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Re: REI question Ricardo-Jump in here.From: Rafael Haciski (haciski@earthlink.net)Sun Sep 18 23:38:32 2005
The thinking here is that there may be possible leakage (or transudation) of toxic substances into the uterus impeding endometrial receptivity and implantation. There are several retrospective studies demonstrating that when there is a visible hydrosalpinx (on sono) then the IVF outcome is reduced, conversely, excising the hydrosalpinx increases the IVF yield. As far as your patient is concerned, you do not know that this hydro is indeed "sterile" - just asymptomatic at this time. The whole thrust of IVF is to minimize all negative factors, and maximize positive factors. While you can go on with IVF in face of hydrosalpinx (or hydrosalpinges), the success rate MAY be reduced, and who wants that, especially considering the cost (financial, temporal, and emotional). I personally disagree with this particular physician's absolute stance in that I would suggest to the patient that the best course of action would be salpingectomy (which is easily and quickly performed through the laparoscope), but if she refused, I would proceed with the IVF with the understanding that she may have possibly REDUCED (not eliminated) her chances for conception.
-- Rafael C. Haciski MD FACOG Palmetto FL
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