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Objectives:To determine the rate and patterns of hysterosalpingography (HSG) abnormality among infertile women at Srinagarind Hospital, Khon Kean University, Thailand.Materials and Methods:The study patients were identified through the reports of the Infertile Clinic. In our hospital, HSG was routinely performed in all women undergoing an evaluation of infertility problems. Medical records were extracted for baseline characteristics, types of infertility, and details of HSG findings. A 95% confidence interval (CI) was calculated to demonstrate the precision of data. Logistic regression model was used to determine an independent impact of the type of infertility on abnormal HSG findings.results:Overall, 589 women were reviewed. The mean ± SD age was 32.9±5.0 years. Secondary infertility was noted in 163 (27.7%) women. Abnormal HSG was noted in 227 (38.5%, 95% CI, 34.6%-42.6%) women. The most common abnormal HSG findings were tubal occlusion and hydrosalpinx. When adjusted with patients’ age, women with secondary infertility carried a higher risk of having abnormal HSG finding compared to those with primary infertility (an adjusted odds ratio, 2.44; 95% CI, 1.68-3.54). Conclusion:Rate of abnormal HSG findings among infertile women in our setting was approximately 40%. Type of infertility was independently associated with abnormal HSG findings.

The majority of cases of symptomatic hydrosalpinx needing treatment are caused by sexually transmitted diseases. However, here, we present a rare case of a hydrosalpinx occurring in a sexually-inactive adolescent girl successfully treated with laparoscopy. A 17-year-old girl presenting with lower abdominal symptoms had a surgical history for an inguinal hernia at infancy. Transabdominal ultrasonography revealed a multicystic lesion in the pelvis, and magnetic resonance imaging suggested hydrosalpinx. Due to the abdominal pain and a suspicion of torsion, laparoscopic surgery was performed. After aspiration and resection of a cystic tumor, we confirmed that the left ovary was normal and that the tumor involved the left fallopian tube, which was twisted at the isthmus. Although relatively rare in postmenarchal sexually inactive adolescents, clinicians and surgeons must still consider hydrosalpinx as a possible diagnosis when encountering an adolescent patient with lower abdominal pain.

Hydrosalpinx can affect the success of embryo transfer (ET). We made a network meta-analysis (NMA) to compare the effects of five hydrosalpinx pretreatments of ET, including salpingectomy, hydrosalpinx aspiration, interventional ultrasound sclerotherapy, proximal tubal occlusion and salpingostomy. This study was based on data-set available from the published studies. The relevant studies were retrieved from Cochrane Library, PubMed and Embase from the inception to January 2017. Data was extracted from cohort studies and the combination of direct and indirect evidence was conducted to assess odds ratio (OR) and surface under the cumulative ranking curves (SUCRA) values of the effects of five hydrosalpinx pretreatments of ET. Thirteen eligible cohort studies were included in this NMA. The results of this NMA demonstrated that compared with the control group (without any treatment), salpingectomy and hydrosalpinx aspiration had comparatively higher ongoing pregnancy rate and implantation rate, interventional ultrasound sclerotherapy had comparatively higher implantation rate. In addition, the cluster analysis revealed that salpingectomy and interventional ultrasound sclerotherapy had better effects on ET. Taken together, this NMA suggested that salpingectomy and interventional ultrasound sclerotherapy had better effects on embryo transfer in patients with hydrosalpinx.

Adipose-derived stem cells (ADSCs), which were initially isolated from the aspirate of human fat by Zuk et al, are considered as an attractive cell source of mesenchymal stem cells (MSCs) for cell-based therapies. Due to their easily accessible, broader sources of multipotent cells and stronger ability for amplification in vitro, ADSCs have attracted considerable attention and curiosity from both scientific and clinical communities for their potential mechanisms in future stem cell treatments. Furthermore, their promising therapeutic characteristics were the unique ability of immunosuppression, secretory function and the potential for multi-directional differentiation. With more research efforts made to understand their effects on both scientific and clinical fields, ADSCs possess great potential as a future therapeutic strategy in treatment for widely various diseases. Therefore, this review intends to lay stress on the clinical application of ADSCs and their advancement in clinical trials across a variety of medical disciplines. Due to their advantages in various fields, ADSCs have a strong potential for application in future stem cell treatments and are beneficial for allogenic transplantation treatments. ADSCs may be considered as an alternative in cell transplantation and tissue engineering clinical treatments.

Ventriculoperitoneal (VP) shunts are the main treatment modality for patients with hydrocephalus. The complications arising in patients with VP shunts are well documented. We present a case of infertility in a patient with a long-standing VP shunt. Her infertility is thought to be the result of pelvic adhesions due to factors related to the distal end of her VP shunt. A 22-year-old female with a 1-year history of infertility was referred due to bilateral hydrosalpinges. Diagnostic laparoscopy revealed multiple adhesions surrounding the distal end of the fallopian tubes. The distal portion of a VP shunt, which was placed over the course of her childhood, was found to be grossly inflamed and densely adherent to the pelvic viscera. VP shunts may produce abdominal adhesions and can cause mechanical infertility. [ABSTRACT FROM AUTHOR]

Objective: To investigate the feasibility of proximal tubal occlusion with fibered platinum coils in subfertile women with hydrosalpinx, and to observe the clinical outcomes of subsequent treatment with in vitro fertilization and embryo transfer (IVF-ET).Study Design: A prospective study was carried out in a university-affiliated teaching hospital. 56 women with uni- or bilateral hydrosalpinx received fibered platinum coil placement before IVF-ET. The clinical pregnancy rate and live birth rate was evaluated. Data analysis was performed with SPSS version 22.0 (SPSS, Inc., Chicago, IL, USA), using two-sided test, and a p value < 0.05 was considered statistically significant. The study has been registered in the ClinicalTrials. gov with the number of NCT03395301.Result(s): Successful placement was achieved in 106 fallopian tubes of 55 patients. The fibered platinum coils induced complete proximal occlusion in 52 out of 55 patients in the following 3-month HSG examination. In the 52 patients, 44 patients received following IVF-ET. The clinical pregnancy rate reached 60.5%(23/38)and live birth rate reached 60.87% (14/23) in patients less than 40 years old.Conclusion(s): Fibered platinum coil is a new, safe and valuable device for hysteroscopic tubal proximal occlusion in subfertile women with hydrosalpinx but with laparoscopic contradictions to improve the reproductive outcomes of IVF-ET. Capsule: Fibered platinum coil is a new, safe and valuable device for hysteroscopic tubal proximal occlusion in subfertile women with hydrosalpinx to improve the reproductive outcomes of in vitro fertilization and embryo transfer. [ABSTRACT FROM AUTHOR]

Abstract Purpose Hirschsprung's disease (HD) is uncommon in females. There are very few reports on the patients' obstetric and gynecological outcome. Hydrosalpinx causes pain and infertility. It is rare in nonsexually active teenagers. It may be because of an intrinsic disease of the fallopian tubes or secondary to surgery. Aim: to describe the relationship between hydrosalpinx and HD or its surgical approach; to report the impact of bilateral hydrosalpinx on fertility in HD. Methods The records of all females with HD since 1980 were reviewed. Only patients who reached menarche were included. Prevalence of hydrosalpinx and hydrosalpinx-free survival were compared after abdominoperineal (A) or transanal (T) surgery. Treatment for hydrosalpinx was reviewed. Results Seventeen out of 27 patients had reached menarche (Group A: 13 patients; Group T: 4 patients). Five patients in group A and none in group T presented bilateral hydrosalpinx (p = 0.261). There were no statistical differences in hydrosalpinx-free survival between groups (p = 0.344). Hydrosalpinx treatment: two bilateral and one unilateral salpingectomy, one pyosalpinx evacuation and one untreated. Three patients had conception desire: one has children; two are on IVF program. Conclusion An association between hydrosalpinx and HD was observed. The development of hydrosalpinx was not associated with surgical approach in our study. Females with HD should have a gynecological follow-up for the development of hydrosalpinx, which can impair fertility. Level of evidence Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Objective: The study was carried out to clarify the IVF outcome after laparoscopic neosalpingostomy for infertile patients affected by hydrosalpinx stage III.Materials and Methods: From January 2010 to June 2015, 91 subjects of hydrosalpinx stage III were treated in out center by laparoscopic surgery before IVF cycle. 43 underwent neosalpingostomy (group 1) and the remaining 48 underwent salpingestomy (group 2). We compared these patients and their IVF outcomes after two different surgical techniques.Results: There were no significant differences between the two groups, except a higher number of patients with bilaterial hydrosalpinges was noted in the neosalpingostomy group (79.1% vs. 56.3%, respectively). 25 patients with neosalpingostomy and 29 with salpingectomy achieved pregnancy by IVF. The ongoing pregnancy rate per cycle in group 1 and group 2 was 51.1 and 47.2%, respectively. Two cases of ampullary ectopic pregnancies were noted in group 1 and one case of right tube interstitial pregnancy in group 2. No significant difference was observed in live birth rate between the groups (48.9% vs. 45.3%, respectively).Conclusions: The outcomes of IVF after neosalpingostomy were matchable with salpingectomy. For patients desire to preserve fallopian tubes, we recommend laparoscopic neosalpingostomy as an alternative choice to manage moderate hydrosalpinx before IVF. [ABSTRACT FROM AUTHOR]

The presence of a hydrosalpinx has been shown to impair the outcome of in vitro fertilization (IVF) treatment. This outcome can be improved by removing the hydrosalpinx; however, there are some concerns regarding its feasibility and safety, especially in women with previous surgeries and dense adhesions. The purpose of our meta-analysis was to evaluate the efficacy of hydrosalpinx aspiration with or without sclerotherapy on the risk of recurrence and the IVF outcome compared with salpingectomy or no intervention. We performed an electronic-based search using PubMed, Embase, Ovid MEDLINE, Google Scholar, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. Our main outcome measures were the recurrence rate, fertility outcome, and adverse events. Ten studies were included in our review. The overall recurrence rates of hydrosalpinx aspiration with or without sclerotherapy were 21.7% to 30.5% and 21.8% to 32.5%, respectively. There was no difference in the clinical pregnancy or miscarriage rate between hydrosalpinx sclerotherapy and salpingectomy. When compared with salpingectomy, hydrosalpinx aspiration only was associated with a significantly lower clinical pregnancy rate and higher miscarriage rate. Compared with no intervention, hydrosalpinx aspiration resulted in significantly higher clinical pregnancies rates but a similar miscarriage rate. We conclude that hydrosalpinx sclerotherapy before IVF improves the fertility outcome and can be used as an alternative to salpingectomy. [ABSTRACT FROM AUTHOR]

In Brazil, great milk productivity was achieved after the implementation of a genetic improvement program. However, reproductive efficiency is still far from optimal, possibly due to the high number of undiagnosed disorders that may affect fertility. The aim of this study was to evaluate occurrences of the main reproductive disorders in dairy goats in southeastern Brazil. Data were collected between January 2015 and May 2017 from 23 commercial herds of different breeds, with goats ranging from 8 months to 12 years of age. Transrectal ultrasound exams were performed in 2680 goats. A total of 14.8% of the does showed a disorder in the reproductive tract: hydrometra (10.0%), ovarian follicular cysts (2.3%), gestational loss (1.5%), and hydrosalpinx (1.1%). This was the first study evaluating reproductive disorders in live animals that used a high number of Brazilian dairy goats. Considering that all these diseases affect fertility to different degrees, the performance of transrectal ultrasonography exams twice a year is strongly suggested, in order to guide precocious treatment or discard the animal as soon as possible, thus reducing economic losses in dairy goat farming. [ABSTRACT FROM AUTHOR]

Hydrosalpinx is an oviduct disease that can compromise female fertility. This study describes the occurrence and characterization of hydrosalpinx in dairy goats and proposes a new approach for an accurate diagnosis of hydrosalpinx by using transrectal ultrasonography (US). The data were collected from 2579 goats subjected to US exams. Six goats had their reproductive tracts collected post mortem and macroscopically and microscopically examined. A total of 28 cases of hydrosalpinx (1.1%) were detected: 27 Saanen goats and one Alpine goat. Among these, 22.2% (6/27) had previously shown other reproductive disorders such as spontaneous abortion (3.7%), follicular cysts (3.7%) and hydrometra (14.8%). Only the oldest goat (12 years old) was pluriparous with history of previous reproductive success, while 27 nulliparous females ranged in age from one to eight years old. The US exams revealed a fluid-filled, rounded structure ( >24 mm) formed by the accumulation of fluid inside the oviduct lumen of the affected goats. The infundibulum was the most commonly affected region, and contained rounded structures up to 100 mm in diameter. The ampulla was the second most commonly affected structure, and minor changes were observed in the isthmus. In one of the 28 positive cases, the presence of bilateral hydrosalpinx was identified. Microscopically, at the infundibulum and ampulla, a decrease and/or absence of the mucosal folds with subsequent reduction of the epithelial surface area was noted. In conclusion, hydrosalpinx may be successfully diagnosed in goats via transrectal US. The occurrence rate of hydrosalpinx in this study reveals the importance of an accurate diagnosis and a strong possibility that hydrosalpinx has been underdiagnosed and neglected in this species. [ABSTRACT FROM AUTHOR]

Background: The most frequent congenital anomalies of the genital tract in women are caused by irregular development of the Müllerian ducts. At present, known Müllerian anomalies include abnormal ductal unification, aplasia, and vaginal cysts. No cases of duplicated Müllerian ducts in females have been described previously. Case: A 33-year-old woman presented with what appeared to be a hydrosalpinx on preoperative ultrasound. It actually was a unique case of an intraperitoneal tubular structure suggestive of a monolateral duplicated Müllerian duct. The uterus, fallopian tubes, and ovaries were all normal. There was an intraperitoneal tubular structure of 15 × 3 cm in the left hemipelvis, running medially to the infundibulopelvic ligament and the fallopian tube, and ending in the left vaginal fornix. Diagnostic vaginoscopy showed a millimetric communication between the tubular intraperitoneal mass and the vagina. The tubular structure was excised laparoscopically. Results: Histopathologic and immunohistochemical evaluations revealed a typical Müllerian duct epithelium with multilayered columnar ciliated cells with positivity for both estrogen receptors and CD 10. Conclusions: The anatomical structure described herein is difficult to categorize because there is a lack of previous similar observations. Based upon a thorough evaluation-including macroscopic anatomy and microscopic and immunohistochemical analysis-the diagnosis was a monolateral complete duplication of the Müllerian duct. Other observations are needed to confirm these findings and possibly gain new insight into the clinical presentation of genital anomalies in women. (J GYNECOL SURG 34:49) [ABSTRACT FROM AUTHOR]

Fallopian tube disease is one of the most common causes of infertility in women that results from tubal damage or obstruction. The American Society for Reproductive Medicine classification, based on scoring system of tubal changes verified by laparoscopy, is most widely used in practice. The aim of the paper is to determine the involvement and stage of hydrosalpinx and surgical therapy options in patients treated for marital infertility due to tubal factors during the preparation for in vitro fertilization after laparoscopy. In the two-year period, at the Clinic for Gyneacology and Obstetrics, Clinical Center Niš, 75 patients underwent videolaparoscopy to confirm previously established diagnosis of hydrosalpinx. Surgical treatment performed depended on the severity stage of hydrosalpinx. Removed Fallopian tubes were submitted for a histopathological analysis to the Institute of Pathology, Clinical Center Niš. An early stage hydrosalpinx was diagnosed by laparoscopy in 32 tubes. Out of them, tubal removal was performed in 9 tubes, and reconstructive surgery in 21. The most conspicuous changes were present in 46 Fallopian tubes. Surgical removal was performed in 41 tubes, occlusion of the isthmic portion of the tube was present in 5 tubes, and no reconstructive surgery was performed (significant correlation p <0.001 between the stage of hydrosalpinx and type of surgery). HP analysis of the removed Fallopian tubes revealed chronic inflammation in 84.27%. It is necessary to employ always the same, clear criteria in the diagnosis and to select properly the patients who will benefit from hydrosalpinx surgery, either tubal removal or reconstructive surgery. [ABSTRACT FROM AUTHOR]

Chlamydia muridarum induction of mouse hydrosalpinx, depending on both tubal infection and inflammation, has been used for investigating Chlamydia trachomatis pathogenesis. We now report that IL-6 both inhibits C. muridarum infection and exacerbates pathogenicity in the mouse genital tract. When intravaginally inoculated with a high dose of C. muridarum , IL-6-deficient mice developed more extensive genital tract infection with severe hydrosalpinx, suggesting that IL-6 is required for controlling the high dose infection but not essential for C. muridarum -induced pathology. However, at a low dose, IL-6-deficient mice still developed more extensive infection in the genital tract but no longer with significant pathology, suggesting that IL-6 is required for both controlling the low dose infection and exacerbating the low dose infection-induced pathology. The lack of hydrosalpinx in IL-6-deficient mice correlated with significantly reduced inflammatory infiltration in the oviduct tissue and decreased spleen CD4+ and CD8+ T cells that produce TNFα. Thus, IL-6-dependent pathways are important for both limiting chlamydial colonization in the genital tract mucosal tissues regardless of the infection doses and exacerbating chlamydial pathogenicity in the upper genital tract when IL-6-independent pathogenic mechanisms are not yet activated with a low infection dose. [ABSTRACT FROM AUTHOR]

With the advances in assisted reproductive technology (ART), the role of reproductive surgery as the primary treatment of infertility has been questioned. Tubo-peritoneal factor infertility is common, and accounts for 30–40% of female infertility. The pathology of tubal disease ranges from peritubal adhesions, proximal and/or distal tubal blockage, hydrosalpinx to previous sterilisation. In tubo-peritoneal factor infertility, reproductive surgery remains an important option and is complementary to ART. It should be considered as the first-line treatment if a good result is expected, when the pathology is amendable or if left untreated will adversely affect the results of ART. The success of reproductive surgery depends on careful patient selection using proper investigative tools, performed in units with expertise following microsurgical principles. [ABSTRACT FROM AUTHOR]

Objective: To determine the optimal time interval between performing laparoscopic tubal ligation for hydrosalpinges and an ICSI-ET treatment cycle. Design: A retrospective cohort study. Setting: Private infertility clinic. Patient(s): The study group included 69 infertile women who had laparoscopic tubal ligation for hydrosalpinges. 41 patients (group A) had an ICSI-ET cycle 16 weeks after surgery. Intervention(s): laparoscopic tubal ligation and ICSI-ET. Main outcome measure(s): Pregnancy rate, clinical pregnancy rate and implantation rate. Result(s): Pregnancy rates were 39%, 50% and 50%, clinical pregnancy rates 31.7%, 45% and 50%, and implantation rates 14.8%, 21.5% and 18% for groups A, B and C respectively. Conclusion(s): Although the reduction in pregnancy rate, clinical pregnancy rate and implantation rate in Group A, as compared Groups B and C, did not reach statistical significance, our results suggest that ICSI-ET treatment cycles be postponed for at least 10 weeks after laparoscopic tubal ligation for hydrosalpinx. A larger prospectively randomized study should be conducted to confirm the minimum delay period required for endometrial receptivity to recover.

The presence of hydrosalpinges is known to significantly reduce the pregnancy and implantation rates following in vitro fertilization (IVF). Salpingectomy or laparoscopic tubal occlusion before IVF have been shown to significantly improve pregnancy rates. Aspiration of the hydrosalpinges at the time of oocyte retrieval for IVF had been proposed as a viable alternative. We present a 36year old nullipara with unilateral hydrosalpinx who declined salpingectomy prior to IVF treatment and subsequently had two failed IVF cycles. She however became pregnant with the third IVF attempt, following transvaginal ultrasound scan guided aspiration of the hydrosalpinx fluid at the time of oocyte retrieval. Large randomized trials are needed to clearly identify the place of ultrasound scan guided aspiration of hydrosalpinges on IVF outcome.

Rationale: Hysterosalpingography is still the main method to begin with when studying the causes of female impossibility to conceive a baby. Objective: The aim of this study is to correlate and evaluate the wide range of tubal pathology discovered by routine hysterosalpingography in a university hospital in Romania with the successful pregnancy rate. Methods and Results: A total of 95 consecutive patients explored by routine hysterosalpingography in a university hospital during 2015 and 2016 were included. Out of 173 fallopian tubes studied, 28.9% were occluded, 13.29% were almost occluded, and only 57.8% were patent. Of these patients, 11 successful pregnancies occurred in 95 women (11.57%) until September 2017. A number of 7 patients delivered a normal baby in our hospital (7.36%). One patient was admitted at 36 weeks of gestation, and another one at 26 weeks of gestation, for risk of premature delivery. None of these two patients delivered in our hospital. Two patients were admitted for miscarriage at 8 weeks and 5 weeks of pregnancy. In all the 7 patients who delivered a normal baby, the fallopian tubes were entirely visible (100%), whether they were patent or not. Discussion: To our knowledge, this is the largest study about hysterosalpingography and the successful pregnancy rate in Romania so far. [ABSTRACT FROM AUTHOR]

Purpose To quantify our experience with and assess the literature on diagnosis and management of isolated fallopian tube torsion (IFTT) with hydrosalpinx (HSX) in children. Methods A PubMed search was performed on pediatric cases of IFTT with HSX to provide a comprehensive review analyzing details and management of this association, focusing on the problem of fertility preservation. Results In addition to our 3 cases, 17 patients of pediatric IFTT associated with HSX were identified, for a total of 21 cases (median age 12.2 years). Menarchal status was present in 10/13 (76.9%); blood tests were reported in 9/20 (42%) showing leucocytosis in 7/9 (75%). Ultrasonography was performed in all cases except one. Laparoscopy was the surgical approach in 84.6% of the reported cases. The torsion was to the right in 36.8%, and to the left in 63.2% of the cases. In one case the torsion was bilateral and asynchronous. Performed procedures were salpingectomy (52.4%) and partial salpingectomy (14.3%); conservative management was reported in 33.3% of the cases. Conclusions The literature describes different management techniques. Salpingectomy is the most frequently performed procedure but recently conservative management seems to be increasingly applied. A long-term study is necessary to define the most effective treatment for the preservation of future fertility in pediatric patients. Type of study Treatment study (Retrospective Study): LEVEL IV. [ABSTRACT FROM AUTHOR]

The preimplantation ultrasound (US) refers to targeted imaging of the uterus and adnexa prior to assisted reproductive techniques (ART) to optimize the infertility treatment outcomes. After a thorough evidence based literature review, we propose the use of transvaginal three-dimensional (3D) US during the early follicular phase. A systematic approach for 3D US examination consists of a detailed examination of the uterine shape, size and contour, evaluation of the endometrial thickness, volume, pattern and vascularity, and assessment of the junctional zone regularity, echogenicity and thickness. Uterine anatomy is explored in the coronal plane by simultaneous visualization of the uterine cavity, the external surface of the fundus and cervix. Saline infusion sonogram (SIS) is recommended for patients with increased endometrial volume, abnormal endometrial pattern and irregular uterine cavity shape suggestive of Müllerian duct anomalies or acquired intracavitary abnormalities. Myometrial lesions should be recognized and proper dimensions and locations should be ascertained. Ovarian dimensions and volume are measured and the antral follicle count is recorded. Adnexa are carefully assessed for masses, endometriosis and dilated tubes. Color power Doppler US may be applied to evaluate vascularity of the ovaries and pelvic lesions. Hysterosalpingo-contrast-sonography (Hy- Co-Sy) should be optimally utilized for assessment of tubal patency. Accessibility and mobility of the ovaries should be checked in real time for better planning of the ultrasoundguided oocyte retrieval. The cul-de-sac is assessed for the presence of free fluid or masses. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the impact of hydrosalpinx fluid (HF) on early human embryonic development. A total of 33 patients who underwent laparoscopic surgery for hydrosalpinx were selected, and the HF specimens obtained from these patients were subjected to bacterial culture,Chlamydiaantigen detection, biochemical analysis, and cytokine detection. Meanwhile, human embryos derived from three pronuclei (3PN) were cultured in various HF concentrations. There was no significant difference in the chemical components and physical characteristics between colorless and colored HF specimens, apart from the glucose concentration which was significantly higher in colorless HF. K+and HCO3−were significantly increased (P< 0.05 andP< 0.01), and Ca2+, Mg2+, and glucose were significantly decreased (P< 0.05,P= 0.006, andP= 0.007) in the two HF specimens, compared to blastocyst culture medium (G-2 medium); no phosphates were detected in the HF specimens. Compared to colorless HF, the concentrations of tumor necrosis factor α (TNF-α) and interleukin 2 (IL-2) in the colored HF specimens were significantly increased (P< 0.05). There were no differences in theChlamydiaantigen-positive rate between the HF groups (62.5% vs. 70.6%), and no bacterial growth occurred in the HF specimens. There were no significant differences in the development of the 3PN embryos between the two HF groups (P> 0.05). High-concentration HF (75%) significantly affected the rates of blastulation, blastocyst hatching, and high-quality blastocyst formation (P< 0.05). HF is related to chlamydial infection. Embryonic development may be significantly affected only in high-concentration HF, possibly due to the deficiency of essential elements required for embryonic development. TNF-α and IL-2 concentrations were found to vary between the clear and colored HF specimens; however, TNF-α and IL-2 in HF do not appear to exert adverse effects on embryonic development. [ABSTRACT FROM AUTHOR]

Background To describe the surgical technique and our initial experience of single-port laparoscopic neosalpingostomy (SP-LN) for treatment of hydrosalpinx. Materials and methods This prospective observational study was carried out at University teaching hospitals. Ten women underwent SP-LN for hydrosalpinx between November 2012 and December 2015. Results The mean (range) age and body mass index were 29.3 (21–36) years and 22.2 (17.7–27.1) kg/m 2 , respectively. Six women had a history of previous abdominal surgery; laparoscopic unilateral salpingectomy for tubal pregnancy in two, laparoscopic appendectomy in three, and laparotomy appendectomy in one. Six women underwent unilateral SP-LN and nine women underwent bilateral SP-LN. The mean (range) operating time, hemoglobin change, return of bowel activity, and length of hospital stay were 91.5 (70–120) minutes, 0.7 (0.1–1.6) g/dL, 19.9 (7.1–25.4) hours, and 3.7 (3–4) days, respectively. There was no conversion to multiport laparoscopy or laparotomy. There were no surgical or wound complications in any patient. Conclusion SP-LN might be a feasible and safe alternative in women with hydrosalpinx. However, further study is needed to confirm this preliminary result and to explore the obstetric outcomes following SP-LN. [ABSTRACT FROM AUTHOR]

The decision on how to treat tubal diseases, specifically hydrosalpinx, is a difficult one. Ιt involves surgical, medical, social, emotional and economic factors. This narrative review aims to increase awareness of tubal disease diagnosis and treatment, to compare between tubal surgery andin vitrofertilisation (IVF) for tubal factor infertility, and to investigate the effect of the combination of both. This way, we can be more effective, safe and provide our patients with better treatment results. The review analysed randomised studies, trials and meta-analysis, which give new aspects on the treatment methods for tubal pathology before IVF. Recent papers published in English have been studied, alongside guidelines and committee opinions from previous years. Tubal surgery and IVF aim to exploit a woman’s reproductive potential. IVF and endoscopic tubal surgery must be thought of as complementary, rather than competing techniques in tubal disease cases, in order to improve fertility outcome. The first-line treatment for young women less than 35 years old with minor tubal pathology, is tubal surgery. IVF should be offered if there are other factors in a couple’s subfertility, if the patient is >38 years old, if moderate to severe tubal disease is present, and if it has been more than 12 months post-surgery. [ABSTRACT FROM PUBLISHER]

A quasi-experiment of 56 patients with hydrosalpinx diagnosis that went to the Natural and Traditional Medicine Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba - referred from the Gynecology and Infertility Services -, was carried out from September, 2014 to December, 2015, to evaluate the response to Su Jok therapy. Among the analyzed variables there were: age, risk factors, clinical features, traditional syndromes, clinical course and response to the treatment. In the case material there was a prevalence of women aged 30-39, pelvic inflammatory disease and sexually transmitted infections as pathological history (71.4%), pain and vaginal secretion as main symptoms, as well as Qi liver stagnation, not firm Qi kidney and coldness - humidity in spleen as most frequent syndromes. Finally, there was a favorable clinical course and an appropriate response to the treatment. [ABSTRACT FROM AUTHOR]

Tubal surgery is performed for a variety of indications in gynecology. Salpingectomy is the most aggressive form of tubal surgery and may be performed for potential risk reduction for epithelial ovarian cancer, sterilization, and ectopic pregnancy and as a method to enhance fertility in the setting of hydrosalpinx. Depending on the indication, alternatives include conservative therapy alone, tubal occlusion, and salpingostomy. However, aggressive tubal surgery may impact fertility and ovarian reserve because of its effects on adjacent ovarian tissue. Ovarian damage may manifest as alterations in serum and sonographic markers of ovarian function as well as in vitro fertilization (IVF) response and, ultimately, impair outcomes in assisted reproductive and spontaneous conception cycles. We performed a review of articles from PubMed, Cochrane, and MEDLINE from 1946 to 2016 and included 48 relevant publications. For most indications for salpingectomy, ovarian reserve is not impacted. Although there are several conflicting studies suggesting a slight impairment of the parameters of ovarian reserve, these studies were mostly in patients who underwent salpingectomy for an ectopic pregnancy. For patients attempting to conceive naturally, salpingectomy overall does not confer a substantial decrease in conception. Conservative options may increase their risk for persistent trophoblastic disease. In patients planning on IVF, salpingectomy does not appear to significantly affect ovarian stimulation parameters or clinical pregnancy rates. Furthermore, salpingectomy is recommended in cases of hydrosalpinx. Overall, salpingectomy has no significant effects on ovarian reserve. However, the impact on IVF success and spontaneous pregnancy rates must be weighed by the indication for possible salpingectomy. A review of these risks and benefits should aid in choosing between salpingectomy and less aggressive alternatives. [ABSTRACT FROM AUTHOR]

Ultrasonography, especially 3D, is essential in the diagnosis and preoperative evaluation of gynecologic surgeries and is important in surgical planning and counseling of patients. In addition, it is useful during hysteroscopic procedures, particularly difficult Asherman syndrome cases, resection of transverse vaginal septum, and treatment of hema-tometria. 3D ultrasound is especially helpful for fibroid mapping as the simultaneous visualization of the endometrium and myometrium with the coronal view is possible, it can be done by the gynecologist and at a lower cost than an magnetic resonance imaging. The ability to visualize with ultrasound during surgery may reduce complications and eliminate the use of laparoscopy. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to compare the clinical outcomes of in vitro fertilization (IVF) for patients with hydrosalpinx between ultrasound sclerotherapy and surgical intervention. Methods The data of 482 IVF/intracytoplasmic sperm injection (ICSI) cycles were divided into three groups according to different intervention protocols before IVF/ICSI. Group A included 265 cycles in which ultrasound sclerotherapy pretreatment was carried out before controlled ovarian hyperstimulation. Group B included 109 cycles in which hydrosalpinx aspiration was carried out under ultrasound guidance on the day of oocyte retrieval. Croup C included 108 cycles in which bilateral salpingectomy was carried out before IVF/ICSI. Results The rates of embryo implantation, biochemical pregnancy, clinical pregnancy, multiple pregnancy, and early abortion showed no significant differences between groups A and C ( P > 0.05); whereas the rates of embryo implantation, biochemical pregnancy, and clinical pregnancy in group B were significantly lower than those in groups A and C ( P < 0.05), and that of early abortion in group B was significantly higher than that in groups A and C ( P < 0.05). Conclusion Ultrasound sclerotherapy on patients with hydrosalpinx before IVF-embryo transfer could obtain a similar clinical outcome to surgical intervention. [ABSTRACT FROM AUTHOR]

The crucial role of plasmid-encoded protein Pgp3 in Chlamydia pathogenesis has been demonstrated in various animal models. Previous studies have revealed that the Pgp3-deficient C. muridarum mutant fails to induce hydrosalpinx after vaginal inoculation in mice. Structural analysis of C. trachomatis Pgp3 trimer has indicated that Trp234 may play a critical role in trimeric crystal packing interactions and that Tyr197 is involved at predominant cation-binding sites. In this study, we constructed C. muridarum transformants harboring Pgp3, Trp234, or Tyr197 point mutations (Pgp3W234A and Pgp3Y197A). C3H/HeJ mice infected with Pgp3W234A mutant failed to induce severe hydrosalpinx in the oviduct tissue, which largely phenocopied the full-length Pgp3-deficient C. muridarum . The Pgp3Y197A variant induced an intermediate severity of pathology. The attenuated pathogenicity caused by the Pgp3W234A mutant may be due to its decreased survival in the lower genital tracts of mice, reduced ascension to the oviduct, and milder induction of inflammatory cell infiltration in the oviduct tissue. Thus, our results point to an important amino acid residue involved in Pgp3 virulence, providing a potential therapeutic target for chlamydial infection., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Huang, Wu, Sun and Liu.)

Background: Tubal surgery's role in infertile women with unilateral tubal pathology (e.g. hydrosalpinx, tubal occlusion) who desire spontaneous or intrauterine insemination (IUI) conception where in-vitro fertilisation is infeasible remains unclear., Objective: To conduct a systematic review on fertility outcomes in women with unilateral tubal pathology desiring to conceive spontaneously or via IUI and to find guidance to support therapeutic tubal procedures to help these women conceive., Search Strategy: Using a protocol registered on PROSPERO (ID CRD42021248720), we searched PubMed, EMBASE, CINAHL, and Cochrane Library from inception until June 2022. Bibliographies were reviewed to identify other relevant articles., Data Collection and Analysis: Two authors independently selected and extracted data. Disagreements were resolved by a third author. Studies presenting fertility outcome data in infertile women with unilateral tubal pathologies desiring spontaneous or IUI conception were included. Methodologic quality was assessed using a modified Newcastle Ottawa Scale for observational studies and the Institute of Health Economics Quality Appraisal Checklist for case series. Primary outcomes collated included cumulative pregnancy rate (CPR) and pregnancy rate per cycle (PR/cycle). Secondary outcomes such as ectopic pregnancy, birth outcomes, and pelvic inflammatory disease were collated. These were stratified by the types of unilateral tubal occlusion (UTO) i.e. hydrosalpinx, proximal tubal occlusion (PTO), or distal tubal occlusion (DTO) MAIN RESULTS: Two studies reported spontaneous or IUI pregnancies after treatment of unilateral hydrosalpinx with one reporting a pregnancy rate of 88% within 5.6 months on average. Thirteen studies compared IUI outcomes between women with UTO vs unexplained infertility and bilateral tubal patency (controls). Almost all were retrospective cohort studies and identified UTO by hysterosalpingography. In general, PTOs had no difference in PR/cycle and CPR compared to controls and significantly higher PR/cycle to DTOs. Women with DTOs had minimal incremental CPR benefit with each additional IUI cycle., Conclusions: Therapeutic salpingectomy or tubal occlusion improve IUI or spontaneous conception in women with hydrosalpinx, although more prospective studies are needed. While significant study heterogeneity hampered assessment of fertility outcomes, overall, infertile women with PTOs had similar IUI pregnancy outcomes to those with bilateral tubal patency while DTOs had inferior PR/cycle. This review highlights significant deficiencies in the evidence guiding management for this group of patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Chlamydia muridarum has been used to study chlamydial pathogenesis because it induces mice to develop hydrosalpinx, a pathology observed in C. trachomatis-infected women. We identified a C. muridarum mutant that is no longer able to induce hydrosalpinx. In the current study, we evaluated the mutant as an attenuated vaccine. Following an intravaginal immunization with the mutant, mice were protected from hydrosalpinx induced by wild-type C. muridarum. However, the mutant itself productively colonized the mouse genital tract and produced infectious organisms in vaginal swabs. Nevertheless, the mutant failed to produce infectious shedding in the rectal swabs following an oral inoculation. Importantly, mice orally inoculated with the mutant mounted transmucosal immunity against challenge infection of wild-type C. muridarum in the genital tract. The protection was detected as early as day 3 following the genital challenge infection and the orally immunized mice were protected from any significant pathology in the upper genital tract. However, the same orally immunized mice failed to prevent the colonization of wild-type C. muridarum in the gastrointestinal tract. The transmucosal immunity induced by the oral mutant was further validated in the airway. The orally vaccinated mice were protected from both lung infection and systemic toxicity caused by intranasally inoculated wild-type C. muridarum although the same mice still permitted the gastrointestinal colonization by the wild-type C. muridarum. These observations suggest that the mutant C. muridarum may be developed into an intr acellular o ral v accine vector (or IntrOv) for selectively inducing transmucosal immunity in extra-gut tissues., Competing Interests: The authors declare no conflict of interest.

Background: Hydrosalpinx and pyosalpinx are rare gynecologic problems during adolescence, especially in girls without a history of sexual activity. They are even rarer in women with Hirschsprung's disease (HD). We herein report a case of pyosalpinx in an adolescent girl with HD treated by transvaginal ultrasound-guided drainage., Case Presentation: The present patient was a 12-year-old girl (weight 83 kg; height 159 cm; body mass index 32.8 kg/m 2 ). She had undergone five laparotomies for long-segment HD by 2 years. Her menarche had occurred at 10 years. She was admitted with lower abdominal and anal pain. Computed tomography (CT), magnetic resonance imaging (MRI), and transvaginal ultrasound showed left pyosalpinx and abdominal abscess. Surgical drainage was necessary; however, she had a history of polysurgery and was severely obese, so laparotomy was considered to carry a high risk. Transvaginal ultrasound was deemed more likely to reach the abscess safely. Therefore, she was treated with transvaginal ultrasound-guided drainage by a gynecologist skilled in the procedure. She was discharged home after 52 days. One year and nine months after discharge, there was no reformation of either the abscess or pyosalpinx., Conclusions: Adolescent girls with HD are at risk of developing hydrosalpinx. Depending on the defecation status, pyosalpinx may also develop. As a less-invasive surgical treatment, transvaginal ultrasound-guided drainage can avoid laparotomy. Collaboration with a gynecologist is essential for the diagnosis and treatment of this clinical condition. Pediatric surgeons should communicate with gynecologists for such cases beginning around puberty for continuous follow-up., (© 2023. The Author(s).)

Introduction. Isolated torsion of the Fallopian tube is an uncommon cause of acute lower abdominal pain and can occur in women of all age groups. Cholecystitis is a frequent cause of upper abdominal pain. We present an unusual case with the presence of these two distinct pathological entities occurring concurrently in the same patient, causing simultaneously occurring symptoms. To our knowledge, this is the first reported presentation of such a case. Methods. We describe a 34-year-old premenopausal woman who presented with right sided upper and lower abdominal pain and nausea. Abdominal ultrasound (US) revealed acute cholecystitis. Vaginal US was suggestive of right hydrosalpinx. Intravenous antibiotics were administered and consent was obtained for operative intervention. During laparoscopy, the right Fallopian tube with hydrosalpinx was noted to be twisted three times. The right ovary appeared normal. The gall bladder wall was thickened and inflamed. Laparoscopic right salpingectomy and cholecystectomy were performed. Results. Surgical pathology revealed hydrosalpinx with torsion and acute calculous cholecystitis. The patient had an uneventful postoperative course and was discharged home on the first postoperative day. Her symptoms resolved after the procedure. Conclusions. In women with abdominal pain, both gynecologic and nongynecologic etiologies should be considered in the differential diagnoses. Concurrent presence of symptomatic gynecologic and nongynecologic intra-abdominal pathology is rare. Isolated Fallopian tube torsion is rare and is associated most often with hydrosalpinx. Some torqued Fallopian tubes can be salvaged. Laparoscopy is useful in management of both Fallopian tube torsion and cholecystitis. [ABSTRACT FROM AUTHOR]