How members of the Society for Reproductive Endocrinology and Infertility and Society of Reproductive Surgeons evaluate, define, and manage hydrosalpinges

Capsule:
Management of hydrosalpinges before IVF is usually consistent among SREI/SRS members.

Authors:
Kenan Omurtag, M.D., Natalia M. Grindler, M.D., Kimberly A. Roehl, M.P.H., Gordon Wright Bates Jr., M.D., Angeline N. Beltsos, M.D., Randall R. Odem, M.D., Emily S. Jungheim, M.D., M.S.C.I.
Volume 97, Issue 5, Pages 1095-1100.e2, May 2012

Objective:
To describe the management of hydrosalpinges among Society for Reproduction Endocrinology and Infertility (SREI)/Society of Reproductive Surgeons (SRS) members.

Design:
Cross-sectional survey of SREI/SRS members.

Setting:
Academic and private practice–based reproductive medicine physicians.

Participant(s):
A total of 442 SREI and/or SRS members.

Intervention(s):
Internet-based survey.

Main Outcome Measure(s):
To understand how respondents evaluate, define, and manage hydrosalpinges.

Result(s):
Of 1,070 SREI and SRS members surveyed, 442 responded to all items, for a 41% response rate. Respondents represented both academic and private practice settings, and differences existed in the evaluation and management of hydrosalpinges. More than one-half (57%) perform their own hysterosalpingograms (HSGs), and 54.5% involve radiologists in their interpretation of tubal disease. Most respondents thought that a clinically significant hydrosalpinx on HSG is one that is distally occluded (80.4%) or visible on ultrasound (60%). Approximately one in four respondents remove a unilateral hydrosalpinx before controlled ovarian hyperstimulation (COH)/intrauterine insemination (IUI) and clomiphene citrate (CC)/IUI (29.3% and 22.8%, respectively), and physicians in private practice were more likely to intervene (COH: risk ratio [RR] 1.81, 95% confidence interval [CI] 1.31–2.51; CC: RR 1.98, 95% CI 1.33–2.95). Although laparoscopic salpingectomy was the preferred method of surgical management, nearly one-half responded that hysteroscopic tubal occlusion should have a role as a primary method of intervention.

Conclusion(s):
SREI/SRS members define a “clinically significant hydrosalpinx” consistently, and actual practice among members reflects American Society for Reproductive Medicine/SRS recommendations, with variation attributed to individual patient needs. Additionally, one in four members intervene before other infertility treatments when there is a unilateral hydrosalpinx present.

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