Letters to the Editors
org
Pregnancy outcomes of interventional ultrasound sclerotherapy
with 98% ethanol on women with hydrosalpinx
TO THE EDITORS: With great interest, we read the article of
Zhang et al.1 They describe a large cohort of patients treated
with sclerotherapy for hydrosalpinx prior to in vitro fertil-
ization (IVF). All patients tolerated the procedure well and no
complications occurred. The pregnancy rate after IVF in the
patients with sclerotherapy was higher compared with the
group of patients without sclerotherapy. Therefore, the
authors concluded that “ultrasound sclerotherapy could
improve pregnancy rate and might be served as an effective,
safe, and acceptable prophylactic intervention alternative to
salpingectomy for patients with hydrosalpinx.”1
The treatment for hydrosalpinx advised by the American
Society for Reproductive Medicine is salpingectomy or
proximal tubal occlusion.2 When investigating the efficacy of
a new therapy, a comparison should be made with the stan-
dard treatment option. Is it correct to state that sclerotherapy
could serve as an alternative to salpingectomy without the use
of patients who underwent salpingectomy for hydrosalpinx as
a control group? Moreover, is it ethical to perform a new
treatment without offering the investigated patients the
choice for the standard treatment?
Unbiased comparison of sclerotherapy with the standard
treatment can be investigated only in a randomized controlled
trail (RCT). In the current paper, the selection of the patient
population is not thoroughly described. Moreover, it is un-
known whether the patients, included in the study by Jiang
et al,3 were also used for analysis in the current paper. In
particular, the introduction of a new treatment should be
performed within a RCT.
So far, the literature on the negative effect of salpingectomy
on the ovarian function is controversial.4 Whereas the possible
complications of salpingectomy are widely discussed in the
current paper, the description of possible complications of
sclerotherapy for hydrosalpinx is sparse. It is reported that no
complications occurred and also the neonatal outcome was not
negatively affected. Unfortunately, the manner of detection of
the complications was not described. Thorough screening for
possible side effects of a new treatment is necessary to prevent
widespread use of an unsafe technique. The finding of multiple
adhesions at laparoscopy after sclerotherapy described by
Shokeir5 is shocking and warrants further investigation on the
safety of sclerotherapy.
Every new treatment option is potentially harmful.
Therefore, it is essential to investigate the possible negative
and positive effects a new treatment carefully. The only
accurate way in which this can be performed is an RCT
in which the new treatment is compared with the standard
treatment. We are looking forward to the first RCT on
ethanol sclerotherapy compared with salpingectomy or
proximal tubal occlusion for patients with hydrosalpinx
prior to IVF. - 10 mm  10 mm2 and segmental separated hydrosalpinx
118 American Journal of Obstetrics & Gynecology JANUARY 2015
ajog.
Jenneke C. Kasius, MD, PhD
Frank J. M. Broekmans, MD, PhD
Department of Reproductive Medicine and Gynaecology
University Medical Center Utrecht
3584 CX Utrecht, The Netherlands
j.c.kasius@umcutrecht.nl
The authors report no conflict of interest.
REFERENCES
1. Zhang WX, Jiang H, Wang XM, Wang L. Pregnancy and perinatal
outcomes of interventional ultrasound sclerotherapy with 98% ethanol on
women with hydrosalpinx before in vitro fertilization and embryo transfer.
Am J Obstet Gynecol 2014;210:250.e1-5.
2. American Society for Reproductive Medicine. Salpingectomy for
hydrosalpinx prior to in vitro fertilization. Fertil Steril 2008;90:S66-8.
3. Jiang H, Pei H, Zhang WX, Wang XM. A prospective clinical study of
interventional ultrasound sclerotherapy on women with hydrosalpinx
before in vitro fertilization and embryo transfer. Fertil Steril 2010;94:2854-6.
4. Almog B, Wagman I, Bibi G, et al. Effects of salpingectomy on ovarian
response in controlled ovarian stimulation for in vitro fertilization: a reap-
praisal. Fertil Steril 2011;95:2474-6.
5. Shokeir T. Letter to the Editor: Re: Comparison of IVF-ET outcomes in
patients with hydrosalpinx pretreated with either sclerotherapy or lapa-
roscopic salpingectomy. Clin Exp Reprod Med 2014;41:37-8.
ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog.
2014.09.018
REPLY
We appreciate Dr Kasius’ insightful comments regarding our
recently published clinical trial of interventional ultrasound
sclerotherapy with 98% ethanol on women with hydrosalpinx
before in vitro fertilization (IVF)eembryo transfer. We think
there may be some misunderstandings about the conclusion
in the article. Although we demonstrated that ultrasound
sclerotherapy before IVF was an effective, safe, and acceptable
prophylactic intervention method for patients with hydro-
salpinx, this does not mean that sclerotherapy should replace
the standard treatment advised by the American Society for
Reproductive Medicine.
We agree with Dr Kasius’s opinion on evaluating the efficacy
of a new therapy. Our unpublished retrospective data, consis-
tent with the results of Na et al,1 showed that interventional
ultrasound sclerotherapy with 98% ethanol on women with
hydrosalpinx yielded similar IVF outcomes to laparoscopic
salpingectomy and proximal tubal ligation. A randomized
controlled trial comparing sclerotherapy with the standard
treatment (salpingectomy) is in progress at our center for
further evaluating the efficacy and safety of sclerotherapy.
Of note, we have found that sclerotherapy was not a
good option for women with hydrosalpinx size less than