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Abstract: The patient was a 40-year-old female with fertility intentions, but had not been pregnant for many years. After communication with the patient and the couple, we recommended assisted reproductive technology first, with embryo freezing, and then surgical treatment of hydrocele, followed by embryo transfer. After treatment, the patient’s hydrosalpinx was treated surgically and the embryo was transferred and the pregnancy was successful.
Basic information】Female, 40 years old
Type of disease】Hydrocele in the fallopian tube
Hospital】Wuhan Children’s Hospital affiliated with Tongji Medical College of Huazhong University of Science and Technology
Date of Consultation】February 2021
Treatment Plan】Surgical treatment (laparoscopic right tubectomy) + assisted reproductive technology (in vitro fertilization, embryo transfer)
Treatment period】3-4 months
Results】The fluid-filled fallopian tube was treated surgically, and the embryo was transferred and the pregnancy was successful.
I. Initial consultation
The patient was married to her husband in 2006 and had a normal sex life; she had one abortion in 2006; she delivered a child at full term in 2009 and was in good health; she had a left tubal pregnancy in 2010 and underwent laparoscopic left tubal resection in a local hospital without contraception, and was still infertile. In February 2021, she had AMH 1.0ng/ml and transvaginal ultrasound indicated hydrosalpinx in the right fallopian tube. The husband’s semen examination did not show any significant abnormality. Now the couple is planning to have another baby, so they came to our hospital. After talking with the patient and the couple, it was suggested that assisted reproductive technology should be used first to freeze the embryos and then surgically treat the hydrosalpinx, followed by embryo transfer.
II. Treatment process
Considering that the patient’s left fallopian tube had been removed and her right fallopian tube had been unblocked with hydrosalpinx, and that she was of advanced age and her ovarian reserve function had decreased, she was recommended to undergo assisted reproductive technology to help her conceive. After completing the relevant examinations, both parties had no contraindications to assisted reproductive technology and started the treatment with PPOS protocol. After 2 months of rest, she returned to the hospital and underwent laparoscopic right tubectomy, and entered the embryo transfer cycle in January after the operation.
III. Treatment results
After comprehensive consideration, the patient was not considered for fresh embryo transfer in this cycle, and she was of advanced age with diminished ovarian function, so the PPOS protocol was chosen for ovulation promotion, and 5 embryos (3 oogenic embryos and 2 blastocysts) were finally obtained. After egg retrieval, the patient was advised to rest for 2 months and then return to the hospital for laparoscopic surgery to remove the right fallopian tube to solve the problem of hydrosalpinx once and for all. Embryo transfer was performed 1 month after the removal of the fluid-filled fallopian tube, and the pregnancy was successful with only 1 transfer.
IV. Notes
We are glad that the patient’s condition improved after treatment, and she successfully conceived and delivered. However, it is still necessary to remind the patient to pay attention to the hygiene of the pubic area in daily life, especially during menstruation. Wash the vulva and change the underwear every day to avoid infection in the pubic area. During the preparation period, avoid bad emotions, learn to relieve stress and release anxiety and tension.
V. Personal insight
Fluid in the fallopian tubes is one of the manifestations of tubal inflammation, which may lead to infertility and may even affect the success rate of IVF. The treatment varies according to the patient’s condition. In this case, the patient’s tubal effusion was serious and her ovarian function had declined, so she decided to use assisted reproductive technology combined with laparoscopic surgery to help her conceive, and eventually she was able to fulfill her dream of having a baby.