The mechanism of hydrosalpinx in embryo implantation
The mechanism of hydrosalpinx in embryo implantation
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DOI：
10.1093/humrep/16.12.2662
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发表时间：
2001-12-01
影响因子：
6.1
通讯作者：
Jaffa, AJ
中科院分区：
文献类型：
--
作者：
Eytan, O;Azem, F;Jaffa, AJ
背景：输卵管积水对胚胎着床有不利影响，并导致胚胎移植后着床率低。胚胎的运输依赖于宫壁运动引起的宫内液体运动，宫壁运动是子宫肌层自发收缩至宫底的结果。方法与结果：应用图像处理技术对5例输卵管积水患者的子宫动力学进行了记录和分析：与正常对照组相比，输卵管积水的频率明显升高，振幅和被动宽度明显降低。现有的蠕动活动本应引起宫内液体流动；然而，记录未能显示预期的液体团注运输。这一观察结果得到了数学模拟的支持，该假说基于输卵管积水患者的输卵管积液增加了输卵管压力，从而在眼底和宫颈之间诱导了压力梯度。这种压力梯度对宫颈到宫底的宫内蠕动产生不利作用，并产生反流电流，可能会将胚胎推离植入部位。结论：回流现象可以解释输卵管积水所致种植率降低的原因。是否应该为了提高体外受精妊娠率而拔除输卵管积水，这一问题的解决应该伴随着前瞻性随机临床试验。
BACKGROUND: Hydrosalpinx adversely affects embryo implantation and contributes to poor implantation rates post embryo transfer. Embryo transport depends on concomitant intrauterine fluid motion induced by uterine wall motility, the result of spontaneous myometrial contractions towards the fundus. METHODS AND RESULTS: The uterine dynamics of five patients with hydrosalpinx were recorded and analysed by image-processing techniques: the frequency was higher while the amplitudes and passive widths were lower compared with healthy volunteers. The existing peristaltic activity should have induced intrauterine fluid flow; however, the recordings failed to show the expected transport of fluid bolus. This observation was supported by mathematical simulations based on the hypothesis that fluid accumulation in the Fallopian tube of a patient with hydrosalpinx increases tubal pressure and thereby induces a pressure gradient between the fundus and the cervix. This pressure gradient acts adversely to the cervix-to-fundus intrauterine peristalsis and generates reflux currents that may thrust embryos away from the implantation site. CONCLUSIONS: The reflux phenomenon could explain the reduced implantation rate associated with hydrosalpinx. Resolution of the issue of whether the removal of a Fallopian tube with hydrosalpinx should be undertaken for improving IVF pregnancy rates should be accompanied by prospective randomized clinical trials.