Research Article| Volume 159, ISSUE 1, P122-126, November 2011

Hydrosalpinx and infertility: what about conservative surgical management?



      The aim of this study was to assess and validate a management protocol for infertile patients affected by at least one hydrosalpinx.

      Study design

      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.


      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%.


      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.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Querleu D.
        Le traitement périopératoire des adhésiolyses pelviennes.
        Gynécologie. 1983; 34: 35-38
        • Choe J.
        • Check J.H.
        Salpingectomy for unilateral hydrosalpinx may improve in vivo fecundity.
        Gynecol Obstet Invest. 1999; 48: 285-287
        • Aboulghar M.A.
        • Mansour R.T.
        • Serour G.I.
        Spontaneous intrauterine pregnancy following salpingectomy for a unilateral hydrosalpinx.
        Hum Reprod. 2002; 17: 1099-1100
        • Zeyneloglu H.B.
        • Arici A.
        • Olive D.L.
        Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization-embryo transfer.
        Fertil Steril. 1998; 70: 492-499
        • Camus E.
        • Poncelet C.
        • Goffinet F.
        • et al.
        Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies.
        Hum Reprod. 1999; 14: 1243-1249
        • Strandell A.
        • Lindhard A.
        • Waldenstrom U.
        • Thorburn J.
        • Janson P.O.
        • Hamberger L.
        Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF.
        Hum Reprod. 1999; 14: 2762-2769
        • Hammadieh N.
        • Afnan M.
        • Evans J.
        • Sharif K.
        • Amso N.
        • Olufowobi O.
        A postal survey of hydrosalpinx management prior to IVF in the United Kingdom.
        Human Reprod. 2004; 19: 1009-1012
        • Ducarme G.
        • Uzan M.
        • Hugues J.N.
        • 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: 1013-1016
        • Puttemans P.J.
        • Brosens I.A.
        Salpingectomy improves in-vitro fertilization outcome in patients with a hydrosalpinx: blind victimization of the fallopian tube?.
        Hum Reprod. 1996; 11: 2079-2081
        • Boer-Meisel M.E.
        • te Velde E.R.
        • Habbema J.D.
        • Kardaun J.W.
        Predicting the pregnancy outcome in patients treated for hydrosalpinx: a prospective study.
        Fertil Steril. 1986; 45: 23-29
        • Mage G.
        • Pouly J.L.
        • Bouquet de Joliniere J.
        • Chabrand S.
        • Bruhat M.A.
        Distal tubal obstructions: microsurgery or in vitro fertilization.
        J Gynecol Obstet Biol Reprod (Paris). 1984; 13: 933-937
        • te Velde E.R.
        • Boer-Meisel M.E.
        • Meisner J.
        • Schoemaker J.
        • Habbema J.D.
        The significance of preoperative hysterosalpingography and laparoscopy for predicting the pregnancy outcome in patients with a bilateral hydrosalpinx.
        Eur J Obstet Gynecol Reprod Biol. 1989; 31: 33-45
        • Hurst B.S.
        • Tucker K.E.
        • Awoniyi C.A.
        • Schlaff W.D.
        Hydrosalpinx treated with extended doxycycline does not compromise the success of in vitro fertilization.
        Fertil Steril. 2001; 75: 1017-1019
        • Hammadieh N.
        • Coomarasamy A.
        • Ola B.
        • Papaioannou S.
        • Afnan M.
        • Sharif K.
        Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves pregnancy outcome in IVF: a randomized controlled trial.
        Human Reprod. 2008; 23: 1113-1117
        • Dubuisson J.B.
        • Bouquet de Joliniere J.
        • Aubriot F.X.
        • Darai E.
        • Foulot H.
        • Mandelbrot L.
        Terminal tuboplasties by laparoscopy: 65 consecutive cases.
        Fertil Steril. 1990; 54: 401-403
        • Canis M.
        • Mage G.
        • Pouly J.L.
        • Manhes H.
        • Wattiez A.
        • Bruhat M.A.
        Laparoscopic distal tuboplasty: report of 87 cases and a 4-year experience.
        Fertil Steril. 1991; 56: 616-621
        • Filippini F.
        • Darai E.
        • Benifla J.L.
        • et al.
        Distal tubal surgery: a critical review of 104 laparoscopic distal tuboplasties.
        J Gynecol Obstet Biol Reprod (Paris). 1996; 25: 471-478
        • Bayrak A.
        • Harp D.
        • Saadat P.
        • Mor E.
        • Paulson R.J.
        Recurrence of hydrosalpinges after cuff neosalpingostomy in a poor prognosis population.
        J Assist Reprod Genet. 2006; 23: 285-288
        • Curtis A.H.
        A cause of adhesions in the right upper quadrant.
        JAMA. 1930; 94: 1221-1222
        • Fitz-Hugh T.
        Acute gonococcic peritonitis of the right upper quadrant in women.
        JAMA. 1934; 102: 2094-2096
        • Guzick D.S.
        • Bross D.S.
        • Rock J.A.
        Assessing the efficacity of The American Fertility Society's classification of endometriosis: application of a dose–reponse methodology.
        Fertil Steril. 1982; 38: 171-176
        • Johnson N.P.
        • Mak W.
        • Sowter M.C.
        Surgical treatment for tubal disease in women due to undergo in vitro fertilisation.
        Cochrane Database Syst Rev. 2004; (CD002125)
        • Marana R.
        • Rizzi M.
        • Muzii L.
        • Catalano G.F.
        • Caruana P.
        • Mancuso S.
        Correlation between the American Fertility Society classifications of adnexal adhesions and distal tubal occlusion, salpingoscopy, and reproductive outcome in tubal surgery.
        Fertil Steril. 1995; 64: 924-929
        • Dubuisson J.B.
        • Chapron C.
        • Morice P.
        • Aubriot F.X.
        • Foulot H.
        • Bouquet de Joliniere J.
        Laparoscopic salpingostomy: fertility results according to the tubal mucosal appearance.
        Hum Reprod. 1994; 9: 334-339
        • Eyraud B.
        • Erny R.
        • Vergnet F.
        Distal tubal surgery using laparoscopy.
        J Gynecol Obstet Biol Reprod (Paris). 1993; 22: 9-14
        • McComb P.F.
        • Taylor R.C.
        Pregnancy outcome after unilateral salpingostomy with a contralateral patent oviduct.
        Fertil Steril. 2001; 76: 1278-1279
        • Mol B.W.
        • Swart P.
        • Bossuyt P.M.
        • van Beurden M.
        • van der Veen F.
        Reproducibility of the interpretation of hysterosalpingography in the diagnosis of tubal pathology.
        Hum Reprod. 1996; 11: 1204-1208
        • Swart P.
        • Mol B.W.
        • van der Veen F.
        • van Beurden M.
        • Redekop W.K.
        • Bossuyt P.M.
        The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis.
        Fertil Steril. 1995; 64: 486-491
        • de Wit wG C.J.
        • Kuik D.J.
        • Lens J.W.
        • Schats R.
        Only hydrosalpinges visible on ultrasound are associated with reduced implantation and pregnancy rates after in-vitro fertilization.
        Hum Reprod. 1998; 13: 1696-1701