Today we are going to present a very interesting clinical case, it is a patient diagnosed with hydrosalpinx who underwent in vitro fertilization with negative results. Here we are going to explain how the hydrosalpinx can negatively affect the results of in vitro fertilization and how we solved it here at Creafam, remember that “Knowledge is power”.
About the patient and the diagnosis.
The patient brings us a hysterosalpingography in which both waterspouts are clearly observed, one of them with hydrosalpix, the hydrosalpingus is nothing more than a distal obstruction of the tube, saying the part that goes to the ovary is obstructed and the tube is dilating , fills with liquid.
What is the negative effect that hydrosalpix can have on the prognosis of in vitro fertilization? If I am telling you that the tube is dilated because it is full of fluid, since that fluid has to come out somewhere and generally refluxes backwards towards the uterus, then we have an inflammatory fluid that is constantly contaminating the uterine cavity, for that reason it is It has been shown that patients who have hydrosalpingus have a worse prognosis for success in in vitro fertilization compared to other patients who also undergo in vitro fertilization but do not have this diagnosis.
Once we have the patient in the consultation, we perform the ultrasound and confirm the information from the hydrosalpix by ultrasound, we realize that at the uterine level the endometrium also had signs of endometrial pathology and we diagnosed a suspicion of endometrial polyps, if you have a uterus that has endometrial polyps because the probability of pregnancy will also be less and that is how, with both diagnoses; hydrosalpinx plus endometrial polyps, we propose performing a hysperolaparoscopy, that is, we are going to perform an endoscopic approach to both the uterine cavity and the abdominal cavity to solve both problems.
When approaching the uterine cavity, we observed multiple polyps of different sizes throughout the cavity. Endometrial polyps represent endometrial glands that have grown and no longer shed with menstruation, so they remain within the cavity, grow, multiply and ultimately generate a uterine cavity that is unsuitable for carrying a pregnancy. To differentiate fibroids, which, on the contrary, are solid structures that come from the uterine muscle; they are hard, they are fibrous in that they grow in different dimensions and in different orientations, some towards the uterine cavity, others outwards, others in the thickness of the myometrial wall.
After resecting the polyps, we observed that the catrina was also small in size and for this reason we performed a resection in the fundus and on the lateral walls to expand the useful space of the cavity and improve the future distension that the uterus will have once it is is pregnant, in conclusion, we improve the conditions of the uterine cavity for this future pregnancy. So this is how a procedure is, because it is quite short, it took approximately 15 minutes, it will allow us to greatly improve the pregnancy prognosis once we perform in vitro fertilization.
Remember that inside the uterus is where the embryo will be implanted, so having a suitable uterine cavity is of vital importance to establish that prognosis.
Later we performed the laparoscopy. What is laparoscopy? We make an approach through some access points through the navel and the abdominal wall, they are very thin points of one centimeter through which we can pass instruments, we pass a camera, we pass forceps and that allows us to approach the cavity in a minimally invasive way. for the patients.
We can observe how the uterus looks, how the ovaries look, how the tubes look in the abdominal cavity in general. The tubes in this case were clearly inflamed, dilated, you can see what the hydrosalpingus looks like, the tube that is much more dilated is approximately 3, 4 times as thick as it should be, and then with these same forceps we progressively resected the tube.
From the uterus to the distal end, the advantage of laparoscopy is that you can have much more precise access to the abdominal structures, you don’t have to make such a wide incision in the abdominal wall, which also affects the patient’s recovery, So we do a cleaner approach with less damage to the reproductive organs and the patient’s recovery was much better.
In total it was a fairly quick procedure and in fact totally ambulatory, once the process was finished the patient in 2 or 3 hours was already in a position to go to her house as it actually was.
If you have been looking for a pregnancy for a long time, if you have gone to other fertility clinics, if you have already had fertility treatments with negative results, it is not just about going for a new cycle of in vitro fertilization, it is about performing all the pertinent tests that allow you to have a better prognosis in that new assisted reproduction treatment that you are going to perform.