A reconsideration of salpingectomy for hydrosalpinx before in vitro fertilization: why bother?
Volume 111, Issue 4, Pages 650–651
William D. Schlaff, M.D.
Why a Fertile Battle over the necessity of salpingectomy or tubal interruption prior to in vitro fertilization (IVF) in women with hydrosalpinges? Considered. Discussed. Settled. When initially suggested as a topic for this feature, the much anticipated onrush of enthusiastic huzzahs was disarmingly absent. Never mind the too-numerous-to-count quotes many of us frequently invoke which caution us to be thoughtful about our embrace of the accepted dogma—perhaps dating back to the first century A.D. when the Roman naturalist Pliny the Elder exhorted, “In these matters the only certainty is that nothing is certain.” We come to this Fertile Battle with a clear understanding that the presence of hydrosalpinges is associated with diminished pregnancy rates in women undergoing IVF. I would expect that even Pliny would concur with this observation. The question being posed in this debate is not whether hydrosalpinges reduce success rates in women undergoing IVF, but rather to what extent should we be counseling our patients that surgical extirpation prior to IVF is clearly the present standard of care, and to consider otherwise would be clinically dubious?