, Hill GA. Permanent impairment of embryo development by hydrosalpinges. Hum Reprod 1998;13:983-6.

Murray DL, Sagoskin AW, Widra EA, Levy MJ. The adverse effect of hydrosalpinges on in vitro fertilization pregnancy rates and the benefit of surgical correction. Fertil Steril 1998;69:41-5.

Chen CD, Yang JH, Lin KC, Chao KH, Ho HN, Yang YS. The significance of cytokines, chemical composition, and murine embryo development in hydrosalpinx fluid for predicting the IVF outcome in women with hydrosalpinx. Hum Reprod 2002;17:128-33.

Hammadieh N, Afnan M, Evans J, Sharif K, Amso N, Olufowobi O. A postal survey of hydrosalpinx management prior IVF in the United Kingdom. Hum Reprod 2004;19:1009-12.

Ducarme G, Uzan M, Hugues JN, Cedrin-Durnerin I, Poncelet C. Management of hydrosalpinx before or during in vitro fertilization-embryo transfer: a national postal survey in France. Fertil Steril 2006;86:1013-6.

Johnson NP, Mak W, Sowter MC. Surgical treatment for tubal disease in women due to undergoing in-vitro fertilization. Cochrane Database Syst Rev 2004;Issue 3:Art No.:CD 002125.

Gillet WR. Evaluation of long term outcome following tubal microsurgery. Assist Reprod Rev 1997;8:140-51.

Kodaman P, Arici A, Seli E. Evidence-based diagnosis and management of tubal factor infertility. Curr Opin Obstet Gynecol 2004;16:221-9.

Strandell A, Lindhard U, Waldestrom U, Thorburn J. Prophylactic salpingectomy does no impair the ovarian response in IVF Treatment. Hum Reprod 2001;16:1135-9.

Stadtmauer LA, Riehl RM, Toma SK, Talbert LM. Cauterization of hydrosalpingues before in vitro fertilization is an effective surgical treatment associated with improved pregnancy rates. Am J Obstet Gynecol 2000;183:367-71.

Surrey ES, Schoolcraft WB. Laparoscopic management of hydrosalpinges before in vitro fertilization embryo transfer: salpingectomy versus proximal tubal occlusion. Fertil Steril 2001;75:612-7.

Kontoravdis A, Makrakis E, Pantos K, Botsis D, Deligeoroglou E, Creatsas G. Proximal tubal occlusion and salpinguectomy results in similar improvement in vitro fertilization outcome in patients with hydrosalpinx. Fertil Steril 2006;86:1642-9.

Sowter MC, Akande VA, Williams JA, Hull MG. Is the outcome of in vitro fertilization and embryo transfer treatment improved by spontaneous or surgical drainage of a hydrosalpinx? Hum Reprod 1997;12:2147-50.

Van Voorhis BJ, Sparks AE, Syrop CH, Stovall DW. Ultrasound guided aspiration of hydrosalpinges is associated with improved pregnancy and implantation rates after in vitro fertilization cycles. Hum Reprod 1998;13:736-9.

ChienLW, Au HK, Xiiao J, Tzeng CR. Fluid accumulation within the uterine cavity reduces pregnancy rates in women undergoing IVF. Hum Reprod 2002;17:351-6.

Hinckley MD, Miki AA. Rapid reaccumulation of hydrometra alter drainage at embryo transfer in patients with hydrosalpinx. Fertil Steril 2003;80:1268-71.

Hurst BS, Tucker KE, Awonyi CA, Schalaff WD. Hydrosalpinx treated with extended doxycyclin does no compromise the success of in vitro fertilization. Fertil Steril 2001;75:1017-9.

Lindhein SR, Hellner D, Ditkoff EC, Sauer MV. Ovarian hyperstimulation compounds the deleterious effect of hydrosalpinx on outcome during IVF-ET. Assist Reprod Rev 1997;7:64-6.

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 18 de abril de 2024];60(2):171-8. Disponible en: https://revista.fecolsog.org/index.php/rcog/article/view/343

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2009-06-30

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