What is a hydrosalpinx? A plea for the use of a proper terminology in scientific discussion

I read with great interest the study of De Wit et al. (1998), where they could clearly demonstrate that hydrosalpinges exert a negative effect on implantation and pregnancy rates in patients undergoing in-vitro fertilization (IVF) and embryo transfer. However, the terminology they use is misleading and may be the cause of the conflicting results reported in the literature (Anderson et al., 1994; Strandell et al., 1994; Vandromme et al., 1995; Akman et al., 1996; Sharara et al., 1996; Ng and Po, 1997). Hydrosalpinx is a Greek word and means a Fallopian tube filled with water or fluid. Using ultrasound, hydrosalpinges are documented as cystic elongated masses in the adnexa, sometimes these cystic masses are tortured around the ovaries. As a tube filled with fluid should be recognized as a cystic mass, all hydrosalpinges should be visible by ultrasound. Distally occluded tubes which are not filled with fluid are, by definition, not hydrosalpinges. Why is this discrimination important? In the discussion of the negative effects of hydrosalpinges on pregnancy rates after IVF/embryo transfer treatment, the tubal fluid plays a crucial role. Due to a leakage of tubal fluid into the uterine cavity: (i) a direct toxic effect on the embryos transferred is postulated (Mukherjee et al., 1996); (ii) a negative effect of endometrial integrin expression has been found (Lessey et al., 1994; Meyer et al., 1997); (iii) a mechanical problem, i.e. disturbed contact between endometrial surface and embryo or even washing out the embryo through the cervical channel is discussed (Mansour et al., 1991; Bloechle et al., 1997). To resolve these problems, tubal surgery, reconstruction or removal, have been intensively debated (Anderson et al., 1996; Puttemans and Brosens, 1996). To obtain more information on patients with hydrosalpinges undergoing IVF/embryo transfer treatment, we need more and prospective data. We have to learn to discern those patients who may profit from surgery and those who will not but, first of all, we must use clear and proper terms, since distally occluded tubes and hydosalpinges are different entities, as De Wit et al. (1998) have clearly demonstrated by their study.