Extended Doxycycline Treatment Versus Aspiration of Hydrosalpingeal Fluid in the Management of Patients With Ultrasound Visible Hydrosalpinx Who Refused or Not Eligible to Undergo Salpingectomy Prior to IVF-ET

Extended Doxycycline Treatment Versus Aspiration of Hydrosalpingeal Fluid in the Management of Patients With Ultrasound Visible Hydrosalpinx Who Refused or Not Eligible to Undergo Salpingectomy Prior to IVF-ET | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Extended Doxycycline Treatment Versus Aspiration of Hydrosalpingeal Fluid in the Management of Patients With Ultrasound Visible Hydrosalpinx Who Refused or Not Eligible to Undergo Salpingectomy Prior to IVF-ET Usama Fouda, Hesham S. Elshaer, Sherin M. Sobh, Emad M. Salah, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-138894/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The purpose of this study was to detect whether antibiotic therapy during IVF-ET cycle is as effective as aspiration of hydrosalpinx fluid under ultrasound guidance in preventing the adverse effect of hydrosalpinx on IVF-ET results. Methods: During the period between November 2012 and January 2020, patients with ultrasound visible hydrosalpinges undergoing IVF-ET who refused to undergo laparoscopic salpingectomy or not eligible for laparoscopy were advised to receive antibiotic therapy during IVF-ET cycle or to undergo aspiration of hydrosalpinx fluid under ultrasound guidance at the time of ovum pick up. A retrospective analysis was done for the results of IVF-ET cycles of patients who received antibiotic therapy ( n = 52 ) or underwent aspiration of hydrosalpinx fluid under ultrasound guidance ( n = 76). In the aspiration group, the tip of the suction needle was introduced into the hydrosalpinx to aspirate the hydrosalpinx fluid after completing the ovum pick up. In the antibiotic group, doxycycline (100 mg/12 h) was commenced one week before ovum pick up and was continued for another week after ovum pick up. Results: The implantation, clinical pregnancy, ongoing pregnancy and live birth rates were significantly higher in the aspiration group ( 16.67%% Vs. 8.33%, P value =0.029, 32.89% Vs. 15.38% P value = 0.026, 30.26% Vs. 13.46%,P value =0.028 and 28,95% Vs. 13.46% P value = 0.04 respectively). Conclusion: The aspiration of hydrosalpinx fluid under ultrasound guidance is more effective than antibiotic therapy in preventing the negative impact of hydrosalpinx on the results of IVF-ET. The results of the current study should be proved by subsequent randomized controlled studies. Sexual & Reproductive Medicine Cancer Biology Doxycycline ultrasound IVF-ET hydrosalpinx Background Several prospective and retrospective studies reported that hydrosalpinx has an adverse effect on assisted conception results ( 1 , 2 ). A meta-analysis including 6713 IVF-ET cycles of patients with tubal infertility (5,569 cycles in patients without hydrosalpinx and 1144 cycles in patients with hydrosalpinx) reported that the implantation and clinical pregnancy rates were reduced by 50% in patients with hydrosalpinx ( 3 ). Since the 90 s, there is agreement by researchers that salpingectomy or proximal tubal occlusion can increase the implantation and pregnancy rates in patients with hydrosalpinx who undergo IVF-ET ( 4 , 5 , 6 ). However, these procedures are expensive. require hospital admission and general anaesthesia and may be associated with perioperative complications especially in patients with multiple laparotomies or extensive adhesions. Moreover, some patients refuse to undergo these procedures because these procedures remove any chance of spontaneous conception ( 6 , 7 ) . Several authors investigated several treatment modalities such as Essure micro-inserts hysteroscopic tubal occlusion, aspiration of hydrosalpinx under ultrasound guidance and the use of medications such as antibiotics or corticosteroids to prevent the negative impact of hydrosalpinx on the results of IVF-ET (2,8,9). Although several studies confirmed that Essure micro-inserts hysteroscopic tubal occlusion and aspiration of hydrosalpinx under ultrasound guidance are effective in the management of patients with hydrosalpinx who undergo IVF-ET ( 2 , 7 , 10 ). However, aspiration of hydrosalpinx fluid under ultrasound guidance may injure pelvic organs or flare pelvic infection ( 10 ). Moreover, Essure micro-inserts hysteroscopic tubal occlusion postpones the IVF-ET cycle for at least 3 months ( to confirm tubal occlusion), and may be associated with complications such as injury of the uterus during insertion, chronic pelvic pain, allergy, menstrual irregularities and device migration. Moreover, it is associated with higher abortion rate compared with other interventions ( 11 , 12 ). There is only one retrospective study which reported the use of antibiotics in patients with hydrosalpinx who undergo IVF-ET. The study compared the results of IVF-cycles of patients with hydrosalpinx treated with extended doxycycline regimen (100 mg / 12 h, 7 days before ovum pick up and 6 days after ovum pick up) with the results of IVF-cycles of patients with tubal adhesions/proximal tubal block and patients with unexplained infertility /endometriosis. The success of IVF-ET cycles was comparable between the three groups ( 9 ). Till now, no studies have compared the efficacy of aspiration of hydrosalpinx fluid under ultrasound guidance with antibiotic therapy in preventing the adverse effect of hydrosalpinx on IVF-ET results . The purpose of this study was to detect whether antibiotic therapy is as effective as aspiration of hydrosalpinx fluid under ultrasound guidance in preventing the adverse effect of hydrosalpinx on IVF-ET results. Methods We performed an analysis for the results of IVF-ET cycles of patients with ultrasound visible hydrosalpinx [tubular structure with folded configuration (forming an incomplete septation)] who received antibiotic therapy during IVF-ET cycle or underwent aspiration of hydrosalpinx fluid under ultrasound guidance at the time of ovum pickup in Riyadh fertility and reproductive health center during the period between November 2012 and January 2020. During the study period, laparoscopic salpingectomy or proximal tubal occlusion were the first management option for patients with ultrasound visible hydrosalpinges. Patients who refused to undergo laparoscopic salpingectomy or proximal tubal occlusion and patients who were not eligible for laparoscopy ( i.e. with multiple laparotomies or extensive pelvic adhesions) were advised to receive antibiotic therapy during IVF-ET cycle or to undergo aspiration of hydrosalpinx fluid under ultrasound guidance at the time of ovum pick up. The study protocol was approved by the institutional ethics committee. Each of the patients signed written informed consent to participate in the study. Exclusion criteria were age less than 18 years or more than 37 years, anti-Müllerian hormone (AMH) less than 0.3 ng/ml, antral follicle count (AFC) less than 6, interstitial uterine fibroid more than 5 cm in diameter, submucous fibroid, polycystic ovary syndrome (PCOS) and history of habitual abortion. The long GnRH agonist protocol was used in all the patients as previously described by Fouda et al ( 7 ). Oocyte retrieval was performed 34 to 36 after HCG administration by transvaginal ultrasound guided follicular fluid aspiration. In aspiration group, the tip of the suction needle was introduced into the hydrosalpinx to aspirate the hydrosalpinx fluid after completing the ovum pick up. The aspirated fluid was submitted for bacteriological analysis. In antibiotic group, doxycycline (100 mg/12 h ) was commenced one week before ovum pick up and was continued for another week after ovum pick up. One to three embryos were transferred under ultrasound guidance 2 to 5 days after ovum pick up. If endometrial fluid was detected at the time of embryo transfer, this fluid was aspirated before embryo transfer. B-subunit HCG was measured in blood two weeks after embryo transfer to diagnose pregnancy. In the aspiration group, transvaginal ultrasound was performed 14 days after embryo transfer to detect recollection of hydrosalpinx fluid. In both groups, transvaginal ultrasound was performed five weeks after embryo transfer to confirm the viability of the fetus and to detect the number of gestational sacs ( 13 ). Vaginal progesterone suppositories 400 mg (twice daily) (Prontogest, Marcyrl, Egypt) were given from the day of the HCG administration till the end of the first trimester or negative pregnancy test. Results During the period between November 2012 and January 2020, 72 patients received antibiotic therapy during IVF-ET cycle and 92 patients underwent aspiration of hydrosalpinx fluid under ultrasound guidance. After exclusion of patients who did not meet the inclusion criteria, the antibiotic group included 52 patients and the aspiration group included 76 patients. Both groups were comparable with respect to age, body mass index (BMI), basal FSH, AMH, number of patients with bilateral hydrosalpinx, duration and type of infertility (Table 1 ). Table 1 Principal characteristics of the patients Aspiration group (n = 76) Antibiotic group (n = 52) P value Age (years ) 28.05 ± 3.66 27.48 ± 3.88 0.404 Body mass index(Kg/m 2 ) 27.09 ± 3.77 26.29 ± 3.18 0.196 Duration of infertility(years) 3.55 ± 1.79 3.15 ± 1.64 0.196 Type of infertility • Primary 58/76 (76.32%) 37/52 (71.15%) 0.512 • Secondary 18/76(23.68%) 15/52 (28.85%) 0.512 Basal FSH(IU/L) 6.36 ± 2.08 6.22 ± 2.02 0.703 AMH 2.05 ± 0.96 1.96 ± 1.04 0.628 Bilateral hydrosalpinx 18/76(23.68%) 13/52(25%) 0.781 Values are expressed as mean ± SD or n/n(%) IVF cycle characteristics are shown in Table 2 . Both groups were comparable with regard to total consumption of gonadotropins, stimulation duration, number of mature follicles, oocytes retrieved, mature oocytes and embryos transferred. Table 2 Outcome of stimulation Aspiration group (n = 76) Antibiotic group (n = 52) P value Stimulation period(days) 11.39 ± 1.19 11.13 ± 1.67 0.336 Consumed HP-uFSH units 2607 ± 517 2744 ± 711 0.239 Follicles ≥ 17 mm on the day of HCG administration 12.16 ± 3.69 13.23 ± 4.63 0.166 Retrieved oocytes 11.09 ± 3.34 12.15 ± 4.65 0.16 Metaphase II oocytes 9.76 ± 3.34 10.98 ± 4.54 0.102 Two pronucleate embryos 7.92 ± 3.12 8.44 ± 3.78 0.413 Fertilization rate 602/742 ( 81.13%) 439/571(76.88%) 0.06 No. of embryos transferred 2.61 ± 0.49 2.54 ± 0.5 0.458 No of embryos transferred • Day 2 14 10 0.653 • Day 3 166 106 • Day 5 18 16 Grade I & II embryos /transferred embryos 121/198 ( 61.11%) 88/132(66.7%) 0.305 Values are expressed as mean ± SD or n/n (%) The implantation rate was 16.67%% in the aspiration group and 8.33% in the antibiotic group ( P = 0.029). The clinical pregnancy and the ongoing pregnancy rates were significantly higher in the aspiration group (32.89% Vs. 15.38% P value = 0.026, 30.26% Vs. 13.46%,P value = 0.028, respectively). The live birth rate was 28,95% in the aspiration group and 13.46% in the antibiotic group (P value = 0.04 )(Table 3). Table 3 Treatment outcomes Aspiration group (n=76) Antibiotic group (n=52) P value Clinical pregnancy rate 25/76(32.89%) 8/52 (15.38%) 0.026 Ongoing pregnancy rate 23/76 (30.26%) 7/52(13.46%) 0.028 Live birth rate 22/76(28,95%) 7/52(13.46%) 0.04 Implantation rate 33/198(16.67%) 11/132(8.33%) 0.029 Spontaneous abortion rate n/IUP 2/25( 8 %) 1/8 (12.5%) 0.7 Values are expressed as n/n (%). IUP= intrauterine pregnancy In the aspiration group, when the patients were scanned at the time of embryo transfer, four patients had recollection of hydrosalpinx fluid and endometrial fluid collection and four patients had only recollection of hydrosalpinx fluid. Moreover, ultrasound scan performed 14 days after embryo transfer detected the recollection of hydrosalpinx fluid in 20 patients. In the antibiotic group, when the patients were scanned at the time of embryo transfer, eight patients had endometrial fluid collection. Table 4 shows the reproductive outcome of the subgroups of patients in the aspiration group. The implantation, pregnancy and live birth rates were non significantly higher in the patients with no recollection of hydrosalpinx fluid compared with the patients with recollection of hydrosalpinx fluid. The two subgroups were comparable with respect to age, early follicular phase FSH, percentage of patients with bilateral hydrosalpinx and number and grade of embryos transferred. None of the patients with endometrial fluid collection on the day of embryo transfer become pregnant. Table 4 Reproductive outcomes of the subgroups of patients in the aspiration group Implantation rate Clinical pregnancy rate Live birth rate No recollection of hydrosalpinx fluid within the first 14 days + no endometrial fluid collection (n = 56) 28/146 (19.18%) 21/56 (37.5%) 19/55(34.55%) Recollection of hydrosalpinx fluid within the first 14 days ± endometrial fluid collection (n = 20) 5/52(9.62%) 4/20 (20%) 3/20(15%) Recollection of hydrosalpinx fluid within the first 14 days + no endometrial fluid collection (n = 16) 5/42(11.9%) 4/16 (25%) 3/16 (18.75%) Recollection of hydrosalpinx fluid within the first 14 days + endometrial fluid collection (n = 4) 0/10 (0%) 0/4 (0%) 0/4 (0%) There were no significant differences between the four subgroups. Values are expressed as n/n (%). Flaring of pelvic infection, peritonitis or injury of pelvic organs were not reported in patients in the aspiration group. Cultures from the hydrosalpinx fluid were negative for bacterial growth. Discussion The current study revealed that the aspiration of hydrosalpinx fluid under ultrasound guidance is more effective than antibiotic treatment in preventing the negative impact of hydrosalpinx on the results of IVF-ET . Several researchers suggested that the flow of hydrosalpinx fluid into the endometrial cavity is the reason of the negative impact of hydrosalpinx on the results of IVF-ET ( 10 ). Two studies revealed that the presence of hydrosalpinx decreases the expression of uterine receptivity markers (Homeobox A10, β-integrin and leukemia inhibitory factor) and that salpingectomy increases the expression of these markers ( 14 , 15 ). Several authors suggested that the inflammatory process in the hydrosalpinx caused by bacteria ( mainly Chlamydia trachomatis ) could extend to the endometrium thought the flow of hydrosalpinx fluid into endometrial cavity or through lymphatics or blood vessels ( 9 ). It was postulated that the inflammatory mediators released by chronic inflammatory cells present in hydrosalpinx may cause embryonic damage or alter endometrial receptivity (16.17). The results of the current study suggested that antibiotic therapy is not effective in the prevention of the adverse effect of hydrosalpinx on IVF-ET outcome. In contrast to our results, a small retrospective study comparing the outcome of IVF-ET cycles of patients with hydrosalpinx who were treated with extended doxycycline regimen with the outcome of IVF-ET cycles of patients with adhesions /proximal tubal block and patients with endometriosis /unexplained infertility, revealed that the success of IVF-ET cycles was comparable between the three groups ( 9 ). The results of the current study are in accordance with several studies which reported that the aspiration of hydrosalpinx fluid at the time of ovum pick up is a simple, safe and inexpensive procedure that can prevent the negative impact of hydrosalpinx on the results of IVF-ET ( 2 , 7 , 18 ). Moreover, the data presented in the current study suggest that the aspiration of hydrosalpinx fluid under ultrasound guidance is less effective in the management of patients with rapid recollection of hydrosalpinx fluid and ineffective in the management of patients with endometrial fluid collection on the day of embryo transfer. Two randomized controlled trials compared aspiration of hydrosalpinx fluid under ultrasound guidance at the time of ovum pick up with no intervention in patients with ultrasound visible hydrosalpinges who undergo IVF-ET. Fouda et al reported that the implantation, clinical pregnancy, and ongoing pregnancy rates were higher in the aspiration group (18.70% Vs. 8.33%, 31.48% Vs. 13.21% and 27.78% Vs 9.43% respectively) ( 2 ). Hammadieh et al reported that the chemical pregnancy rate was 43.8% in the aspiration group and 20.6% in the control group (P value = 0.04). The clinical pregnancy rate was higher in the aspiration group but the difference failed to reach statistical significance (31.3% vs. 17.6%, P = 0.20)( 18 ) . In a randomized controlled trial including 160 patients with ultrasound visible hydrosalpinx, Fouda et al compared the effectiveness of aspiration of hydrosalpinx fluid under ultrasound guidance with salpingectomy in the management of patients with hydrosalpinges who undergo IVF-ET. Rapid recollection of hydrosalpinx fluid ( i.e. within 2 weeks after embryo transfer) was noticed in 34.21% of the patients in the aspiration group. The clinical pregnancy and the implantation rates were higher in salpingectomy group compared with the subgroup of patients with rapid recollection of hydrosalpinx fluid (42.67% vs. 19.23% and 18.95% vs. 7.58%, respectively). On the other hand, the clinical pregnancy and the implantation rates were comparable between the salpingectomy group and the subgroup of patients with no recollection of hydrosalpinx fluid (42.67% vs. 34% and 18.95% vs. 15.5% respectively)( 7 ). In the current study, four patients in the aspiration group and eight patients in the antibiotic group had endometrial fluid collection on the day of embryo transfer. None of those patients conceived. The results of the current study are in accordance with numerous studies which reported that the subgroup of patients with endometrial fluid collection on the day of embryo transfer has the lowest pregnancy rates ( 2 , 7 , 19 , 20 ). Several authors suggested that the ideal treatment option for this subgroup of patients is to cryopreserve the embryos and to transfer the embryos in subsequent cycles after performing salpingectomy or proximal tubal occlusion ( 21 )( 7 ). The major weakness of the current study is the retrospective design. However, our study has several strengths. Our study is largest study which reported the use of antibiotic therapy in patients with ultrasound visible hydrosalpinges who undergo IVF-ET. Moreover, the current study is the first study which compared the efficacy of antibiotic therapy with aspiration of hydrosalpinx fluid under ultrasound guidance in the management of patients with ultrasound visible hydrosalpinges who undergo IVF-ET. Conclusion In conclusion, the aspiration of hydrosalpinx fluid under ultrasound guidance is more effective than antibiotic therapy in preventing the negative impact of hydrosalpinx on the results of IVF-ET. The results of the current study should be proved by subsequent randomized controlled studies. Abbreviations AFC: Antral follicle count AMH: Anti-Müllerian hormone ART: Assisted reproductive techniques FSH: Follicle stimulating hormone ICSI: Intra cytoplasmatic sperm injection IVF-ET: In vitro fertilization embryo transfer. IUP: intrauterine pregnancy PCOS: Polycystic ovary syndrome Declarations Ethics approval and consent to participate The study protocol was approved by the ethics committee of Riyadh fertility and reproductive health center. Informed consent was obtained from all the patients. Declaration of interest No conflict of interests Grants No grants Acknowledgements No Availability of data and materials section All data from the current study supporting the conclusions are presented in the article. Consent for publication Not applicable. Authors contribution All the authors [Usama M. Fouda ,Hesham S. Elshaer , , Sherin M. Sobh , Emad M. Salah, Fatma F. Darweesh, Ahmed A. Wali , Tarek El Husseiny and Mohammad A. Taymour ] participated in the conception , design of the work ,the acquisition, analysis, interpretation of data, have drafted the work and substantively revised it References Kassabji M, Sims JA, Butler L, Muasher SJ. Reduced pregnancy outcome in patients with unilateral or bilateral hydrosalpinx after in vitro fertilization. Eur J Obstet Gynecol Reprod Biol.1994,56(2):129–32. Fouda UM, Sayed AM. Effect of ultrasound-guided aspiration of hydrosalpinx fluid during oocyte retrieval on the outcomes of in vitro fertilisation-embryo transfer: a randomised controlled trial (NCT01040351). Gynecol Endocrinol.2011,27(8):562–7. Zeyneloglu HB, Arici A, Olive DL. Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization – embryo transfer. Fertil Steril.1998, 70:492–9. Strandell A, Lindhard A, Waldenstrom U, Thorburn J, Janson PO, Hamberger L . 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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. Hum Reprod. 2008, 23: 1113–1117. Chien LW, Au HK, Xiao J, Tzeng CR . Fluid accumulation within the uterine cavity reduces pregnancy rates in women who undergo IVF. Hum Reprod.2002, 17:351–356. Akman MA, Erden HF, Bahceci M. Endometrial fluid visualized through ultrasonography during ovarian stimulation in IVF cycles impairs the outcome in tubal factor, but not PCOS, patients. Hum Reprod .2005,20:906–909. Sharara FI, McClamrock HD . Endometrial fluid collection in women with hydrosalpinx after human chorionic gonadotrophin administration: a report of two cases and implications for management. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-138894","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":7335868,"identity":"4142c1b3-f673-4a38-aeed-560cf8bbf964","order_by":0,"name":"Usama Fouda","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYFACxgcMFUCygb2BgZlILcwGDGdAWngOkKxFIoFILQbXDrN9OFBxWLZ/5hvDzwUVNgz87d0J+LXcTmaeceDMYeMZt3OMpWecSWOQOHN2AwEt+YeZP7YdTmy4nWMgzdt2mMFAIpeQlmRmhoNALfNvnjH+TZqWDTd4zIizRRKk5cCZdOONZ9LKrHnOpPEQ9AsfWEuFtey844c33+apsJHjb+/FrwUJcBiASB5ilYMA+wNSVI+CUTAKRsEIAgD7BUyjBnZyVwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-5002-4188","institution":"Cairo University","correspondingAuthor":true,"prefix":"","firstName":"Usama","middleName":"","lastName":"Fouda","suffix":""},{"id":7335869,"identity":"59a33584-c22b-4d6e-8637-bdb35e8cc30d","order_by":1,"name":"Hesham S. 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Darweesh","email":"","orcid":"","institution":"Cairo University Kasr Alainy Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Fatma","middleName":"F.","lastName":"Darweesh","suffix":""},{"id":7335873,"identity":"e6cfe241-c6e3-4cc0-9f20-644f28127c60","order_by":5,"name":"Ahmed A. Wali","email":"","orcid":"","institution":"Cairo University Kasr Alainy Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"A.","lastName":"Wali","suffix":""},{"id":7335874,"identity":"72b6e651-628b-41df-8c07-cfcf24cd639e","order_by":6,"name":"Tarek El Husseiny","email":"","orcid":"","institution":"Cairo University Kasr Alainy Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tarek","middleName":"El","lastName":"Husseiny","suffix":""},{"id":7335875,"identity":"3789e8ef-d472-4466-a52f-2b4e44305a43","order_by":7,"name":"Mohammad A. Taymour","email":"","orcid":"","institution":"Cairo University Kasr Alainy Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"A.","lastName":"Taymour","suffix":""}],"badges":[],"createdAt":"2020-12-31 14:24:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-138894/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-138894/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13643117,"identity":"985a75d5-4dea-4da5-9405-c4665d03fb7e","added_by":"auto","created_at":"2021-09-17 09:10:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":485986,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-138894/v1/274371ad-1a94-4480-80a5-38cc458092c6.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eExtended Doxycycline Treatment Versus Aspiration of Hydrosalpingeal Fluid in the Management of Patients With Ultrasound Visible Hydrosalpinx Who Refused or Not Eligible to Undergo Salpingectomy Prior to IVF-ET\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eSeveral prospective and retrospective studies reported that hydrosalpinx has an adverse effect on assisted conception results (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e). A meta-analysis including 6713 IVF-ET cycles of patients with tubal infertility (5,569 cycles in patients without hydrosalpinx and 1144 cycles in patients with hydrosalpinx) reported that the implantation and clinical pregnancy rates were reduced by 50% in patients with hydrosalpinx (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eSince the 90\u0026nbsp;s, there is agreement by researchers that salpingectomy or proximal tubal occlusion can increase the implantation and pregnancy rates in patients with hydrosalpinx who undergo IVF-ET (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e). However, these procedures are expensive. require hospital admission and general anaesthesia and may be associated with perioperative complications especially in patients with multiple laparotomies or extensive adhesions. Moreover, some patients refuse to undergo these procedures because these procedures remove any chance of spontaneous conception (\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e) .\u003c/p\u003e\n\u003cp\u003eSeveral authors investigated several treatment modalities such as Essure micro-inserts hysteroscopic tubal occlusion, aspiration of hydrosalpinx under ultrasound guidance and the use of medications such as antibiotics or corticosteroids to prevent the negative impact of hydrosalpinx on the results of IVF-ET (2,8,9). Although several studies confirmed that Essure micro-inserts hysteroscopic tubal occlusion and aspiration of hydrosalpinx under ultrasound guidance are effective in the management of patients with hydrosalpinx who undergo IVF-ET (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e). However, aspiration of hydrosalpinx fluid under ultrasound guidance may injure pelvic organs or flare pelvic infection (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e). Moreover, Essure micro-inserts hysteroscopic tubal occlusion postpones the IVF-ET cycle for at least 3 months ( to confirm tubal occlusion), and may be associated with complications such as injury of the uterus during insertion, chronic pelvic pain, allergy, menstrual irregularities and device migration. Moreover, it is associated with higher abortion rate compared with other interventions (\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThere is only one retrospective study which reported the use of antibiotics in patients with hydrosalpinx who undergo IVF-ET. The study compared the results of IVF-cycles of patients with hydrosalpinx treated with extended doxycycline regimen (100\u0026nbsp;mg / 12\u0026nbsp;h, 7 days before ovum pick up and 6 days after ovum pick up) with the results of IVF-cycles of patients with tubal adhesions/proximal tubal block and patients with unexplained infertility /endometriosis. The success of IVF-ET cycles was comparable between the three groups (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eTill now, no studies have compared the efficacy of aspiration of hydrosalpinx fluid under ultrasound guidance with antibiotic therapy in preventing the adverse effect of hydrosalpinx on IVF-ET results .\u003c/p\u003e\n\u003cp\u003eThe purpose of this study was to detect whether antibiotic therapy is as effective as aspiration of hydrosalpinx fluid under ultrasound guidance in preventing the adverse effect of hydrosalpinx on IVF-ET results.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe performed an analysis for the results of IVF-ET cycles of patients with ultrasound visible hydrosalpinx [tubular structure with folded configuration (forming an incomplete septation)] who received antibiotic therapy during IVF-ET cycle or underwent aspiration of hydrosalpinx fluid under ultrasound guidance at the time of ovum pickup in Riyadh fertility and reproductive health center during the period between November 2012 and January 2020.\u003c/p\u003e\n\u003cp\u003eDuring the study period, laparoscopic salpingectomy or proximal tubal occlusion were the first management option for patients with ultrasound visible hydrosalpinges. Patients who refused to undergo laparoscopic salpingectomy or proximal tubal occlusion and patients who were not eligible for laparoscopy ( i.e. with multiple laparotomies or extensive pelvic adhesions) were advised to receive antibiotic therapy during IVF-ET cycle or to undergo aspiration of hydrosalpinx fluid under ultrasound guidance at the time of ovum pick up. The study protocol was approved by the institutional ethics committee. Each of the patients signed written informed consent to participate in the study.\u003c/p\u003e\n\u003cp\u003eExclusion criteria were age less than 18\u0026nbsp;years or more than 37 years, anti-M\u0026uuml;llerian hormone (AMH) less than 0.3\u0026nbsp;ng/ml, antral follicle count (AFC) less than 6, interstitial uterine fibroid more than 5\u0026nbsp;cm in diameter, submucous fibroid, polycystic ovary syndrome (PCOS) and history of habitual abortion.\u003c/p\u003e\n\u003cp\u003eThe long GnRH agonist protocol was used in all the patients as previously described by Fouda et al (\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e). Oocyte retrieval was performed 34 to 36 after HCG administration by transvaginal ultrasound guided follicular fluid aspiration. In aspiration group, the tip of the suction needle was introduced into the hydrosalpinx to aspirate the hydrosalpinx fluid after completing the ovum pick up. The aspirated fluid was submitted for bacteriological analysis. In antibiotic group, doxycycline (100\u0026nbsp;mg/12\u0026nbsp;h ) was commenced one week before ovum pick up and was continued for another week after ovum pick up.\u003c/p\u003e\n\u003cp\u003eOne to three embryos were transferred under ultrasound guidance 2 to 5 days after ovum pick up. If endometrial fluid was detected at the time of embryo transfer, this fluid was aspirated before embryo transfer. B-subunit HCG was measured in blood two weeks after embryo transfer to diagnose pregnancy. In the aspiration group, transvaginal ultrasound was performed 14 days after embryo transfer to detect recollection of hydrosalpinx fluid. In both groups, transvaginal ultrasound was performed five weeks after embryo transfer to confirm the viability of the fetus and to detect the number of gestational sacs (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e). Vaginal progesterone suppositories 400\u0026nbsp;mg (twice daily) (Prontogest, Marcyrl, Egypt) were given from the day of the HCG administration till the end of the first trimester or negative pregnancy test.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the period between November 2012 and January 2020, 72 patients received antibiotic therapy during IVF-ET cycle and 92 patients underwent aspiration of hydrosalpinx fluid under ultrasound guidance. After exclusion of patients who did not meet the inclusion criteria, the antibiotic group included 52 patients and the aspiration group included 76 patients.\u003c/p\u003e\n\u003cp\u003eBoth groups were comparable with respect to age, body mass index (BMI), basal FSH, AMH, number of patients with bilateral hydrosalpinx, duration and type of infertility (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePrincipal characteristics of the patients\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAspiration group\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAntibiotic group\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge (years )\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.404\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBody mass index(Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.09\u0026thinsp;\u0026plusmn;\u0026thinsp;3.77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.29\u0026thinsp;\u0026plusmn;\u0026thinsp;3.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.196\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDuration of infertility(years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.196\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eType of infertility\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026bull; Primary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58/76 (76.32%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37/52 (71.15%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.512\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026bull; Secondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18/76(23.68%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15/52 (28.85%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.512\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBasal FSH(IU/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.703\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAMH\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.628\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBilateral hydrosalpinx\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18/76(23.68%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13/52(25%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.781\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eValues are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n/n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIVF cycle characteristics are shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. Both groups were comparable with regard to total consumption of gonadotropins, stimulation duration, number of mature follicles, oocytes retrieved, mature oocytes and embryos transferred.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eOutcome of stimulation\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAspiration group\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAntibiotic group\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStimulation period(days)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.336\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConsumed HP-uFSH units\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2607\u0026thinsp;\u0026plusmn;\u0026thinsp;517\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2744\u0026thinsp;\u0026plusmn;\u0026thinsp;711\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.239\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFollicles\u0026thinsp;\u0026ge;\u0026thinsp;17\u0026nbsp;mm on the day of HCG administration\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.16\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.166\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRetrieved oocytes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.09\u0026thinsp;\u0026plusmn;\u0026thinsp;3.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.16\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMetaphase II oocytes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.102\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTwo pronucleate embryos\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.92\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.44\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.413\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFertilization rate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e602/742 ( 81.13%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e439/571(76.88%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo. of embryos transferred\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.458\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo of embryos transferred\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026bull; Day 2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.653\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026bull; Day 3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e166\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e106\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026bull; Day 5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGrade I \u0026amp; II embryos /transferred embryos\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121/198 ( 61.11%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e88/132(66.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.305\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eValues are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n/n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe implantation rate was 16.67%% in the aspiration group and 8.33% in the antibiotic group ( P\u0026thinsp;=\u0026thinsp;0.029). The clinical pregnancy and the ongoing pregnancy rates were significantly higher in the aspiration group (32.89% Vs. 15.38% P value\u0026thinsp;=\u0026thinsp;0.026, 30.26% Vs. 13.46%,P value\u0026thinsp;=\u0026thinsp;0.028, respectively). The live birth rate was 28,95% in the aspiration group and 13.46% in the antibiotic group (P value\u0026thinsp;=\u0026thinsp;0.04 )(Table\u0026nbsp;3).\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\u003ccaption\u003e\n\u003cp\u003eTable 3\u003c/p\u003e\n\u003cp\u003eTreatment outcomes\u0026nbsp;\u003c/p\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"234\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"158\"\u003e\n\u003cp\u003eAspiration\u0026nbsp; group\u003c/p\u003e\n\u003cp\u003e(n=76)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"124\"\u003e\n\u003cp\u003eAntibiotic \u0026nbsp;\u0026nbsp;\u0026nbsp;group\u003c/p\u003e\n\u003cp\u003e(n=52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"234\"\u003e\n\u003cp\u003eClinical pregnancy rate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"158\"\u003e\n\u003cp\u003e25/76(32.89%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"124\"\u003e\n\u003cp\u003e8/52 (15.38%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e0.026\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"234\"\u003e\n\u003cp\u003eOngoing pregnancy rate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"158\"\u003e\n\u003cp\u003e23/76 (30.26%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"124\"\u003e\n\u003cp\u003e7/52(13.46%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e0.028\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"234\"\u003e\n\u003cp\u003eLive birth rate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"158\"\u003e\n\u003cp\u003e22/76(28,95%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"124\"\u003e\n\u003cp\u003e7/52(13.46%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u0026nbsp;0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"234\"\u003e\n\u003cp\u003eImplantation rate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"158\"\u003e\n\u003cp\u003e33/198(16.67%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"124\"\u003e\n\u003cp\u003e11/132(8.33%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e0.029\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"234\"\u003e\n\u003cp\u003eSpontaneous abortion rate n/IUP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"158\"\u003e\n\u003cp\u003e2/25( 8 %)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"124\"\u003e\n\u003cp\u003e1/8 (12.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" width=\"606\"\u003e\n\u003cp\u003eValues are expressed as n/n (%). IUP= intrauterine pregnancy\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the aspiration group, when the patients were scanned at the time of embryo transfer, four patients had recollection of hydrosalpinx fluid and endometrial fluid collection and four patients had only recollection of hydrosalpinx fluid. Moreover, ultrasound scan performed 14 days after embryo transfer detected the recollection of hydrosalpinx fluid in 20 patients. In the antibiotic group, when the patients were scanned at the time of embryo transfer, eight patients had endometrial fluid collection.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e shows the reproductive outcome of the subgroups of patients in the aspiration group. The implantation, pregnancy and live birth rates were non significantly higher in the patients with no recollection of hydrosalpinx fluid compared with the patients with recollection of hydrosalpinx fluid. The two subgroups were comparable with respect to age, early follicular phase FSH, percentage of patients with bilateral hydrosalpinx and number and grade of embryos transferred. None of the patients with endometrial fluid collection on the day of embryo transfer become pregnant.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eReproductive outcomes of the subgroups of patients in the aspiration group\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eImplantation rate\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eClinical pregnancy rate\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eLive birth rate\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo recollection of hydrosalpinx fluid within the first 14 days\u0026thinsp;+\u0026thinsp;no endometrial fluid collection (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28/146 (19.18%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21/56 (37.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19/55(34.55%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRecollection of hydrosalpinx fluid within the first 14 days \u0026plusmn; endometrial fluid collection (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5/52(9.62%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4/20 (20%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3/20(15%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRecollection of hydrosalpinx fluid within the first 14 days\u0026thinsp;+\u0026thinsp;no endometrial fluid collection (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5/42(11.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4/16 (25%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3/16 (18.75%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRecollection of hydrosalpinx fluid within the first 14 days\u0026thinsp;+\u0026thinsp;endometrial fluid collection (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0/10 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0/4 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0/4 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eThere were no significant differences between the four subgroups.\u003c/p\u003e\n\u003cp\u003eValues are expressed as n/n (%).\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFlaring of pelvic infection, peritonitis or injury of pelvic organs were not reported in patients in the aspiration group. Cultures from the hydrosalpinx fluid were negative for bacterial growth.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study revealed that the aspiration of hydrosalpinx fluid under ultrasound guidance is more effective than antibiotic treatment in preventing the negative impact of hydrosalpinx on the results of IVF-ET .\u003c/p\u003e\n\u003cp\u003eSeveral researchers suggested that the flow of hydrosalpinx fluid into the endometrial cavity is the reason of the negative impact of hydrosalpinx on the results of IVF-ET (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e). Two studies revealed that the presence of hydrosalpinx decreases the expression of uterine receptivity markers (Homeobox A10, \u0026beta;-integrin and leukemia inhibitory factor) and that salpingectomy increases the expression of these markers (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eSeveral authors suggested that the inflammatory process in the hydrosalpinx caused by bacteria ( mainly Chlamydia trachomatis ) could extend to the endometrium thought the flow of hydrosalpinx fluid into endometrial cavity or through lymphatics or blood vessels (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e). It was postulated that the inflammatory mediators released by chronic inflammatory cells present in hydrosalpinx may cause embryonic damage or alter endometrial receptivity (16.17).\u003c/p\u003e\n\u003cp\u003eThe results of the current study suggested that antibiotic therapy is not effective in the prevention of the adverse effect of hydrosalpinx on IVF-ET outcome. In contrast to our results, a small retrospective study comparing the outcome of IVF-ET cycles of patients with hydrosalpinx who were treated with extended doxycycline regimen with the outcome of IVF-ET cycles of patients with adhesions /proximal tubal block and patients with endometriosis /unexplained infertility, revealed that the success of IVF-ET cycles was comparable between the three groups (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe results of the current study are in accordance with several studies which reported that the aspiration of hydrosalpinx fluid at the time of ovum pick up is a simple, safe and inexpensive procedure that can prevent the negative impact of hydrosalpinx on the results of IVF-ET (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e). Moreover, the data presented in the current study suggest that the aspiration of hydrosalpinx fluid under ultrasound guidance is less effective in the management of patients with rapid recollection of hydrosalpinx fluid and ineffective in the management of patients with endometrial fluid collection on the day of embryo transfer.\u003c/p\u003e\n\u003cp\u003eTwo randomized controlled trials compared aspiration of hydrosalpinx fluid under ultrasound guidance at the time of ovum pick up with no intervention in patients with ultrasound visible hydrosalpinges who undergo IVF-ET. Fouda et al reported that the implantation, clinical pregnancy, and ongoing pregnancy rates were higher in the aspiration group (18.70% Vs. 8.33%, 31.48% Vs. 13.21% and 27.78% Vs 9.43% respectively) (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e). Hammadieh et al reported that the chemical pregnancy rate was 43.8% in the aspiration group and 20.6% in the control group (P value\u0026thinsp;=\u0026thinsp;0.04). The clinical pregnancy rate was higher in the aspiration group but the difference failed to reach statistical significance (31.3% vs. 17.6%, P\u0026thinsp;=\u0026thinsp;0.20)(\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e) .\u003c/p\u003e\n\u003cp\u003eIn a randomized controlled trial including 160 patients with ultrasound visible hydrosalpinx, Fouda et al compared the effectiveness of aspiration of hydrosalpinx fluid under ultrasound guidance with salpingectomy in the management of patients with hydrosalpinges who undergo IVF-ET. Rapid recollection of hydrosalpinx fluid ( i.e. within 2 weeks after embryo transfer) was noticed in 34.21% of the patients in the aspiration group. The clinical pregnancy and the implantation rates were higher in salpingectomy group compared with the subgroup of patients with rapid recollection of hydrosalpinx fluid (42.67% vs. 19.23% and 18.95% vs. 7.58%, respectively). On the other hand, the clinical pregnancy and the implantation rates were comparable between the salpingectomy group and the subgroup of patients with no recollection of hydrosalpinx fluid (42.67% vs. 34% and 18.95% vs. 15.5% respectively)(\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn the current study, four patients in the aspiration group and eight patients in the antibiotic group had endometrial fluid collection on the day of embryo transfer. None of those patients conceived. The results of the current study are in accordance with numerous studies which reported that the subgroup of patients with endometrial fluid collection on the day of embryo transfer has the lowest pregnancy rates (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e). Several authors suggested that the ideal treatment option for this subgroup of patients is to cryopreserve the embryos and to transfer the embryos in subsequent cycles after performing salpingectomy or proximal tubal occlusion (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e)(\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe major weakness of the current study is the retrospective design. However, our study has several strengths. Our study is largest study which reported the use of antibiotic therapy in patients with ultrasound visible hydrosalpinges who undergo IVF-ET. Moreover, the current study is the first study which compared the efficacy of antibiotic therapy with aspiration of hydrosalpinx fluid under ultrasound guidance in the management of patients with ultrasound visible hydrosalpinges who undergo IVF-ET.\u003c/p\u003e"},{"header":"Conclusion","content":" \u003cp\u003eIn conclusion, the aspiration of hydrosalpinx fluid under ultrasound guidance is more effective than antibiotic therapy in preventing the negative impact of hydrosalpinx on the results of IVF-ET. The results of the current study should be proved by subsequent randomized controlled studies.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eAFC: Antral follicle count\u003c/p\u003e\n\u003cp\u003eAMH: Anti-M\u0026uuml;llerian hormone\u003c/p\u003e\n\u003cp\u003eART: Assisted reproductive techniques\u003c/p\u003e\n\u003cp\u003eFSH: Follicle stimulating hormone\u003c/p\u003e\n\u003cp\u003eICSI: Intra cytoplasmatic sperm injection\u003c/p\u003e\n\u003cp\u003eIVF-ET: In vitro fertilization embryo transfer.\u003c/p\u003e\n\u003cp\u003eIUP: intrauterine pregnancy\u003c/p\u003e\n\u003cp\u003ePCOS: Polycystic ovary syndrome\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the ethics committee of Riyadh fertility and reproductive health center.\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all the patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflict of interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGrants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo grants\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials section\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data from the current study supporting the conclusions are presented in the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors [Usama M. Fouda\u0026nbsp;,Hesham S. Elshaer \u003csup\u003e, \u003c/sup\u003e, Sherin M. Sobh , Emad M. Salah, Fatma F. Darweesh, Ahmed A. Wali , Tarek El Husseiny and Mohammad A. Taymour ] participated in the conception\u0026nbsp;, design of the work\u0026nbsp;,the acquisition, analysis, interpretation of data, have drafted the work and substantively revised it\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eKassabji M, Sims JA, Butler L, Muasher SJ.\u003c/strong\u003e Reduced pregnancy outcome in patients with unilateral or bilateral hydrosalpinx after in vitro fertilization. Eur J Obstet Gynecol Reprod Biol.1994,56(2):129\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eFouda UM, Sayed AM.\u003c/strong\u003e Effect of ultrasound-guided aspiration of hydrosalpinx fluid during oocyte retrieval on the outcomes of in vitro fertilisation-embryo transfer: a randomised controlled trial (NCT01040351). Gynecol Endocrinol.2011,27(8):562\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eZeyneloglu HB, Arici A, Olive DL. \u003c/strong\u003eAdverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization \u0026ndash; embryo transfer. Fertil Steril.1998, 70:492\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eStrandell A, Lindhard A, Waldenstrom U, Thorburn J, Janson PO, Hamberger L .\u003c/strong\u003eHydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia onsalpingectomy prior to IVF. Hum Reprod.1999, 14:2762\u0026ndash;2769.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMoshin V, Hotineanu A\u003c/strong\u003e. Reproductive outcome of the proximal tubal occlusion prior to IVF in patients with hydrosalpinx. Hum Reprod.2006, 21:i193\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eJohnson N, van Voorst S, Sowter MC, Strandell A, Mol BW\u003c/strong\u003e\u003cstrong\u003e. \u003c/strong\u003eSurgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev.2010,20(1):CD002125.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eFouda UM, Sayed AM, Abdelmoty HI, Elsetohy KA.\u003c/strong\u003e Ultrasound guided aspiration of hydrosalpinx fluid versus salpingectomy in the management of patients with ultrasound visible hydrosalpinx who undergo IVF-ET: a randomized controlled trial. BMC Womens Health. 2015,15:21.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMatorras R, Rabanal A, Prieto B, Diez S, Brouard I, Mendoza R, et al.\u003c/strong\u003e Hysteroscopic hydrosalpinx occlusion with Essure device in IVF patients when salpingectomy or laparoscopy is contraindicated. Eur J Obstet Gynecol Reprod Biol.2013,169(1):54\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eHurst BS, Tucker KE, Awoniyi CA, Schlaff WD.\u003c/strong\u003e Hydrosalpinx treated with extended doxycycline does not compromise the success of in vitro fertilization. Fertil Steril.2001, 75:1017\u0026ndash;1019.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eD'Arpe S, Franceschetti S, Caccetta J, Pietrangeli D, Muzii L, Panici PB. \u003c/strong\u003eManagement of hydrosalpinx before IVF: a literature review. J Obstet Gynaecol.2015,35(6):547-50.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eArora P, Arora R, Cahill D. \u003c/strong\u003eEssure\u0026reg; for management of hydrosalpinx prior to in vitro fertilisation-a systematic review and pooled analysis. BJOG.2014, 121(5):527\u0026ndash;36.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBarbosa MW, Sotiriadis A, Papatheodorou SI, Mijatovic V, Nastri CO, Martins WP. \u003c/strong\u003eHigh miscarriage rate in women treated with Essure\u0026reg; for hydrosalpinx before embryo transfer: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016,48(5):556-565.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eFouda U, Sayed A.\u003c/strong\u003e Extended high dose letrozole regimen versus short low dose letrozole regimen as an adjuvant to gonadotropin releasing hormone antagonist protocol in poor responders undergoing IVF-ET*. Gynecological Endocrinology .2011,27(12) 1018-1022.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMeyer WR, Castelbaum AJ, Somkuti S, Sagoskin AW, Doyle M, Harris JE, et al.\u003c/strong\u003e Hydrosalpinges adversely affect markers of endometrial receptivity. Hum Reprod.1997,12:1393\u0026ndash;1398.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSeli E, Kayisli UA, Cakmak H, Bukulmez O, Bildirici I, Guzeloglu-Kayisli O, \u003c/strong\u003eet al\u003cstrong\u003e. \u003c/strong\u003eRemoval of hydrosalpinges increases endometrial leukaemia inhibitory factor (LIF) expression at the time of the implantation window. Hum Reprod. 2005,20(11):3012-7.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDavid A, Garcia CR, Czernobilsky B.\u003c/strong\u003e Human hydrosalpinx. Histologic study and chemical composition of fluid. Am J Obstet Gynecol. 1969,105(3):400-11.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBedaiwy MA, Goldberg JM, Falcone T, Singh M, Nelson D, Azab H, et al\u003c/strong\u003e\u003cstrong\u003e. \u003c/strong\u003eRelationship between oxidative stress and embryotoxicity of hydrosalpinx fluid. Hum Reprod.2002, 17(3):601-4.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eHammadieh N, Coomarasamy A, Ola B, Papaioannou S, Afnan M, Sharif K. \u003c/strong\u003eUltrasound-guided hydrosalpinx aspiration during oocyte collection improves pregnancy outcome in IVF: a randomized controlled trial. Hum Reprod. 2008, 23: 1113\u0026ndash;1117.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eChien LW, Au HK, Xiao J, Tzeng CR\u003c/strong\u003e . Fluid accumulation within the uterine cavity reduces pregnancy rates in women who undergo IVF. Hum Reprod.2002, 17:351\u0026ndash;356.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAkman MA, Erden HF, Bahceci M.\u003c/strong\u003e Endometrial fluid visualized through ultrasonography during ovarian stimulation in IVF cycles impairs the outcome in tubal factor, but not PCOS, patients. Hum Reprod .2005,20:906\u0026ndash;909.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSharara FI, McClamrock HD\u003c/strong\u003e. Endometrial fluid collection in women with hydrosalpinx after human chorionic gonadotrophin administration: a report of two cases and implications for management. Hum Reprod. 1997,12(12):2816\u0026ndash;9\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Doxycycline, ultrasound, IVF-ET, hydrosalpinx","lastPublishedDoi":"10.21203/rs.3.rs-138894/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-138894/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe purpose\u0026nbsp;of this study was to detect\u0026nbsp;whether antibiotic therapy during IVF-ET cycle\u0026nbsp;is as effective as aspiration of hydrosalpinx fluid under ultrasound guidance\u0026nbsp;in preventing\u0026nbsp;the adverse effect of hydrosalpinx on IVF-ET results.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u0026nbsp;During the period between November\u0026nbsp;2012 and January\u0026nbsp;2020, patients with ultrasound visible hydrosalpinges\u0026nbsp;undergoing\u0026nbsp;IVF-ET who refused to undergo laparoscopic salpingectomy or not eligible for laparoscopy were advised to receive antibiotic therapy during IVF-ET cycle or to undergo aspiration of hydrosalpinx fluid under ultrasound guidance at the time of ovum pick up. A retrospective analysis was done for the results of IVF-ET cycles of patients who received antibiotic therapy ( n = 52 )\u0026nbsp;or underwent aspiration of hydrosalpinx fluid under ultrasound guidance ( n = 76). In the aspiration group, the\u0026nbsp;tip of the suction\u0026nbsp;needle\u0026nbsp;was introduced\u0026nbsp;into the hydrosalpinx to aspirate the\u0026nbsp;hydrosalpinx fluid after completing the ovum pick up. In the antibiotic group, doxycycline (100 mg/12 h) was commenced one week\u0026nbsp;before ovum pick up\u0026nbsp;and was continued for another\u0026nbsp;week\u0026nbsp;after ovum pick up.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The implantation, clinical pregnancy, ongoing pregnancy and live birth rates were significantly higher in the aspiration\u0026nbsp;group ( 16.67%% Vs. 8.33%, P value =0.029, 32.89% Vs. 15.38% P value = 0.026, 30.26% Vs. 13.46%,P value =0.028\u0026nbsp;\u0026nbsp;\u0026nbsp;and\u0026nbsp;28,95% Vs. 13.46% P value = 0.04 respectively).\u0026nbsp;\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The aspiration of hydrosalpinx fluid under ultrasound guidance\u0026nbsp;\u0026nbsp;is more effective than antibiotic therapy in preventing the negative impact\u0026nbsp;of hydrosalpinx on the results of IVF-ET. The results of the current study should be proved by subsequent\u0026nbsp;randomized controlled studies.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Extended Doxycycline Treatment Versus Aspiration of Hydrosalpingeal Fluid in the Management of Patients With Ultrasound Visible Hydrosalpinx Who Refused or Not Eligible to Undergo Salpingectomy Prior to IVF-ET","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-01-05 20:11:16","doi":"10.21203/rs.3.rs-138894/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9439a802-898c-44d3-9337-4e7d53cd802a","owner":[],"postedDate":"January 5th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":1710433,"name":"Sexual \u0026 Reproductive Medicine"},{"id":1710434,"name":"Cancer Biology"}],"tags":[],"updatedAt":"2021-01-20T20:59:27+00:00","versionOfRecord":[],"versionCreatedAt":"2021-01-05 20:11:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-138894","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-138894","identity":"rs-138894","version":["v1"]},"buildId":"2u56kwukJI3zHK-uzyFNs","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}