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Hydrosalpinx is one of the causes of repeated embryo implantation failures in assisted reproductive technology. It is generally considered that mechanical washout, reduced endometrial receptivity, and toxic effects of hydrosalpinx on the embryos are the major pathogenic mechanisms underlying the effect of hydrosalpinx upon pregnancy outcomes. In recent years, research progress has been achieved in the pathogenic mechanism of hydrosalpinx affecting pregnancy outcomes. For the selection of treatment strategies of hydrosalpinx, clinicians should choose individualized treatment according to the severity of hydrosalpinx of each patient. This article reviews the research progress on the impact of hydrosalpinx on pregnancy outcomes and the selection of treatment strategies, aiming to improve the pregnancy outcomes of patients with hydrosalpinx.

Objective: To identify the prevalence and risk factors for chronic endometritis (CE) with tubal factors and the correlation between chronic endometritis and tubal factors among infertile populations. Method: A total of 52 patients with chronic endometritis (CE group) who underwent laparoscopy and hysteroscopic surgery were recruited between July 2020 and December 2021. A total of 38 patients without chronic endometritis (non-CE group) were included as a control. Patients with endometriosis and intra-uterine abnormalities were excluded. Endometrial samples were collected during surgery for CD138 immunohistochemistry staining for the diagnosis of CE. Preoperative information (including age, reproductive health characteristics, previous medical and surgical history), intra-operative information (including the patency of the fallopian tube, the presence of hydrosalpinx, score and the grade of tubal lesion condition) and post-operative information (counts of CD138-positive HPF in the endometrial specimen) were collected. Result: A multivariate analysis revealed that tubal factors with unilateral or bilateral occlusion were significantly higher in the CE group (OR 3.066, 95% CI 1.020–9.213, p = 0.046). The bilateral occlusion of fallopian tubes (OR 8.785, 95% CI 1.408–54.818, p = 0.020) rather than unilateral occlusion (OR 2.860, 95% CI 0.893–9.162, p = 0.077) was significantly associated with chronic endometritis. The presence of a hydrosalpinx on one side (OR 7.842, 95% CI 1.279–48.086, p = 0.026) or both sides (OR 9.450, 95% CI 1.037–86.148, p = 0.046) was significantly associated with chronic endometritis. The comparison of CD138-positive HPF counts among the tubal occlusion patients without hydrosalpinx, patients with unilateral hydrosalpinx and patients with bilateral hydrosalpinx were as follows: 1 HPF (50.00% vs. 12.50% vs. 11.11%, p = 0.051), 2 HPF (38.89% vs. 25.00% vs. 22.22%, p = 0.615), ≥3 HPF (11.11% vs. 62.50% vs. 66.67%, p = 0.005). The stage of tubal condition was positively correlated with CD138-positive HPF counts in women with chronic endometritis (r = 0.460, p = 0.001). Conclusion: CE was closely related to the blockage of fallopian tubes and hydrosalpinx. The severity degree of the fallopian lesion condition was associated with inflammation of the endometrium. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health Sciences of Kocaeli University / Kocaeli Üniversitesi Sağlık Bilimleri Dergisi is the property of Institute of Health Sciences of Kocaeli University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Hydrosalpinx is considered one of the obstacles that could hinder the success of IVF techniques due to the toxic effect of the hydrosalpinx fluid pouring into the uterine cavity. Tubal disconnection by either hysteroscopic or laparoscopic approaches is considered the standard in the operative management of hydrosalpinx prior to IVF cycles. The aim of the current study was to compare the success rate of hysteroscopic tubal occlusion using electro-coagulation with laparoscopic tubal disconnection in cases of hydrosalpinx prior to in vitro fertilization (IVF). Methods: A total of 108 women with unilateral or bilateral hydrosalpinx, who were candidates for tubal occlusion before IVF, were equally randomized into two groups. Group A (n = 54) underwent hysteroscopic tubal occlusion using the roller-ball electro-coagulation of the interstitial part of the tube and the uterine cornual area, and group B (n = 54) underwent laparoscopic tubal disconnection using bipolar coagulation and a proximal tubal cut. Operative time, complications, postoperative pain measured by the visual analogue score (VAS score), and postoperative hospital stay were recorded for both groups. The success rate of tubal occlusion was assessed 1 month later using a post-menstrual hysterosalpingogram (HSG). Results: Laparoscopic tubal disconnection was more successful than the hysteroscopic approach regarding tubal occlusion rate (96.15% vs. 86.67% respectively, p = 0.044). The operative time and postoperative pain VAS scores in the hysteroscopy group (3.65 ± 1.03 min and 1.81 ± 1.35, respectively) were significantly lower than that in the laparoscopy group (17.48 ± 4.70 min and 4.06 ± 1.65, respectively) with p < 0.001. Conclusion: Although laparoscopic tubal disconnection is more successful, the hysteroscopic approach is an alternative which has its own limitations that can be assessed by hysterosalpingogram, especially when laparoscopy is contraindicated, technically difficult, or refused by the patient. Trial registration: It was first registered at ClinicalTrials.gov on 30/07/2019 with registration number . [ABSTRACT FROM AUTHOR]

Adnexal torsion is a significant cause of acute pelvic pain and a common gynaecological emergency. While ovarian cysts are well-recognized predisposing factors, hydrosalpinx is a less common precursor. This case report presents a unique instance of isolated fallopian tube torsion accompanied by hydrosalpinx. A 27-year-old primiparous woman at 37 weeks gestation presented with severe right lumbar pain. The patient's vital signs were stable, and abdominal and vaginal examinations were conducted. Imaging confirmed a progressing pregnancy and a 7.5 cm hemorrhagic cystic formation on the right side. Suspecting adnexal torsion, she underwent an urgent cesarean section and surgical exploration, which revealed a twisted distal right hydrosalpinx—the treatment involved detorsion, right salpingectomy, and ovarian suspension. Postoperative recovery was uneventful with histopathological confirmation of hydrosalpinx. Isolated fallopian tube torsion is rare, particularly during pregnancy. This condition's etiopathogenesis involves rotation of the tube around its ligamentous supports, possibly exacerbated by factors such as hydrosalpinx, pregnancy, and anatomical variances. Despite the availability of imaging techniques, diagnosis remains challenging, often confirmed only during surgical intervention. The literature highlights the importance of considering this diagnosis in pregnant women with acute pelvic pain and identifying characteristic ultrasound features. Isolated tubal torsion in pregnancy is an exceptional clinical challenge. Early and accurate diagnosis is critical to prevent irreversible damage to the fallopian tube and preserve fertility. This case underscores the need for awareness among clinicians and provides insights into the effective management of such cases. • The case report details a rare instance of isolated fallopian tube torsion with hydrosalpinx in a 27-year-old woman at 37 weeks of pregnancy, emphasizing the rarity and diagnostic challenges. • Highlighting the urgency and complexity of surgical management, the patient underwent a cesarean section followed by the successful detorsion and removal of the necrotic fallopian tube, leading to an uncomplicated postoperative recovery and preserving the patient's health. • Despite advancements in imaging technologies, the diagnosis of isolated tubal torsion remains predominantly intraoperative. This case illustrates the critical need for high clinical suspicion and timely intervention to prevent severe complications such as irreversible ischemia of the fallopian tube. [ABSTRACT FROM AUTHOR]

This article discusses the challenges of accurately diagnosing adnexal torsion (AT) through ultrasound (US) imaging. The study analyzed preoperative US images of 80 patients with AT and identified new US signs not previously described, including "figure-eight with a waist," "the mass with the tail," and "fimbriae resembling papillations." These signs were observed in 18 out of the 80 patients. The sensitivity of classical US signs in diagnosing AT was found to be 64.7%, with a specificity of 97.5%. The authors conclude that these new patterns can optimize the diagnosis of AT when combined with other symptoms. [Extracted from the article]

Background/Aim: Around 15-20 % of couples worldwide struggle with infertility, a difficult and aggravating gynaecological issue. Conception occurs in both partners, male and female, as they are both responsible for conception. This study aimed to evaluate the diagnostic accuracy of hysterosalpingography (HSG) in the detection of tubal infertility factors, by comparing the findings of HSG with the findings of laparoscopy (LPSC). Methods: A retrospective study from 1st January 2018, to 31st December 2019, is presented. Infertile patients who underwent LPSC, HSG and ultrasound to evaluate sterility during this timeframe were included in the research. Results: The study involved 63 infertile patients with a mean lifespan of 33.3 ± 4.7 years. The conclusions of LPSC and HSG, in general, were in good correlation and the percentage of agreement among the diagnostic procedures was 77.8 %. In the case of dichotomous categories, there is a good alignment between LPSC and HSG results with a percentage of 85.7 %. Hydrosalpinx: The findings of LPSC and HSG are quite similar. The percentage of agreement among the diagnostic techniques used was 79.2 %. Canal obturation: LPSC and HSG results are in good correlation with a percentage of 78.6 %. Terminal obturation: LPSC and HSG results are also in good agreement with the calculated percentage of 82.1 %. Conclusion: In determining tubal sterility factors, there is considerable consistency between LPSC and HSG results (c = 0.68; 95 % CI 0.54-0.83). There is a good correlation between LPSC and HSG findings of dichotomous categories (ch2 = 0.63; 95 % CI: 0.41-0.86). 86.2 % of subjects with peritubular appendages and 8.8 % of subjects without peritubular appendages had hydrosalpinx, which is a statistically significant difference (ch2 = 37.957; p < 0.001). Between LPSC and HSG data, there is a good agreement in the diagnosis of hydrosalpinx (c = 0.64; 95 % CI: 0.38-0.91).

Key content: Referral criteria to recurrent pregnancy loss (RPL) services vary, owing in part to a lack of consensus on the definition of RPL.Good quality evidence is limited, and controversies exist on recommendations for investigations and management of RPL.People with RPL will most likely achieve a live birth in their next pregnancy but should have an individualised approach that identifies and corrects any modifiable risk factors and offers appropriate psychological support. Learning objectives: To look at the variations in definition and aetiology of RPL and use current evidence available for recommendations towards investigations and management of RPL.To be familiar with evidence‐based guidelines published by the Royal College of Obstetricians and Gynaecologists, the American Society for Reproductive Medicine and the European Society of Human Reproduction, as well as recently published data, which will help to improve clinical outcome utilising the interventions with proven efficacy. Ethical issues: Differences in referral criteria and the controversies around RPL mean there can be considerable variation in how these patients are managed between services.The lack of good quality evidence can result in patients opting for management strategies with unproven efficacy. [ABSTRACT FROM AUTHOR]

Objective. To explore the risk factors affecting the recurrence of endometrial polyps (EPs) after hysteroscopic diagnosis and treatment of EPs following in vitro fertilization-embryo transfer (IVF-ET) failure by multivariate analysis. Methods. The clinical data of 369 patients with EPs hysteroscopically treated in our department due to IVF-ET failure from January 2017 to January 2020 were retrospectively analyzed, including the number and size of polyps, postoperative treatment, endometriosis (EM), hydrosalpinx (HSP), and polycystic ovarian syndrome (PCOS), and the effects of these factors on EP recurrence were observed. Results. Of the patients enrolled, 184 cases (49.9%) were treated by curettage, and 185 cases (50.1%) by electrotomy. A total of 72 cases (19.5%) of postoperative recurrence were determined, including 34 cases (9.2%) without postoperative medication, 31 cases (8.4%) with one month of postoperative Didroxyprogesterone (DG) administration, and 7 cases (1.9%) with three months of postoperative DG administration. Surgical methods, 3 months of postoperative medication, PCOS, and polyp number and size significantly influence the recurrence of EPs, which were all the influencing factors of polyp recurrence. After controlling for other factors, the risk of EP recurrence after electrotomy was found to be lower than that after curettage, with an odds ratio (OR) (95% confidence interval (CI)) of 0.354 (0.163–0.767); the risk of EP recurrence after 3 months of postoperative medication was lower than that without postoperative medication, with an OR (95% CI) of 0.024 (0.005–0.104); the risk of EP recurrence in patients with PCOS was higher than that without PCOS, and the OR (95% CI) was 2.505 (1.113–5.639); patients with multiple polyps (≥2) were at an increased risk of recurrence than those with a single polyp, with an OR (95% CI) of 66.552 (14.711–301.084); patients with polyp diameter ≥ 2 cm had a higher risk of recurrence than those with polyp diameter < 2 cm, and the OR (95% CI) was 1084.76 (148.743–7910.999). Conclusions. PCOS patients are at an elevated risk of EP recurrence than non-PCOS patients. In patients with multiple polyps, those with a diameter ≥ 2 cm have an increased risk of polyp recurrence compared with those with polyp diameter < 2 cm; electrotomy is associated with a lower recurrence risk of EPs than curettage. The risk of EP recurrence in patients treated with postoperative progesterone for 3 months is lower than that of patients without postoperative medication. [ABSTRACT FROM AUTHOR]

Introduction: This study was planned to investigate the effect of L/S salpingectomy to be performed before IVF/ICSI on clinical pregnancy, live birth, and abortion rates in infertile patients diagnosed with hydrosalpinx. Materials and Methods: Forty patients who were found to have hydrosalpinx in routine evaluations before ART were included in the study. The diagnosis of Hydrosalpinx (HX) was made by transvaginal ultrasonography or hysterosalpingography (HSG). Based on HSG or sonography, a unilateral or bilateral hydrosalpinx was noted as being present or absent. A hydrosalpinx was defined as an echo-free cyst-like fluid accumulation or irregular cystic lesion located outside the ovary and uterus. Salpingectomy was recommended because it may adversely affect ART results. The patients were divided into two groups according to their salpingectomy decisions. Group 1 (n=23) consisted of patients with uni or bilateral HX and accepted salpingectomy. Group 2 (n=17) consisted of patients who were found to have uni or bilateral HX but did not accept salpingectomy. Fifteen patients who did not have HX and were planned for IVF/ICSI due to unexplained infertility were accepted as the control group. The primary outcome measures of the study were detection of serum beta-hCG levels, clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate. Results: Positive beta-hCG was detected in 11 of 23 patients who underwent salpingectomy (47.8%), while hCG was positive in six of 17 patients who did not undergo salpingectomy (35.2%). In the salpingectomy group, clinical pregnancy was detected in 10 patients (43.4%), nine patients had a live birth (39.1%), and abortion was found in 1 patient (9.0%). In the group that did not undergo salpingectomy, clinical pregnancy was detected in 5 patients (29.4%), three patients gave live birth (17.6%), and abortion was found in 2 patients (33.3%). Positive beta-hCG (47.8% vs. 35.2%, p<0.01), CPR (43.4% vs. 29.4%, p<0.002), and LBR (39.1% vs. 17.6%, p<0.001) were found to be significantly higher in the salpingectomy group compared to the nonsalpingectomy group. Abortion rates were significantly higher in the group that did not undergo salpingectomy (33.3% vs. 9.0%, p<0.01). The hCG positivity, CPR, and LBR of the unexplained infertile patients were similar to the salpingectomy group. In this group, pregnancy test positivity was found in seven of 15 patients (46.6%), clinical pregnancy was found in 6 patients (40%), and five patients had a live birth (33.3%). Abortion was detected in one case in the control group (14.2%). Conclusion: Performing salpingectomy for HX improves clinical pregnancy and live birth rates and reduces miscarriage rates. [ABSTRACT FROM AUTHOR]

Hydrosalpinx is a chronic inflammatory condition with high recurrence rate, and it is reported among female population having fallopian tubal factor infertility. Previously, we have reported that interventional ultrasound sclerotherapy improves endometrial receptivity and pregnancy rate with negligible adverse effects in patients suffering from hydrosalpinx. During present investigation, we have used next generation sequencing (NGS) to characterize the isomiR profiles from the endometrium of patients suffering from hydrosalpinx before and after interventional ultrasound sclerotherapy. Our results indicated that miRNA arm shift and switch remained unaffected when compared in patients before and after interventional ultrasound sclerotherapy. We observed that isomiRs with trimming at 3' and isomiRs with canonical sequences were lower in post-treatment than in pre-treatment group. Gene ontology (GO) annotation and KEGG pathway analysis revealed that the expression of mature mir-30 was significantly lower in the pre-treatment as compared to post treatment group while the expression of mir-30 isomiR was 4.26-fold higher in pre-treatment when compared with the post-treatment group. These different expression patterns of mir-30 mature miRNA and mir-30 isomiRs in two groups are affecting the physiological function of the endometrium. Our results suggested that differential isomiR distribution in hydrosalpinx patients before and after treatment plays an important role in hydrosalpinx incidence and can help in designing novel strategy for the treatment of hydrosalpinx in female population. [ABSTRACT FROM AUTHOR]

Objective: This study aims to illustrate our laparoscopic salpingostomy approach for two types of hydrosalpinx, emphasizing various reproductive surgical techniques., Design: A step-by-step demonstration of the technique is provided alongside narrated video footage., Setting: University hospital., Patient(s): Infertile patients with hydrosalpinx seeking natural conception., Intervention(s): Laparoscopic salpingostomy for clubbed hydrosalpinx is demonstrated with video and includes the following steps: creating an opening into the tube at the terminal end for hydrosalpingeal fluid drainage; dissecting and removing peritubal and periovarian adhesions; excising redundant fimbrial tissues to restore fimbrial mobility; evert the mucosa using an intussusception method until endothelial folds are visible; confirming tubal patency with a dye test; heating the serosal surface of the tube to evert the edges; suturing the edges using 5-0 vicryl to the proximal serosa of the tube circumferentially with an inverting suture technique; thoroughly irrigating with Ringer's solution to remove blood clots and debris; and applying auto-crosslinked hyaluronan gel to the exposed raw surface. Salpingostomy for the cystic type differs, notably in carefully shaving the adhesive tubal end from the ovary until the tubo-ovarian ligament is completely exposed., Main Outcome Measure(s): The primary aim of salpingostomy is to reduce the likelihood of distal tube re-obstruction. If hydrosalpinx recurs after salpingostomy, there remains a possibility of requiring additional surgery, such as salpingectomy, before in vitro fertilization., Result(s): Extensive adhesions were meticulously dissected and removed from the peritoneal cavity. Fimbrial mobility was restored to establish a patent fallopian tube capable of ovum pickup. Electrocoagulation and suturing techniques were employed to evert the tube edges, effectively reducing the risk of re-obstruction. The utilization of an inverting suture technique aided in inwardly turning the cut edges, minimizing the risk of adhesion formation., Conclusion(s): Laparoscopic salpingostomy, when performed by surgeons proficient in reproductive surgical techniques, provides a significant option for patients with hydrosalpinx seeking natural conception. The decision to preform salpingostomy or salpingectomy is usually made intraoperatively on the basis of the severity of tubal disease. Clinical history is also an important factor in decision to perform salpingostomy., Competing Interests: Declaration of Interests J.L. has nothing to disclose. D.W. has nothing to disclose. C.Z. has nothing to disclose., (Copyright © 2024 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Aim: To determine the effect of salpingectomy on ovarian reserve. Methods: PubMed, EMBASE, Web of Science, Dynamed plus, and Cochrane Controlled Trials Register databases were searched from their inception to December 2020 to identify relevant studies, including cross‐sectional studies, retrospective studies, and randomized controlled trials. Studies that compared anti‐Müllerian hormone (AMH) levels and/or antral follicle count (AFC) between the control and salpingectomy groups or before and after surgery were included. Results: Twenty‐one articles were included in the systematic review. Meta‐analyses were performed on 16 studies in which data were presented as mean ± SD values. A meta‐analysis comparing AMH levels before and after surgery in the same patients showed no significant decrease in all cases, irrespective of whether it was unilateral or bilateral salpingectomy. There was no significant decrease in the AFC in the meta‐analysis comparing levels before and after bilateral salpingectomy, either. In contrast, in the case–controlled study the salpingectomy group had significantly lower levels of AMH in all meta‐analyses of unilateral and bilateral surgery (mean difference: −0.31, 95% confidence interval [CI]: −0.55, −0.07), only unilateral cases (mean difference: −0.28, 95% CI: −0.50, −0.06), and only bilateral cases (mean difference: −0.71, 95% CI: −1.19, −0.23). The salpingectomy group that included unilateral and bilateral cases had significantly lower AFC compared with no‐surgery controls (mean difference: −1.31, 95% CI: −2.13, −0.48). Conclusion: Although not conclusive, it does appear that patients who underwent salpingectomy (either unilateral or bilateral) have a decreased ovarian reserve. [ABSTRACT FROM AUTHOR]

The high efficacy of modern assisted reproductive technology (ART) and increase in the number of noninfertile patients who are using ART for family building in the United States call into question the relevance of the standard, one-size-fits-all infertility evaluation. Here, we explore whether all patients presenting for ART need uterine cavity and tubal assessment and what tests are most appropriate, efficient, and cost-effective in current times. [ABSTRACT FROM AUTHOR]

Tubal diseases account for 25–40% of female factor infertility. Mainly, they involve the distal part of the fallopian tube, and hydrosalpinx is the most severe manifestation. Usually, the management decision is made between reconstructive surgery and ART, depending on the severity of the tubal damage, patient age, ovarian reserve, and seminogram, as well as financial, religious, ethical, and psychological factors. Estimated live-birth rates after corrective surgery range from 9% to 69%. The success rate of IVF is about 30% live-birth rate per cycle initiated in women across all ages with tubal factor infertility. Surgery offers a long-term cure and patients may attempt conception many times but are burdened with perioperative adverse events. IVF bypasses potential complications of operative treatment; however, this has its own unique risks. The effectiveness of reconstructive surgery versus ART has not been adequately evaluated. The success of fertility management depends on a thorough interpretation of existing data and careful patient selection. The presented review provides updates on the most recent progress in this area. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of hydrosalpinx in susceptibility to chronic endometritis (CE). Methods: This is a retrospective cohort study, which includes 624 patients with hydrosalpinx (group A) and 789 patients without hydrosalpinx (group B) undergoing laparoscopy and hysteroscopy simultaneously. Endometrial morphology was recorded under hysteroscopy. Endometrial biopsy was obtained after hysteroscopy, and immunohistochemical staining for syndecan-1 (CD138) was carried out. Results: No significantly statistical differences were found between the two groups when comparing the incidence of endometrial hyperemia or endometrial micro-polyps under hysteroscopy (P > 0.05). Hydrosalpinx had a significant impact on the incidence of CE (P < 0.05) (plasma cell count: no plasma cells: odds ratio [OR] 0.71, 95% confidence interval [CI] 0.58-0.88, P = 0.002; =1/high-power field [HPF]: OR 1.40, 95% CI 1.14-1.74, P = 0.002; =3/HPF: OR 1.50, 95% CI 1.18-1.91, P = 0.001; =5/HPF: OR 1.62, 95% CI 1.27-2.21, P < 0.001). There were no significant differences in the comparison of plasma cell count between the unilateral hydrosalpinx group (274 patients) and the bilateral hydrosalpinx group (350 patients) (P > 0.05). Conclusion: The presence of hydrosalpinx increased the incidence of CE. Bilateral hydrosalpinx did not significantly increase the incidence of CE compared with unilateral hydrosalpinx. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Sactosalpinx means a collection of fluid (serum, blood or pus) in the fallopian tube. CAH (Congenital Adrenal Hyperplasia) is a typical 46XX DSD (Disorder of Sex Development) due to a steroidogenic enzymatic defect. Both conditions are rare and can lead to reduced fertility rate. Case presentation We describe two post-menarche virgin girls with CAH who were hospitalized for acute abdomen due to laparoscopically confirmed sactosalpinx. Case 1 recovered after conservative management, case 2 after a second-look and bilateral salpingectomy. The first case consisted of right sactosalpinx and previous peritonitis reported; the second one of bilateral symptomatic pyosalpinx and previous vaginal stenosis. Recurrent abdominal pain persisted at follow-up in Case 1: post-operative MRI (Magnetic Resonance Imaging) showed bilateral hydrosapinx that disappeared at a following ultrasound scan control. Follow-up was uneventful 36 months after surgery in Case 2, except for the surgical revision of the vaginal introitus. Conclusions CAH-sactosalpinx association is a very rare but not negligible event. We suggest a conservative approach for sactosalpinx if tubal and/or ovary torsion can be excluded. Pyosalpinx is more challenging to treat, but during pediatric age we suggest starting with a conservative approach, especially in patients with CAH who have a potential low fertility rate. Careful gynecological follow-up after menarche is recommended to rule out any further causes of infertility.

Abstract Hydrosalpinx is a disease characterized by the obstruction of the salpinx, with progressive accumulation in the shape of a fluid-filled sac at the distal part of the tuba uterina, and closed to the ovary. Women with hydrosalpinges have lower implantation and pregnancy rates due to a combination of mechanical and chemical factors thought to disrupt the endometrial environment. Evidence suggests that the presence of hydrosalpinx reduces the rate of pregnancy with assisted reproductive technology. The main aim of the present is review to make an overview of the possible effects of hydrosalpinx on in vitro fertilization (IVF).We conducted a literature search on the PubMed, Ovid MEDLINE, and Google Scholar data bases regarding hydrosalpinx and IVF outcomes. Hydrosalpinx probably has a direct toxic effect on sperm motility and on the embryos. In addition, the increasing liquid inside the salpinges could alter the mechanisms of endometrial receptivity. The window of endometrial receptivity is essential in the implantation of blastocysts, and it triggers multiple reactions arising from the endometrium as well as the blastocysts. Hydrosalpinx could influence the expression of homeobox A10 (HOXA10) gene, which plays an essential role in directing embryonic development and implantation. Salpingectomy restores the endometrial expression of HOXA10; therefore, it may be one mechanism by which tubal

Background: Hydrosalpinx is the most common lesion of the distal part of the tube. Hydrosalpinx is well known to have deleterious effect on fertility. Methods: Two options are doable in case of hydrosalpinx: radical treatment(salpingectomy) or conservative treatment (salpingoneostomy). Results: This work demonstrates that in experienced hands and with an acute selection, salpingoneostomy gives results comparable to those obtained after IVF.The cuff salpingoneostomy technique is much better than racket form salpingoneostomy and should be preferred whenever it is possible. Conclusions: Conservative treatment should be discussed in infertile patients having hydrosalpinx after a careful selection.

Hydrosalpinx is a condition with a crucial prognostic role in reproduction, and its diagnosis by a non-invasive technique such as ultrasound is key in achieving an adequate reproductive assessment while avoiding unnecessary laparoscopies. The aim of the present systematic review and meta-analysis is to synthetize and report the current evidence on transvaginal sonography (TVS) accuracy to diagnose hydrosalpinx. Articles on the topic published between January 1990 and December 2022 were searched in five electronic databases. Data from the six selected studies, comprising 4144 adnexal masses in 3974 women, 118 of which were hydrosalpinxes, were analyzed as follows: overall, TVS had a pooled estimated sensitivity for hydrosalpinx of 84% (95% confidence interval (CI) = 76–89%), specificity of 99% (95% CI = 98–100%), positive likelihood ratio of 80.7 (95% CI = 33.7–193.0), and negative likelihood ratio of 0.16 (95% CI = 0.11–0.25) and DOR of 496 (95% CI = 178–1381). The mean prevalence of hydrosalpinx was 4%. The quality of the studies and their risk of bias were assessed using QUADAS-2, evidencing an overall acceptable quality of the selected articles. We concluded that TVS has a good specificity and sensitivity for diagnosing hydrosalpinx.

To compare the pregnancy outcomes of in vitro fertilisation (IVF) following tubal occlusion by microcoil placement versus laparoscopic tubal ligation for hydrosalpinges. This was a single centre retrospective study of 127 infertile women aged <43 years with unilateral or bilateral hydrosalpinges on transvaginal ultrasound who underwent either tubal occlusion by the microcoil placement under X-ray control (the microcoil group (n = 60)) or laparoscopic tubal ligation (the ligation group (n = 67)) prior to IVF at the discretion of the attending physicians. In all women, laparoscopy was not considered to be contraindicated due to extensive pelvic adhesions. The pregnancy outcomes of the IVF cycle following the treatment for hydrosalpinges were compared. Both groups had comparable demographic and cycle stimulation characteristics. The positive pregnancy test (43.3% (26/60) vs 64.2% (43/67), p = 0.02, RR = 0.68 (0.48–0.95)), ongoing pregnancy (35.0% (21/60) vs 58.2% (39/67), p = 0.009, RR = 0.60 (0.40–0.89)) and implantation rates (33.3% (34/102) vs 49.5% (56/113), p = 0.016, RR 0.67 (0.48–0.94)) were significantly lower in the microcoil group than those in the ligation group. Both groups had similar miscarriage, multiple pregnancy and ectopic pregnancy rates. A multivariate logistic regression revealed that only the women's age and the treatment method of hydrosalpinx were significant factors in predicting the ongoing pregnancy. A lower ongoing pregnancy rate of IVF was found in women with hydrosalpinges following tubal occlusion by microcoil placement under X-ray when compared with laparoscopic tubal ligation. [ABSTRACT FROM AUTHOR]

The objective of this paper is to compare assisted reproductive technology (ART) cumulative live birth rates after hysteroscopic proximal tubal occlusion and laparoscopic salpingectomy in endometriosis patients, for management of hydrosalpinx. This is an observational cohort study at a university hospital, including all endometriosis patients with hydrosalpinges undergoing ART, between January 2013 and December 2018. The patients underwent either laparoscopic salpingectomy or hysteroscopic proximal tubal occlusion with Essure® when laparoscopy was not an option (extensive pelvic adhesions at exploratory laparoscopy or a history of multiple abdominal surgeries with frozen pelvis). The diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography (TVUS) and magnetic resonance imaging (MRI). Endometriosis patients with hydrosalpinges diagnosed by hysterosalpingography and/or TVUS and/or MRI were included. The primary outcome was the cumulative live birth rate. A total of 104 patients were included in the study; 74 underwent laparoscopic salpingectomy and 30 underwent proximal tubal occlusion with Essure®. The Essure® group had longer infertility durations (58.9 ± 30.0 months vs. 39.5 ± 19.1 months, p = 0.002) and a higher incidence of associated adenomyosis (76.7% vs. 39.1%, p < 0.001) than the salpingectomy group. The cumulative live birth rate was 56.6% after 44 ART cycles in the Essure® group and 40.5% after 99 ART cycles in the salpingectomy group (p = 0.13). In a population of endometriosis patients undergoing ART, women treated by Essure® for management of hydrosalpinx have similar cumulative live birth rates as women treated by laparoscopic salpingectomy. [ABSTRACT FROM AUTHOR]

Reproductive surgery remains an important treatment option for some women with subfertility secondary to tubal disease. This review offers a comprehensive update on current evidence and guidance. Accurate investigation of the cause, site, extent is first paramount, with fertility-preserving surgical procedures reserved for women with mild tubal disease and no confounding subfertility factors. For severe tubal disease, including hydrosalpinx, a shift towards assisted reproductive technology (ART) is more often recommended, with tubal surgery instead offering a valuable adjunct to enhance reproductive success. Decisions regarding management of tubal disease are complex and require a patient-specific approach. Only surgeons with appropriate laparoscopic surgical expertize should perform tubal surgery; training the next generation of reproductive surgeons remains imperative. [ABSTRACT FROM AUTHOR]

Primary retroperitoneal cysts (RPCs) are a rare surgical entity and are mostly detected incidentally. Usually, they are asymptomatic. At times, they may attain a huge size and may present with a large abdominal lump. Often, they pose a dilemma at diagnosis and for management. Though the laparoscopic approach has been described for their surgical excision, open surgery is still the preferred approach. We herein present a case of a voluminous retroperitoneal pelvic cystic mass in a 40-year-old female, which was diagnosed as hydrosalpinx on a magnetic resonance imaging scan. The patient was referred to us by the specialist in gynecologic laparoscopy after the incidental discovery of the RPC during his surgical intervention, purportedly for large hydrosalpinx. At our hospital, 4 days after the above intervention, she underwent laparoscopic complete excision of the cyst. Her postoperative recovery was uneventful and she was discharged on postoperative day 3 without any complications. Histopathology was suggestive of Mullerian inclusion cyst. This case report aims to share a rare case of a large primary retroperitoneal pelvic cystic lesion, which caused a diagnostic challenge preoperatively but was eventually managed successfully, laparoscopically.

Background: Women with abnormal hysterosalpingography (HSG) are anxious regarding the presence of tubal pathology. It is important to know the predictive value of HSG and the need for subsequent laparoscopy following an abnormal report. In the era of assisted reproductive technology, the role of invasive testing such as diagnostic laparoscopy is being increasingly questioned due to its invasiveness and associated risks. There is a need to explore the positive predictive value (PPV) of HSG in detecting bilateral tubal block in our population as PPV changes with the prevalence of disease. Aim: The aim of this study was to evaluate the diagnostic accuracy of HSG in identifying tubal blockage in subfertile women. Setting and Design: This was a prospective diagnostic study conducted in the department of reproductive medicine and surgery in a university-level hospital. Materials and Methods: The study included 199 subfertile women who had undergone HSG earlier and were planned for laparoscopy from April 2017 to January 2021. Findings of HSG and laparoscopy were compared with HSG as index test and laparoscopy as reference test, and the outcomes analysed were PPV of HSG for a bilateral tubal block, bilateral hydrosalpinx, abnormal HSG (unilateral or bilateral tubal block) and agreement between HSG and diagnostic laparoscopy in detecting normal and abnormal findings. Statistical Analysis: Kappa statistics, Stuart–Maxwell tests of marginal homogeneity and prevalence-adjusted bias-adjusted kappa (PABAK) statistics were used. Results: The PPV for a bilateral block with HSG was 20.9% (95% CI: 13.7–29.7). The PPV of HSG for bilateral hydrosalpinx was 50.0% (95% CI: 6.8–93.2). PABAK was estimated to be 0.42 (95% CI: 0.30–0.55), suggestive of moderate agreement between the tests. Findings of laparoscopy in women with at least one patent tube in HSG showed that in 12.3% of cases, the management was likely to change due to the operative findings. Conclusion: The current study showed low PPV for bilateral tubal block diagnosed with HSG which translates into a need for further confirmation by laparoscopy. In one out of every eight women with at least one patent tube on HSG, performing laparoscopy changed the management.

The article focuses on a 12-year-old female with bilateral hydrosalpinx and repeated acute abdomen, despite being negative for sexually transmitted diseases. Topics discussed include the patient's clinical presentation, diagnostic findings, surgical intervention, recurrence, and the potential involvement of Escherichia coli in hydrosalpinx development in non-sexually active individuals.

Hydrosalpinx induced torsion of the adnexa in a premenarchal child without sexual experience is a rare situation and immediate intervention is necessary. This report describes a 10-year old premenarchal female without a history of sexual intercourse who presented with left lower abdominal pain. Ultrasound imaging revealed a left adnexa with thick-walled cystic lesion measuring 5.1 × 3.7 × 2.7 cm suggestive of hydrosalpinx or para ovarian cyst. Diagnostic laparoscopic surgery showed ischaemic tubular shaped cystic left hydrosalpinx that was twisted along its own axis at the level of isthmus. Laparoscopic left salpingectomy was performed within 24 h of presentation leaving behind a healthy left ovary. Early diagnosis is important in preventing further complications including severe infection and peritonitis and to prevent complications that might affect fertility. [ABSTRACT FROM AUTHOR]

Objectives: Currently available hysteroscopic tubal patency testing relies only on anatomical passage of air bubbles or flow of irrigating fluid and debris via tubal ostia. The aim of this study was to assess the reliability of a hysteroscopic proximal tubal bubble flow test and a peristalsis test separately or in combination (Darwishscope test) for detection of tubal patency in apparently normal fallopian tubes and hydrosalpinges as confirmed by laparoscopy. Materials and Methods: A prospective comparative cohort study was conducted at an endoscopy unit of a tertiary university hospital. The subjects were infertile women undergoing concurrent laparoscopy and hysteroscopy for infertility management. The patients were classified into group A (women with normal-caliber and patent fallopian tubes seen on laparoscopy) or group B (women with unilateral or bilateral distended and blocked distal ends of their fallopian tubes [hydrosalpinx] seen on laparoscopy). A combined hysteroscopic bubble flow test and proximal tubal peristalsis (Darwishscope test) were performed. The primary outcome was how many patients had positive combined bubble flow and proximal tubal peristalsis tests separately or in combination (Darwishscope test) in both apparently normal and hydrosalpingeal tubes. Feasibility of the procedure, access and any proximal tubal abnormalities were secondary outcome measures. Results: Among 115 infertile women, there was an insignificant difference between both groups regarding basic data except a significant increased history of pelvic inflammatory disease in group B. Endometriosis was reported in 20 (33.9%) and 24 (42.7%) cases in both groups, respectively. On hysteroscopy, the bubble flow test was positive in 106 tubes (89.8%) in group A and 56 (50%) tubes in group B after exclusion of unilateral patent tubes with a sensitivity of 84.8% (95% confidence interval [CI]: 73.0–92.8) and 88.1% (95% CI: 77.1–95.1) on the right and left sides, respectively. Tubal peristalsis was positive in 80 tubes (67.8%) in group A and in 13 tubes (14%) in group B after exclusion of unilateral patent tubes with higher specificity than the bubble flow test (57.1% [95% CI: 43.2–70.3] and 67.9% [95% CI: 54.0–79.7] versus 47.6% [95% CI: 32.0–63.6] and 29.8% [95% CI: 17.3–44.9] on the right and left sides, respectively). Use of the Darwishscope test resulted in a rise of specificity, a positive predictive value, a negative predictive value, and diagnostic accuracy on both sides, compared to either test alone in both normal and pathologic tubes. Conclusions: The bubble flow test is the most-sensitive test of patency of the proximal part of the fallopian tubes. A fallopian tube peristalsis physiologic patency test is more-specific than a bubble flow test. The Darwishscope test is superior to either test alone for assessing proximal tubal function, as it this is test the most-specific test of both anatomical and physiologic patency in normal and pathologic tubes with high diagnostic accuracy. (J GYNECOL SURG 38:49) [ABSTRACT FROM AUTHOR]

Context: Hysterosalpingography (HSG), is the radiographic evaluation of the uterine cavity and fallopian tubes after the administration of a contrast medium through the cervical canal. Aims: To determine the pattern of infertility, the risk factors for infertility in women presenting for HSG, and the findings among women with infertility at Federal Medical Centre Katsina. Study Design: Cross-sectional, descriptive study design. Materials and Methods: This was a retrospective study of HSG findings done at the federal medical center Katsina over a 12-month period. Information on the patients was obtained from the Picture Archiving Communication System (PACS) system which includes the presenting clinical history, the age, and the outcome of HSG. Statistical Analysis: Data analysis was performed using SPSS version 23.0. Results: A total of one hundred and forty-four (144) women were examined. Their age ranged from 17 48 years with a mean of 31.2 ± 6.3 years. The most common indication for the procedure was infertility, accounting for 89.6% of all cases. The most common Radiological finding was tubal occlusion (factor), which was seen in 40 patients constituting 28% of the radiological findings. The right tubal occlusion was seen at 11.8% while the left tubal occlusion was seen at 6.9%. Bilateral tubal occlusion was seen in 9.0%. Conclusions: The frequent indication for HSG is infertility and the common finding on HSG was a tubal factor with hydrosalpinx being the frequent cause of infertility in our environment. The right tubal occlusion constitutes a higher percentage than the left. Secondary infertility was more common than primary infertility [ABSTRACT FROM AUTHOR]

Background: Tubal factor of infertility resulting from various forms of tub peritoneal damage remains an extremely common cause of female infertility. Probably the most severe form of tubal pathology is hydrosalpinx. Objectives: To compare the efficacy of hysteroscopic tubal electrocoagulation versus laparoscopic salpingectomy for management of hydrosalpinx related infertility among patients undergoing intracytoplasmic sperm injection (ICSI). Patients and methods: This retrospective study was conducted at outpatient clinic in Private Infertility Unit, Menoufia, Egypt, from November 2018 to August 2019. This study included 120 infertile patients who were candidate for ICSI and fulfilled inclusion and exclusion criteria, half of the patients underwent hysteroscopic tubal electrocoagulation who have laparoscopic contraindications, while the other half underwent laparoscopic salpingectomy. After tubal occlusion was done, an ICSI cycle was started with assessment of chemical pregnancy rate. Results: The rate of positive chemical pregnancy was 56.16% in hysteroscopic group and 43.84% in laparoscopic group. Conclusion: Hysteroscopic tubal electrocoagulation was found to be a successful treatment for hydrosalpinges before ICSI when laparoscopy is contraindicated with chemical pregnancy rate comparable to laparoscopic tubal disconnection. [ABSTRACT FROM AUTHOR]

Study Objective: To study features of isolated fallopian tube torsion (IFTT) to promote early diagnosis of this entity and describe options for management.Design: Retrospective cohort study from October 2017 through October 2020.Setting: Tertiary care hospital.Patients: All patients with surgically confirmed adnexal torsion or IFTT during the study period.Interventions: All of the patients underwent gynecological examination, imaging, and laparoscopy.Measurements and Main Results: During this 3-year period, 64 patients underwent laparoscopy owing to confirmed torsion, of which 55 had adnexal torsion, and 9 had IFTT. Patients with IFTT tended to be younger (21.2 years ± 8.2 vs 29.1 years ± 11.9, p = .06) and had more fever on admission (p = .007). On ultrasound examination, isolated hydrosalpinx was demonstrated only in patients with IFTT (p <.001). During surgery, more para-ovarian cysts were observed in patients with IFTT (44.4% vs 10.9%, p = .01), whereas patients with adnexal torsion had more ovarian cysts (52.7% vs 0%, p = .003). The most common procedure was detorsion in both groups. Most patients that underwent detorsion of the tube had a normal ultrasound scan on follow-up examination.Conclusion: IFTT is probably underdiagnosed. Its clinical presentation is more equivocal than adnexal torsion, and ovaries are usually of normal size on ultrasonography. Hydrosalpinx or para-ovarian cysts should raise suspicion toward IFTT. Detorsion of the tube is probably a valid management option, although further research with long-term follow-up analyzing tubal patency is necessary to define the optimal management for this condition. [ABSTRACT FROM AUTHOR]

Primary retroperitoneal cysts (RPCs) are a rare surgical entity and are mostly detected incidentally. Usually, they are asymptomatic. At times, they may attain a huge size and may present with a large abdominal lump. Often, they pose a dilemma at diagnosis and for management. Though the laparoscopic approach has been described for their surgical excision, open surgery is still the preferred approach. We herein present a case of a voluminous retroperitoneal pelvic cystic mass in a 40-year-old female, which was diagnosed as hydrosalpinx on a magnetic resonance imaging scan. The patient was referred to us by the specialist in gynecologic laparoscopy after the incidental discovery of the RPC during his surgical intervention, purportedly for large hydrosalpinx. At our hospital, 4 days after the above intervention, she underwent laparoscopic complete excision of the cyst. Her postoperative recovery was uneventful and she was discharged on postoperative day 3 without any complications. Histopathology was suggestive of Mullerian inclusion cyst. This case report aims to share a rare case of a large primary retroperitoneal pelvic cystic lesion, which caused a diagnostic challenge preoperatively but was eventually managed successfully, laparoscopically. [ABSTRACT FROM AUTHOR]

Purpose of the study: to improve the scheme of conservative treatment of chronic salpingo-oophoritis complicated by hydrosalpinx in young women. Materials and methods. The study included 65 patients with chronic salpingo-oophoritis complicated by hydrosalpinx. The mean age of patients was 28 ± 5.9 years. Women were randomized into 2 groups depending on the therapy scheme. Group I (33 women) in addition to the standard complex were prescribed Distreptaza® suppositories rectally for a period of 15 days. Group II (32 women) received a standard complex, which included an antibacterial drug and a symbiotic. The diagnostic complex carried out in the treatment dynamics included a general clinical, gynecological examination, microbiological studies. Ultrasound and determination of luteinizing hormone, follicle-stimulating hormone, prolactin, estradiol and progesterone in plasma were performed before therapy and 1 month after. Results. Faster regression of pain in patients receiving treatment with Distreptaza® was accompanied by no sonographic signs of distal occlusion in fallopian tube in 48.48% patients; standard therapy was effective in 21.87% women. Microbiocenosis of the genital tract was restored in most patients of the examined groups after a month of treatment. There was a significant (p

Abstract Background Isolated fallopian tube torsion associated with hydrosalpinx is a rare condition in the pediatric population. We present this unusual clinical case study in a sexually inactive girl. Case presentation a12-year-old Caucasian girl presented symptoms of acute abdominal pain. Pelvic ultrasound revealed a normal looking uterus and ovaries and next to left ovary a imaging compatible with hydrosalpinx. She was discharged 48 hours later after clinical monitoring with oral analgesia and normal blood workup. At 3 weeks, she was readmitted for acute abdominal pain. Leukocytosis with left shift and raised C-reactive protein were observed. Her clinical condition worsened, and complication of the preexisting hydrosalpinx was suspected. Exploratory laparoscopy confirmed torsion of the fallopian tube. Left salpingectomy was performed. Histopathologic study confirmed a fallopian tube with hemorrhagic infarct. Conclusion Torsion of the fallopian tube must be considered in the event of acute abdominal pain. Early diagnosis and trying conservative management with a view to preserving fertility in this group of patients are essential.

Abstract Background The aim of this study was to determine whether the treatment with doxycycline before and after oocyte retrieval is as effective as salpingectomy in minimizing the detrimental effect of hydrosalpinx on the outcomes of IVF-ET. Methods A retrospective analysis was done for the outcomes of the IVF-ET cycles of patients with hydrosalpinx who underwent laparoscopic salpingectomy prior to IVF cycle (n = 260) or were treated with extended doxycycline treatment during the IVF cycle (n = 45). In doxycycline group, doxycycline (100 mg twice daily) was started 1 week before anticipated oocyte retrieval and was continued for 1 week after oocyte retrieval. In salpingectomy group, the mesosalpinx was coagulated as close as possible to the fallopian tube. Results The implantation, clinical pregnancy, ongoing pregnancy and live birth rates were significantly higher in the salpingectomy group (20.87% Vs. 9.91%, P value =0.007, 44.62% Vs. 20%, P value = 0.002, 39.62% Vs. 17.78%, P value = 0.005 and 37.31% Vs. 15.56%, P value = 0.005 respectively). Conclusion Salpingectomy is more effective than extended doxycycline treatment in improving the outcomes of IVF-ET in patients with hydrosalpinx undergoing IVF-ET. Further, larger well designed randomized controlled trials should be conducted to confirm the findings of this study.

Objective: The objective of the study was to evaluate the effects of recurrent hydrosalpinx after proximal tubal ligation and distal salpingostomy on the outcomes of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment. Materials and Methods: Seven hundred and twenty-six patients with hydrosalpinx undergoing laparoscopic surgery before IVF were enrolled in the study. Five hundred and sixty-two patients treated with proximal tubal ligation and distal salpingostomy were included in Group A. One hundred and sixty-four cases managed with salpingectomy were grouped into Group B. Group A were further divided into two subgroups. One hundred and forty-six patients in Group A1 had a recurrence of hydrosalpinx. Four hundred and sixteen patients in Group A2 had no repetition of hydrosalpinx. We compared the pregnancy outcomes of their subsequent fresh embryo transfer cycles among the three groups. Results: There were no significant differences among the three groups in terms of age, body mass index (23.56 ± 3.27 vs. 23.13 ± 3.42 vs. 23.63 ± 3.73, P = 0.195), basal hormone level (7.03 ± 1.75 vs. 7.08 ± 2.26 vs. 7.44 ± 2.93, P = 0.195), antral follicle count (12.25 ± 5.92 vs. 12.63 ± 5.71 vs. 11.70 ± 4.98, P = 0.188), duration of gonadotropin (Gn) (11.19 ± 2.1 vs. 10.93 ± 1.84 vs. 10.79 ± 2.03, P = 0.182), consumption of Gn (2136.73 ± 855.65 vs. 1997.15 ± 724.72 vs. 2069.05±765.12 , P = 0.14), endometrial thickness (1.1 ± 0.27 vs. 1.1 ± 0.24 vs. 1.1 ± 0.17, P = 0.352), base follicle-stimulating hormone (6.21 ± 3.43 vs. 6.52 ± 3.20 vs. 5.89 ± 3.10, P = 0.1), number of embryos transferred (1.87 ± 0.36 vs. 1.83 ± 0.42 vs. 1.88 ± 0.37, P = 0.224), and number of high-grade embryos (3.77 ± 2.42 vs. 4.01 ± 2.72 vs. 4.17 ± 2.74, P = 0.41). No differences were detected in clinical pregnancy rate (50% vs. 54.8% vs. 50%, P = 0.439), the live birth rate (86.3% vs. 82.0% vs. 87.8%, P = 0.398), fertilization rate (64.1% vs. 64.4% vs. 64.7%, P = 0.928), and biochemical pregnancy rate (4% vs. 4.5% vs. 7%, P = 0.332) among the three groups. Conclusion: The recurrence of hydrosalpinx after tubal ligation does not affect the outcomes of IVF/ICSI. It is not necessary to worry about the effect of recurrent hydrosalpinx on pregnancy outcomes of IVF/ICSI that may due to the spread of inflammation through lymphatic circulation or blood circulation.

We report four cases of isolated fallopian tube torsion (IFTT) successfully treated with laparoscopic surgery over the past 10 years. Two young women (each 19 years old) were IFTT with paraovarian cyst (POC) and tubal preservation was possible with detorsion and cystectomy. The other two patients (a 41-year-old woman with hydrosalpinx and a 50-year-old woman with hematosalpinx) underwent salpingectomy and adnexectomy, respectively, because there was no desire for tubal preservation. One patient had emergency surgery due to severe abdominal pain, one had semi-emergency surgery due to mild abdominal pain, and the other two were diagnosed during scheduled surgery without symptoms.Although IFTT was considered a very rare disease, our case series and recent reports suggest that it may have been underestimated, as it accounts for approximately 10% of adnexal torsion cases. Preoperative diagnosis of IFTT may be more difficult than for adnexal torsion because of its infrequency and nonspecific, vague clinical symptoms.　Since the prevalent age for this disease is young, as in our first 2 patients, early surgical intervention to preserve the fallopian tubes should be chosen when necessary, and it seems to be important for gynecologists to be aware of this disease for earlier diagnosis and appropriate surgical intervention.

Objectives: To compare different methods to treat hydrosalpinx, based on both ablative and non-ablative approaches, in infertile patients before undergoing IVF-ET., Methods: Systematic review and network meta-analysis (NMA) of comparisons between different treatments of hydrosalpinx in infertile patients undergoing IVF., Data Sources: structured searches in common citation databases. Study inclusion criteria: peer-reviewed randomized trials (RCT) or cohort studies comparing effects of salpingectomy, laparoscopic proximal tubal occlusion (LTO), insertion of intratubal device (ITD), sclerotherapy, ultrasound-guided aspiration and no treatment, on live birth, ongoing pregnancy, clinical pregnancy as main outcomes, considering also miscarriage, ectopic pregnancy and complications as secondary outcomes. Principal NMA included RCT, and aggregated NMA of RCT and observational studies was carried out. Pooled effects have been estimated by Odds Ratio (OR) and its 95% confidence interval (CI) for direct and indirect-mixed comparisons, derived from random-effects models. Imprecision and heterogeneity of NMA estimations was assessed by comparison of its 95% CI with predefined intervals for clinically relevant size of effect (OR <0.9 or >1.1). Surface under the cumulative ranking curve (SUCRA) were used to predict treatment rankings for each outcome., Results: Nine RCT were included in main analysis, plus 17 additional observational studies in additional analysis. NMA of RCT did not identify significant differences in the effect of compared treatments on live birth rate, and LTO was the option with the highest value of SUCRA (0.92, mean rank: 1.2). Salpingectomy and US-aspiration associated to a significant increase of ongoing pregnancy rate compared to no treatment, according to NMA results (NMA OR: 4.35; 95% CI: 1.7, 11.14 and 2.8; 95% CI: 1.03, 7.58 respectively). Salpingectomy had the highest SUCRA value (0.88, mean rank: 1.4). NMA estimated significant increase of clinical pregnancy rate for salpingectomy compared with no treatment (NMA OR: 2.24; 95% CI: 1.3, 3.86) as well as for LTO versus no treatment (NMA OR: 2.55; 95% CI: 1.2, 5.41). Both comparisons were affected by a high grade of heterogeneity. For clinical pregnancy, LTO was the intervention with highest SUCRA (0.85; mean rank: 1.6). Regarding secondary outcomes, feasible NMA estimates did not support significant differences between treatments effects. According to aggregated NMA including randomized and observational studies, sclerotherapy showed significant beneficial effects on live birth rate compared to no treatment (NMA (OR: 4.6; 95% CI: 1.21, 17.46). Compared with untreated patients, the aggregated NMA estimates a higher ongoing pregnancy rate in patients treated with salpingectomy (NMA OR: 3.35; 95% CI: 2.12, 5.12), US-aspiration (NMA OR: 2.16; 95% CI: 1.28, 3.65) and LTO (NMA OR: 2.46; 95% CI: 1.11, 5.43). Salpingectomy and LTO produced a higher beneficial effect compared to ITD, based on both direct and indirect comparisons. Salpingectomy obtained the highest SUCRA value in rank of effects on ongoing pregnancy (0.94; mean rank: 1.2). NMA found significant effects on clinical pregnancy for comparisons between the different active management procedures compared with no treatments, with the exception of ITD insertion. LTO had more increasing effect on clinical pregnancy rate compared with US-aspiration (NMA OR: 2.04; 95% CI: 1.05, 3.97), while for the rest of the comparisons between procedures no significant differences were identified. NMA ranked LTO as the treatment with a highest SUCRA value (0.91; mean rank: 1.5). NMA prediction models identified LTO as best intervention to reduce miscarriage (SUCRA value: 0.84; mean rank: 1.8), as sclerotherapy as safer option in terms of ovarian response to IVF stimulation., Conclusions: The present NMA fails to support the effectiveness of any option to treat hydrosalpinx before IVF in order to improve live birth rates, although the beneficial effect of salpingectomy and US aspirations on ongoing pregnancy rates and of both salpingectomy and LTO on clinical pregnancy rates emerges from our analysis, which reinforces current recommendations. Based on the aggregated analyses, sclerotherapy could be a promising alternative to conventional laparoscopic techniques, combined with a favorable safety profile. This article is protected by copyright. All rights reserved., (This article is protected by copyright. All rights reserved.)

Background: Women with abnormal hysterosalpingography (HSG) are anxious regarding the presence of tubal pathology. It is important to know the predictive value of HSG and the need for subsequent laparoscopy following an abnormal report. In the era of assisted reproductive technology, the role of invasive testing such as diagnostic laparoscopy is being increasingly questioned due to its invasiveness and associated risks. There is a need to explore the positive predictive value (PPV) of HSG in detecting bilateral tubal block in our population as PPV changes with the prevalence of disease. Aim: The aim of this study was to evaluate the diagnostic accuracy of HSG in identifying tubal blockage in subfertile women. Setting and Design: This was a prospective diagnostic study conducted in the department of reproductive medicine and surgery in a university-level hospital. Materials and Methods: The study included 199 subfertile women who had undergone HSG earlier and were planned for laparoscopy from April 2017 to January 2021. Findings of HSG and laparoscopy were compared with HSG as index test and laparoscopy as reference test, and the outcomes analysed were PPV of HSG for a bilateral tubal block, bilateral hydrosalpinx, abnormal HSG (unilateral or bilateral tubal block) and agreement between HSG and diagnostic laparoscopy in detecting normal and abnormal findings. Statistical Analysis: Kappa statistics, Stuart–Maxwell tests of marginal homogeneity and prevalence-adjusted bias-adjusted kappa (PABAK) statistics were used. Results: The PPV for a bilateral block with HSG was 20.9% (95% CI: 13.7–29.7). The PPV of HSG for bilateral hydrosalpinx was 50.0% (95% CI: 6.8–93.2). PABAK was estimated to be 0.42 (95% CI: 0.30–0.55), suggestive of moderate agreement between the tests. Findings of laparoscopy in women with at least one patent tube in HSG showed that in 12.3% of cases, the management was likely to change due to the operative findings. Conclusion: The current study showed low PPV for bilateral tubal block diagnosed with HSG which translates into a need for further confirmation by laparoscopy. In one out of every eight women with at least one patent tube on HSG, performing laparoscopy changed the management. [ABSTRACT FROM AUTHOR]

Isolated tubal torsion is an unusual cause of acute abdominal pain in young sexually inactive patients. However, it should be still taken into account regarding the differential diagnosis of such conditions. [ABSTRACT FROM AUTHOR]

Background: Sactosalpinx means a collection of fluid (serum, blood or pus) in the fallopian tube. CAH (Congenital Adrenal Hyperplasia) is a typical 46XX DSD (Disorder of Sex Development) due to a steroidogenic enzymatic defect. Both conditions are rare and can lead to reduced fertility rate. Case presentation: We describe two post-menarche virgin girls with CAH who were hospitalized for acute abdomen due to laparoscopically confirmed sactosalpinx. Case 1 recovered after conservative management, case 2 after a second-look and bilateral salpingectomy. The first case consisted of right sactosalpinx and previous peritonitis reported; the second one of bilateral symptomatic pyosalpinx and previous vaginal stenosis. Recurrent abdominal pain persisted at follow-up in Case 1: post-operative MRI (Magnetic Resonance Imaging) showed bilateral hydrosapinx that disappeared at a following ultrasound scan control. Follow-up was uneventful 36 months after surgery in Case 2, except for the surgical revision of the vaginal introitus. Conclusions: CAH-sactosalpinx association is a very rare but not negligible event. We suggest a conservative approach for sactosalpinx if tubal and/or ovary torsion can be excluded. Pyosalpinx is more challenging to treat, but during pediatric age we suggest starting with a conservative approach, especially in patients with CAH who have a potential low fertility rate. Careful gynecological follow-up after menarche is recommended to rule out any further causes of infertility. [ABSTRACT FROM AUTHOR]

In this article, the intra-uterine flow with small suspended particles under the impact of heat transfer is investigated. Intra-uterine fluid motion occurs in a non-pregnant uterus which is essential for examining the embryo movement in a uterus. It also plays a key role in assisting sperm movement to the fallopian tube. The Jeffrey fluid through a tapered channel with compliant boundary walls is taken into account. The proposed Jeffrey fluid model has the following features. It is electrically conducting, incompressible, irrotational with constant density, etc. The mathematical formulation is conducted under the lubrication approach for both fluid and particulate phases. The formulated equations are linearly coupled, which are solved with the help of computational software, and the exact solutions for temperature and velocity profile are presented. The influence of key parameters for velocity, and thermal profiles is illustrated graphically. It is observed that the graphical results are in accordance with the physical expectations. The presented analysis is believed to aid in reducing the risk of miscarriages and fetal withering. The obtained results are helpful in examining the embryo transfer and hydrosalpinx. [ABSTRACT FROM AUTHOR]