Human Reproduction Vol.17, No.2 pp.

351–356, 2002

Fluid accumulation within the uterine cavity reduces

pregnancy rates in women undergoing IVF

Li-Wei Chien, Heng-Kien Au, Jean Xiao and Chii-Ruey Tzeng1

Department of Obstetrics and Gynaecology, Taipei Medical University Hospital, Taipei, Taiwan
1To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, Taipei Medical University Hospital,
No. 252, Wu-Shing Street, Taipei 110, Taiwan. E-mail: tzengcr@tmu.edu.tw

BACKGROUND: The occurrence of fluid accumulation within the uterine cavity was examined in women undergoing
IVF to investigate its correlation with tubal disease and impact on the pregnancy outcome. METHODS: A registry
of ultrasound procedures spanning 5 years was retrospectively studied. RESULTS: Thirty five out of 746 (4.7%)
IVF cycles were identified as having uterine fluid accumulation, and 15 (2.0%) persisted until the day of embryo
transfer. Two of the 20 cycles of women with transient fluid accumulation were pregnant, and none of those with
fluid retention on the day of embryo transfer conceived. The pregnancy rate was only 5.7% (2/35) in women with
uterine fluid accumulation detected during IVF cycles. In contrast, the pregnancy rate was 27.1% (193/711) among
women in whose cycles no fluid accumulation was detected (P ⍧ 0.0048). Uterine fluid accumulation during IVF
cycles was found in 8% (18/225) of women documented with tubal factor compared with 3.3% (17/521) with non-
tubal factor (P ⍧ 0.005). CONCLUSIONS: Fluid accumulation within the uterine cavity during the IVF transfer
treatment could be observed in patients with both tubal and non-tubal factors; however, it mainly occurred in
women with tubal infertility. Although it is not a common complication of IVF cycles, excessive uterine fluid is
detrimental to embryo implantation.

Key words: hydrometra/implantation/IVF/tubal infertility

Introduction Materials and methods

The effect of hydrosalpinx on pregnancy outcome of IVF has
been discussed extensively in recent years. Most studies have
reported that implantation and pregnancy rates were low in
women with hydrosalpinx (Strandell et al., 1994; Fleming and
Hull, 1996; Katz et al., 1996; Sharara et al., 1996; Camus
et al., 1999). One of the explanations is that fluid of hydrosalp-
inges may reflux into the uterine cavity and accumulate there,
which may disturb embryo implantation (Mansour et al., 1991;
Andersen et al., 1994; Bloechle et al., 1997; Sharara and
McClamrock, 1997). However, fluid accumulation within the
uterine cavity or hydrometra after ovarian stimulation and
before embryo transfer has only sporadically been reported in
the literature (Welker et al., 1989; Mansour et al., 1991;
Gürgan et al., 1993; Andersen et al., 1994; Bloechle et al.,
1997; Sharara and McClamrock, 1997; Sharara and Prough,
1999), and most of those cases were also claimed to have
hydrosalpinges. How often this complication occurs in women
with tubal infertility and whether women with other indications
of IVF would also have the same problem are still unknown.
The aim of this study was to report our experiences with
uterine fluid accumulation in a large consecutive series of IVF
cycles and to investigate its correlation with tubal disease.
Patients
A total of 746 cycles in 547 women receiving IVF treatment from
January 1995 to December 1999 was included in this study. Indications
for IVF were pure tubal factors (22%), unexplained infertility (8%),
endometriosis (21%), male factor (24%), and mixed factors (25%).
Before the initiation of treatment, transvaginal ultrasound examination
was performed to detect pelvic pathology. Tubal condition was
evaluated by hysterosalpingography, laparoscopy with chromopertub-
ation, laparotomy, and/or ultrasonography.
IVF procedure
Women whose partners had severe male factors were treated with
ICSI procedures, while standard IVF techniques were used for other
patients. Briefly, GnRH-agonist suppression either in an ultra-short
protocol by s.c. injections of buserelin acetate (Supremon®; Hoechst,
Frankfurt am Main, Germany), 0.5 mg/day started on the second day
of the menstrual cycle for a fixed 3 day treatment course, or in an
ultra-long protocol by monthly leuprolide acetate (Leuplin Depot®
3.75 mg; Takeda Chemical Industries, Osaka, Japan) injection on the
second day of the menstrual cycle for 2–3 months was used. Ovarian
stimulation was then initiated with FSH (Metrodin®; Serono, Rome,
Italy) and HMG (Pergonal®; Serono). HCG (HCG-SERONO®;
Serono) at 10 000 IU was given i.m. when there were at least two
leading follicles with a diameter ⬎16 mm. Oocytes were retrieved

© European Society of Human Reproduction and Embryology 351

L-W.Chien et al.
Figure 1. Fluid accumulation in the uterine cavity detected by
transvaginal ultrasound in a patient before embryo transfer.
by transvaginal ultrasound-guided follicular aspiration 34–36 h after
HCG injection. All patients had at least one good-quality embryo, as
defined by the morphology criteria, for transfer on the second or third
day after oocyte retrieval. The embryos were evaluated by a scoring
system based on cell number combined with grading of fragmentation
pattern (FP) of each embryo according to criteria described previously
(Desai et al., 2000). Briefly, the FP was scored as the criteria
previously outlined (Alikani et al., 1999) with FP pattern I exhibiting
minimal fragments and pattern V as extensive fragmentation. If the
FP was greater than II, two points were subtracted from the blastomere
number to give the embryo score. An average score of embryos
transferred was shown for comparison.
Ultrasonography examination
Sonographic examinations were performed using an Ultramark®
9 HDI (Advanced Technology Laboratories, Bothell, WA, USA) with
a 5–9 MHz multi-frequency transvaginal probe. The endometrium
was scanned sagittally along the mid-line axis of the uterus, and
alterations in the endometrial thickness and echogenic pattern/structure
were recorded during gonadotrophin administration, on the day of
oocyte retrieval, and on the day of embryo transfer. The thickness of
endometrium was measured at the maximum distance between each
myometrial/endometrial interface through the longitudinal axis of the
uterine body. Fluid accumulation within the uterine cavity was defined
as an echolucent ring configuration distended by a certain amount of
fluid between the anterior and posterior endometrial linings in a
sagittal view (Figure 1). In cases of fluid accumulation, the thickness
of endometrium was measured by subtracting the maximal fluid
diameter from the maximal distance between the opposing myometrial/
endometrial interfaces. The maximal fluid diameter and the sur-
rounding endometrial thickness were used for analysis. All the
ultrasound examinations were performed by two of the authors
(L-W.C. and H-K.A.) and the inter-observer variation was below 5%.
Women who had fluid accumulation in the uterine cavity during
IVF cycles were categorized as the study group, and those without
fluid accumulation as the control group. Cycles that involved the use
of frozen embryos, donor oocytes, or assisted hatching were excluded.
All pregnancies were confirmed by rising serum β-HCG levels and by
gestational sacs identified by transvaginal sonographic examination.
Statistics
Continuous data are presented as the mean ⫾ SEM. Rates for all
results were compared between the patient groups by using the χ2
test. Fisher’s exact test was used for small numbers. Measured
352
variables were compared by using the Mann–Whitney U-test or
Student’s t-test as appropriate. A P value of ⬍0.05 was considered
significant.
Results
Fluid accumulation within the uterine cavity during IVF
treatment was noted in 35 cycles of 33 women with an incidence
of 4.7% (35/746). Of them, persistent fluid accumulation on
the day of embryo transfer was found in 15 cycles (2.0%) of
14 women. In the other 20 cycles, transient uterine fluid
accumulation was shown during gonadotrophin administration
and/or on the day of oocyte retrieval but became undetectable
on the day of embryo transfer. Fluid accumulations were noted
before HCG injection in four (11%) cycles. In the other 31
(89%) cycles, fluid accumulations were detected after HCG
was given. None of the women with persistent uterine fluid
accumulation up to the day of embryo transfer conceived.
For cycles with transient uterine fluid accumulation, two
intrauterine pregnancies (10%) with one aborted and one
ectopic pregnancy were noted. Overall, there was only one
successful pregnancy (2.8%) in 35 cycles of women with
uterine fluid detected during IVF–embryo transfer cycles. In
contrast, the pregnancy rate was 27.1% (193/711) and the
abortion rate was 16.6% (32/193) among cycles with no fluid
accumulation (Table I). There were no significant differences
between the two groups in terms of duration of infertility,
stimulation length, number of oocytes collected, number of
embryos transferred, average embryo score or peak serum
estradiol and progesterone concentrations on the day of HCG
administration and day of embryo transfer. Patients were
younger and the endometrium was thinner on the day of
embryo transfer in the group with uterine fluid accumulation
when compared with the group without fluid (P ⫽ 0.0007 and
P ⫽ 0.011 respectively).
Clinical data of patients with uterine fluid accumulation are
summarized in Table II. Over half (19 out of 35 cycles, 54.3%)
of the women who showed fluid accumulation during IVF–
embryo transfer cycles had tubal infertility. Among the women
with non-tubal infertility, endometriosis was the major cause
for IVF in 12 cycles (34.3%), five (14.3%) were male factors,
and one was polycystic ovarian syndrome (PCOS). There were
no significant differences in patient characteristics or treatment
outcomes between the two groups with persistent and transient
fluid accumulation. The mean maximal fluid diameter was
3.1 ⫾ 0.4 mm (range 1.2–8.2 mm) in cycles with fluid
accumulation during gonadotrophin administration or on the
day of oocyte retrieval. In cycles with fluid accumulation at
embryo transfer, the mean maximal fluid diameter was greater
(P ⫽ 0.028), i.e. 5.2 ⫾ 0.9 mm (range 2.0–14.8 mm). The
thickness of the endometrium, however, showed no significant
difference on the day of embryo transfer between two groups
with persistent and transient fluid accumulation (10.2 ⫾ 0.9
versus 10.3 ⫾ 0.5 mm, P ⫽ not significant).
Repeated accumulation of fluid in two successive cycles
was found in two patients. One of them had been treated with
tuboplasty for obstructive tubal disease. Her first IVF cycle
showed transient fluid accumulation on the day of oocyte
 Uterine fluid accumulation in IVF

Table I. Comparison of clinical parameters and pregnancy outcome in cycles with and without fluid
accumulation within the uterine cavity during IVF treatment

Parameter Cycles with fluid Cycles without fluid P

(n ⫽ 35) (n ⫽ 711)

Number of women 33 514

Age (years) 31.5 ⫾ 0.5 33.8 ⫾ 0.1 0.0007
Duration of infertility (years) 4.4 ⫾ 0.4 4.5 ⫾ 0.1 NS
Stimulation length (d) 8.3 ⫾ 0.3 8.8 ⫾ 0.1 NS
Number of oocytes retrieved 8.4 ⫾ 0.7 7.2 ⫾ 0.2 NS
Number of embryos transferred 3.2 ⫾ 0.2 2.9 ⫾ 0.1 NS
Average embryo scorea 8.3 ⫾ 0.3 8.2 ⫾ 0.1 NS
E2 level (HCG day) (pg/ml) 1895.2 ⫾ 231.9 1494.8 ⫾ 49.7 NS
P4 level (HCG day) (ng/ml) 1.25 ⫾ 0.08 1.12 ⫾ 0.02 NS
E2 level (embryo transfer day) (pg/ml) 1105.4 ⫾ 162.9 839.7 ⫾ 34.3 NS
P4 level (embryo transfer day) (ng/ml) 128.4 ⫾ 10.7 107.7 ⫾ 3.1 NS
Endometrial thickness (HCG day) (mm) 11.1 ⫾ 0.5 11.6 ⫾ 0.1 NS
Endometrial thickness (embryo transfer day)(mm) 10.2 ⫾ 0.5 11.4 ⫾ 0.1 0.011
Number of pregnancies (%) 2 (5.7%) 193 (27.1%) 0.0048
Number of ectopic pregnancies (%) 1 (2.9%) 13 (1.8%) NS
Number of abortions (%) 1 (50%) 32 (16.6%) NS

Values are expressed as the mean ⫾ SEM.

aDefined by cell number and grading of fragmentation pattern of each embryo.
E2 ⫽ estradiol; P4 ⫽ progesterone.

Table II. Comparison of patient characteristics and treatment outcomes of women in whom uterine fluid
accumulation was detected during IVF treatment

Parameter Transient fluid Persistent fluid P

accumulation accumulation

Number of women 19 14
Age (years) 31.7 ⫾ 0.6 31.3 ⫾ 1.0 NS
Duration of infertility (years) 5.3 ⫾ 0.5 3.1 ⫾ 0.4 0.0025
No. (%) of women with indicated major cause of infertility
Tubal factor 8 (40) 9 (61.5)
Endometriosis 6 (30) 5 (28.5)
Male factor 5 (25) 0
Ovulation 1 (5) 0
Total 20a 14
Number of oocytes retrieved 8.3 ⫾ 0.7 8.0 ⫾ 1.2 NS
Number of embryos transferred 3.3 ⫾ 0.3 2.8 ⫾ 0.3 NS
Average embryo score b 8.3 ⫾ 0.3 8.4 ⫾ 0.6 NS
E2 level (HCG day) (pg/ml) 1969.7 ⫾ 307.1 1780.6 ⫾ 364.1 NS
P4 level (HCG day) (ng/ml) 1.30 ⫾ 0.07 1.17 ⫾ 0.17 NS
E2 level (embryo transfer day) (pg/ml) 1147.8 ⫾ 231.7 1040.2 ⫾ 219.7 NS
P4 level (embryo transfer day) (ng/ml) 143.2 ⫾ 13.0 105.6 ⫾ 17.1 NS
Endometrial thickness (HCG day) (mm) 11.1 ⫾ 0.6 11.1 ⫾ 0.9 NS
Endometrial thickness (embryo transfer day) (mm) 10.3 ⫾ 0.5 10.2 ⫾ 0.9 NS
Mean fluid diameter (mm) 3.1 ⫾ 0.4 5.2 ⫾ 0.9 0.028
Number of pregnancy (%) 2 (10) 0 NS
Number of ectopic pregnancy (%) 1 (5) 0 NS

Values are expressed as the mean ⫾ SEM.

aOne endometriosis patient had repeated transient fluid accumulation at embryo transfer on two successive
cycles.
bDefined by cell number and grading of fragmentation pattern of each embryo.

retrieval, which ended with an ectopic pregnancy after embryo
transfer. Persistent fluid accumulation on the day of embryo
transfer was found in the second cycle and did not result in
pregnancy. The other patient had undergone vaginoplasty plus
pelvic surgery due to agenesis of the upper vagina with
severe pelvic endometriosis before IVF treatment began. Fluid
accumulations were noted after ovarian stimulation and per-
sisted on the day of embryo transfer. Transmyometrial embryo
transfer was performed in the second cycle, yet no pregnancy
resulted. In eight women who had more than one IVF cycle
with the same protocol of ovarian stimulation, no fluid accumu-
lation was shown in successive cycles. There was no intrauter-
ine fluid accumulation during non-treatment cycles in any of
the cases studied.
The incidence of fluid accumulation in relation to tubal
conditions is shown in Table III. There were 225 cycles in
women who had documented tubal disease, and of these, 18
cycles (8%) showed fluid accumulation during the IVF treat-
353
L-W.Chien et al.
Table III. Incidence of uterine fluid accumulation during IVF cycles in relation to tubal conditions
Tubal factor
Hydrosalpinx
Number of cycles 142
Number of fluid-filled cycles 13 (9.1%)a
Number of cycles with 8 (5.6%)b
persistent fluid accumulation
aP ⫽ 0.40; bP ⫽ 0.071; cP ⫽ 0.005; dP ⫽ 0.0019.
ment and nine cycles (4%) had persistent fluid accumulation.
On the other hand, in 521 cycles of women without tubal
lesions, 17 cycles (3.3%) showed fluid accumulation, and the
fluid was still detected on the day of embryo transfer in six
cycles (1.1%). The incidences of transient and persistent uterine
fluid accumulation were both significantly higher in tubal
factor cycles than those of non-tubal factor cycles (P ⬍ 0.005
and P ⬍ 0.005 respectively). Out of 225 tubal factor cycles,
142 had hydrosalpinges. Among these, 13 cycles (9.1%)
showed fluid accumulation, and eight (5.6%) persisted on the
day of embryo transfer. Of the other 83 cycles of tubal
infertility without documented hydrosalpinges, five cycles
(6.0%) showed fluid accumulation, and only one (1.2%) was
noted on the day of embryo transfer. Although the incidence
of uterine fluid accumulation seemed to be higher in tubal-
infertility women with hydrosalpinges than those with no
hydrosalpinges, the difference did not reach statistical signific-
ance. Nine of 14 (64.3%) women who demonstrated fluid
accumulation on the day of embryo transfer had obstructive
tubal disease, and eight out of nine had hydrosalpinges detected
before IVF treatment. Four of eight women with hydrosalpinges
also had adnexal cystic masses detected by ultrasonography
before treatment was initiated. None of them underwent
surgical intervention prior to IVF.
Discussion
The use of ultrasound to evaluate the uterine cavity for fluid
collection prior to embryo transfer was previously reported
(Mansour et al., 1991; Andersen et al., 1994; Bloechle et al.,
1997), yet it is not performed systematically in most centres
during IVF treatment cycles. This study demonstrates that
uterine fluid accumulation can be detected in women both
with and without concomitant tubal lesions. Although the
incidence is low during IVF–embryo transfer treatment, it is
important to identify this condition because of marked negative
consequences on pregnancy outcome.
The mechanism of uterine fluid accumulation during IVF
treatment is not completely understood. Hydrosalpinx was
present in most cases as reported in the literature (Welker
et al., 1989; Mansour et al., 1991; Gürgan et al., 1993;
Andersen et al., 1994; Bloechle et al., 1997; Sharara and
McClamrock, 1997). Our data confirm that tubal obstruction
is the major cause of uterine fluid retention during IVF–
embryo transfer cycles. We also show that it can be detected
in women both with and without hydrosalpinges, but those
354
Non-tubal factor
Non-hydrosalpinx Total
83 225 521
5 (6.0%)a 18 (8%)c 17 (3.3 %)c
1(1.2%)b 9 (4 %)d 7 (1.3%)d
with documented hydropic tubes were more likely to have
fluid accumulation. Although visible fluid retention in the
uterine cavity does not seem to be a common complication in
women with tubal infertility undergoing IVF treatment as
shown in this study, it is reasonable to expect that the incidence
of occult reflux of fluid into the uterine cavity may be higher
in these women. It may help explain the poor pregnancy
outcome observed in women with hydrosalpinges receiving
IVF–embryo transfer demonstrated in many recent reports
(Camus et al., 1999).
Obstruction of the cervical canal can lead to fluid accumula-
tion, as found in one of our patients who had recurrence in
two successive cycles. She suffered from agenesis of the upper
vagina, and partial obstruction of the endocervical canal was
noted despite reconstruction surgery performed before the IVF
procedures. Gürgan also reported a case of fluid accumulation
due to endocervical canal obstruction by an endocervical cyst,
which was evident after HCG administration (Gürgan et al.,
1993). In our case, fluid accumulation was visible soon after
gonadotrophin stimulation and increased in amount up to
14 mm in diameter after HCG administration. Patients with
subtle cervical canal occlusion may be susceptible to uterine
fluid accumulation during the treatment cycles, but it might
be difficult to detect it prior to ovarian stimulation. Whether
these women may benefit from cervical dilatation before IVF
treatment to avoid repeated fluid accumulation in subsequent
cycles still needs to be investigated. It is interesting to
note that pelvic endometriosis is the main cause of fluid
accumulation in non-tubal factor patients. In women with
moderate to severe endometriosis, pelvic adhesions may some-
times cause tubal obstruction. Cervical stenosis also has been
suggested to coexist in some cases of pelvic endometriosis
(Barbieri, 1998). These correlations may contribute to the fluid
accumulation observed in patients with endometriosis. This
complication is not common in women with endometriosis
undergoing IVF treatment, but its significance in affecting the
pregnancy outcome may warrant further observation.
Recently, Sharara and Prough (1999) reported four cases of
endometrial fluid collection in more than 600 IVF cycles. All
of them had PCOS and were undergoing ovarian stimulation
for IVF but with no concomitant hydrosalpinx (Sharara and
Prough, 1999). Their findings suggest that fluid accumulation
in the uterine cavity might develop in women without hydrosal-
pinx. In our study, one patient with PCOS demonstrated
transient fluid accumulation after HCG injection. Five women
with male factor infertility were shown to have transient fluid

accumulation on the day of oocyte retrieval, suggesting that it
might not be correlated with PCOS but with the effect of
ovarian stimulation. Ovarian stimulation definitely plays an
important role in the development and maintenance of uterine
fluid accumulation, because none of these patients showed
fluid accumulation in the preceding or subsequent resting
cycles. We also noted that, under the same stimulation protocol,
only two out of 10 women showed fluid accumulation in
subsequent cycles, implying that this condition might not
necessarily be recurrent.
The timing of detection and the amount of fluid collection
are important in determining the impact on pregnancy outcome.
Most studies (Mansour et al., 1991; Andersen et al., 1994;
Bloechle et al., 1997; Sharara and McClamrock, 1997) found
that the fluid-filled uterine cavity usually developed after
receiving an HCG injection, but others (Sharara and Prough,
1999) reported that endometrial fluid collection could be
detected before HCG but after gonadotrophin administration.
We found that a large amount of fluid collection (⬎3 mm in
the largest diameter) usually developed after receiving HCG
except in one woman combined with cervical stenosis who
showed prominent fluid accumulation before HCG was given.
Transient uterine fluid accumulation, usually less than 3 mm
in the largest diameter, could be found in some cases during
gonadotrophin stimulation and after HCG injection. The fluid
accumulation might have disappeared by the time of embryo
transfer, but it still had a negative effect on the pregnancy
outcome. If fluid accumulation reached a diameter of over
3 mm either before or after HCG was given, it usually persisted
until the time of the peri-implantation period and affected
embryo implantation (Andersen et al., 1994).
The apposition of embryos to the endometrium may enhance
embryonic development potential and optimize the synchron-
ization between the embryo and the endometrium, which is
important for improved implantation efficiency during IVF
treatment. Excessive fluid within the uterine cavity at the time
of embryo transfer will interfere with the attachment of the
embryo to the endometrial surface. It is interesting to note that
glandular cystic atrophy of the uterine glands has been found
in goats with development of hydrometra (Wittek et al., 1998),
suggesting a pressure effect of a distended uterine cavity on
the endometrium. Our data also demonstrate a significantly
thinner endometrium at the time of embryo transfer in patients
with fluid accumulation during the cycle compared with
patients without fluid accumulation. Other explanations for the
deleterious effects of fluid include release of intrauterine
cytokines, prostaglandins, and other inflammatory compounds
directly onto the endometrium (Ben-Rafael and Orvieto, 1992).
There might be some embryotoxic substances existing in the
fluid, as in hydrosalpinx fluid (Mukherjee et al., 1996; Rawe
et al., 1997; Freeman et al., 1998), but this mechanism is still
controversial (Spandorfer et al., 1999).
Factors that may lead to fluid accumulation must be corrected
before IVF treatment to prevent this unfavourable uterine
condition. Women with tubal infertility require further evalu-
ation. Before initiation of an IVF cycle, a baseline pelvic
ultrasound scan is needed to rule out any adnexal cystic mass
of other than ovarian origin. Episodes of hydrorrhoea and of
Uterine fluid accumulation in IVF
fluid accumulation in the uterine cavity during the luteal phase
have been reported in the most severe cases of hydrosalpinx
(Andersen et al., 1994). Two prospective randomized studies
(Strandell et al., 1999; Statdmauer et al., 2000) have shown
that surgical correction of hydrosalpinges before IVF may
improve the pregnancy outcome. Salpingectomy or proximal
tubal interruption could prevent the reflux of tubal fluid into
the endometrial cavity and thus reduce intrauterine fluid
accumulation. For women with cervical stenosis and a history
of difficult embryo transfer, cervical dilatation is recommended.
In patients with fluid accumulation in the previous cycles but
without any pelvic pathology, however, there is no evidence
that surgical treatment is beneficial. Careful ultrasound mon-
itoring of the endometrium in all women undergoing IVF is
required to detect fluid in the uterine cavity. If fluid accumula-
tion is found before HCG administration, cancellation of the
cycle should be considered. Evacuation of the fluid can be
attempted if noted after HCG is given, but re-collection of
fluid immediately after aspiration has been reported in previous
trials (Mansour et al., 1991; Bloechle et al., 1997). When fluid
accumulation is noted before embryo transfer, transmyometrial
embryo transfer may be an alternative method (Kato et al.,
1993; Sharif et al., 1996), yet the effectiveness is unproven.
Cryopreservation of embryos until a favourable cycle is the
treatment of choice at the present time, but it has to be proved
in further study.
In conclusion, we found that fluid accumulation within the
uterine cavity during IVF treatment mainly occurred in patients
with tubal infertility. However, it can also be observed in
patients with non-tubal factors. Although it is not a common
complication of IVF–embryo transfer cycles, the presence of
excessive uterine fluid is detrimental to embryo implantation.
Serial transvaginal ultrasonography evaluation of both the
endometrium and uterine cavity is necessary during the entire
treatment cycle to avoid transferring embryos into an unfavour-
able uterus.
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Submitted on July 10, 2001; accepted on October 11, 2001