Effects of hydrosalpinx on endometrial implantation failures: evaluating salpingectomy in women undergoing in vitro fertilization / Efeitos do hydrosalpinx no falho de implantação endometrial: Avaliar a salpingectomia nas mulheres em curso de fertilização in vitro

Abstract Hydrosalpinx is a disease characterized by the obstruction of the salpinx, with progressive accumulation in the shape of a fluid-filled sac at the distal part of the tuba uterina, and closed to the ovary. Women with hydrosalpinges have lower implantation and pregnancy rates due to a combination of mechanical and chemical factors thought to disrupt the endometrial environment. Evidence suggests that the presence of hydrosalpinx reduces the rate of pregnancy with assisted reproductive technology. The main aim of the present is review to make an overview of the possible effects of hydrosalpinx on in vitro fertilization (IVF).We conducted a literature search on the PubMed, Ovid MEDLINE, and Google Scholar data bases regarding hydrosalpinx and IVF outcomes. Hydrosalpinx probably has a direct toxic effect on sperm motility and on the embryos. In addition, the increasing liquid inside the salpinges could alter the mechanisms of endometrial receptivity. The window of endometrial receptivity is essential in the implantation of blastocysts, and it triggers multiple reactions arising from the endometrium as well as the blastocysts. Hydrosalpinx could influence the expression of homeobox A10 (HOXA10) gene, which plays an essential role in directing embryonic development and implantation. Salpingectomy restores the endometrial expression of HOXA10; therefore, it may be one mechanism by which tubal

Consideraciones sobre la obstruccion tubarica distal / Considerations about obstruction of distal fallopian tube

La cirugia de la parte distal de la trompa de Falopio puede ir desde la lisis de adherencias para mejorar la relacion anatomica entre la trompa y el ovario, a la salpingostomia en la cual se crea un nuevo ostium en una trompa gravemente lesionada. El exito de esta cirugia depende de varios factores: 1.- El grado de dano de la trompa. 2.- La edad de la paciente. 3.- La tecnica quirurgica utilizada. Es obvio que el cirujano no tiene control en los dos primeros factores, los cuales tienen un gran impacto en el resultado final. La clasificacion de la enfermedad distal de la trompa de Falopio es importante porque hay una gran variacion en el pronostico. Este es inversamente proporcional al dano de la fimbria, o sea entre mayor sea el dano, peor es el pronostico. Algunas pacientes presentan un mejor pronostico si se observan a la histerosalpingografia pliegues en la porcion ampular de las trompas obstruidas. El tamano del hidrosalpinx esta relacionado directamente con el grado de dano de la fimbria; los hidrosalpinx pequenos tienen un mejor pronostico que los grandes, cuando se realiza la salpingostomia. Es importante por lo anterior realizar una clasificacion adecuada del dano de la porcion distal de la trompa de Falopio con el objeto de dar un pronostico real al paciente.