In literature the argument on whether to perform salpingostomy under certain criteria and or remove the hydrosalpinges prior to proceeding with IVF is noted. In addition, it is not clear whether salpingectomy has a negative effect on the haematosis of the ovaries and therefore the development of the follicles.
The removal or ligation of the fallopian tubes is better to be performed under certain criteria, as a satisfactory pregnancy rate has been observed in IVF without the surgical removal or ligation of hydrosalpinges. Some of the criteria for salpingectomy include: large distension of hydrosalpinges which is obvious in transvaginal ultrasound, hydrosalpinges with thick walls and failure of one or two consecutive IVF treatment cycles with good embryo quality (embryos with satisfactory cell number and good blastomere morphology). The transvaginal ultrasound although highly specialized has poor sensitivity to the diagnosis of hydrosalpinges. The diagnosis of hydrosalpinges is mainly made with hysterosalpingography and is confirmed with laparoscopy.
In conclusion, the selection of salpingostomy or salpingectomy in the laparoscopic approach of hydrosalpinges must be decided according to strict pre-operative peri-operative criteria. The different treatment solutions must be explained to the subfertile couple in a clear manner so as to avoid any trouble and lose precious time. Nowadays, IVF which has high pregnancy rates is the treatment of choice for hydrosalpinges, while salpingostomy should only be offered as an alternative solution to young women with hydrosalpinges.