An Australasian survey of the management of hydrosalpinges in women due to undergo in vitro fertilisation.

OBJECTIVE: To ascertain current practice of surgical interventions for women with hydrosalpinges prior to in vitro fertilisation and to compare this with a subsequent systematic review of the literature. DESIGN: Survey. SETTING: Specialists in Australasian IVF clinics. METHODS: Questionnaire sent to all specialists in Australasian IVF clinics via the clinical directors of these units. RESULTS: There were 79 respondents from 33 fertility clinics. Although only 66% expressed a belief that there was convincing evidence of an improvement in pregnancy outcomes from surgical treatment for hydrosalpinges prior to in vitro fertilisation, 94% currently offer surgical treatment for hydrosalpinges prior to in vitro fertilisation, 32% always and 62% only in selected cases. Of the 74 respondents offering surgery, all but three expressed a preference for the laparoscopic approach. Of those offering surgery, 89% performed unilateral or bilateral salpingectomy depending whether unilateral or bilateral hydrosalpinges were present, 5% routine bilateral salpingectomy 14% proximal tubal occlusion with clips, 24% salpingostomy, 7% ultrasound-guided needle aspiration of hydrosalpinges at the time of egg collection. CONCLUSIONS: The diverse practice among Australasian fertility specialists reflects the apparent conflict in the literature prior to this survey. A Cochrane Review has now demonstrated the efficacy of laparoscopic salpingectomy in improving the odds of live birth for women with hydrosalpinges due to undergo in vitro fertilisation. It will be interesting to review whether this leads to greater uniformity of practice in the coming years.