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Background: There are few studies which assess the therapeutic role of salpingostomy and HSG in patients with hydrosalpinx regarding rates and outcomes of pregnancy. This study aimed to assess therapeutic effects of salpingostomy, diagnostic and therapeutic effects of HSG after salpingostomy in patients with hydrosaplinx. Methods: We assessed clinical findings of 60 patients diagnosed with hydrosalpinx and underwent HSG before and after performing laparoscopic salpingostomy Results: There is statistically significant relation between improvement of oviduct and pregnancy time (p-0.007). Rates of spontaneous pregnancies were 46.88% in the improvement group, versus 13.33% in the nonimprovement group. Rates of pregnancy in both groups were statistically significant (p=0.028). Average time to pregnancy in the improvement group was 13 (11-15) months and in the non-improvement group was 16 (14-18) months. Conclusions: Performing HSG after laparoscopic salpingostomy might be a good choice for treatment of infertile patients diagnosed with hydrosalpinx. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To compare the effect of three different surgical approaches: simple terminal salpingostomy, bilateral proximal tubal ligation plus terminal salpingostomy, and bilateral salpingectomy.A retrospective analysis was conducted on the clinical data of 292 patients who underwent laparoscopic surgery for hydrosalpinx and embryo transfer within 2 years postoperatively from January 2018 to August 2021. The patients were divided into three groups: Group A (68 cases) underwent simple terminal salpingostomy, Group B (199 cases) underwent ligation plus terminal salpingostomy, and Group C (25 cases) underwent bilateral salpingectomy.Age, body mass index, surgical time, intraoperative bleeding, length of hospital stay, and infertility type showed no significant differences among the different surgical groups (P > 0.05), except for the age 30–39 group, which showed statistically significant differences in surgical time (P < 0.001) and length of hospital stay (P < 0.001); the age 40 or above group showed statistically significant differences in intraoperative bleeding (P = 0.008). A total of 336 oocyte retrievals and 451 embryo transfers were successfully performed in the 292 patients within 2 years postoperatively.The choice of surgical approach for hydrosalpinx does not affect pregnancy rates after embryo transfer within the same age group. [ABSTRACT FROM AUTHOR]

Copyright of Ege Journal of Medicine is the property of Ege University, Faculty of Medicine 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.)

Key content: Pelvic pathologies such as fibroids, polyps, congenital uterine anomalies, intrauterine adhesions, hydrosalpinges, adenomyosis, endometriosis and ovarian cysts may have a negative impact on fertility and the success of assisted reproductive technology (ART).If pelvic pathologies are identified during the course of investigations for subfertility, information based on the latest available evidence should be provided so that individuals can make informed decisions about how they wish to proceed.In some situations, surgical intervention prior to ART is strongly recommended, but in others, the evidence is more limited/conflicting. Learning objectives: To learn more about how and why pelvic pathologies such as fibroids, polyps, congenital uterine anomalies, intrauterine adhesions, hydrosalpinges, adenomyosis, endometriosis and ovarian cysts affect fertility and outcomes following ART treatment.To understand when surgical intervention is (and equally is not) indicated in the management of different pelvic pathologies in women with subfertility who are contemplating ART.To appreciate the different options on how to manage women with different pelvic pathologies identified before and during an ART cycle.To smooth the transition between secondary/tertiary NHS care and ART providers so that women are given consistent advice and managed according to evidence based recommendations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Infertility is a global health issue with varying etiology. This study determined the prevalence and pattern of tubal and uterine pathologies with genital tract microbial infection among infertile women in Ogun State, Nigeria. METHODS: A cross-sectional study was conducted in a year among 230 infertile women aged 20 years and above scheduled for hysterosalpingography (HSG). Samples for high vaginal and endocervical swabs were analyzed as part of the study. RESULTS: The mean age was 34.65 (6.18) years, and the age group 30 – 39 years had the highest frequency of infertility. The mean duration of infertility was 4.93 (3.88) years, and secondary infertility (77.8%) was higher than primary infertility (22.2%). Tubal pathology was the most common (36.1%), followed by uterine pathology (30.0%), where the tubal blockage was 82.5% and hydrosalpinx was 17.5%. There were 57 (54.8%) and 47 (45.2%) patients with single and bilateral tubal blockage, respectively. Hydrosalpinx was observed in four (20%), nine (45%), and seven patients (35%) with a right, left and bilateral distribution, respectively. Univariate regression analysis showed older women with tubal pathology were 2.01 times more likely to be infertile than the younger patients (95% CI: 1.042 – 4.100, p = 0.005), and patients with longer duration of infertility were 1.1 more likely to be infertile than patients with shorter infertility duration (95% CI: 0.995 – 1.187, p = 0.010). Of the microbes, 33.9% and 22.2% were isolated in the high vaginal and endocervical swabs of participants with tubal pathologies. CONCLUSION: Increasing age, infertility duration, and genital microbes are significant risk factors for tubal infertility; hence, their prompt evaluation is essential. [ABSTRACT FROM AUTHOR]

Objective: Evaluation of hysteroscopic and laparoscopic findings in subfertile women predictive of tuberculosis. Design: Retrospective case series analysis. Setting: Tertiary hospital in India. Population: A retrospective analysis of 16 784 subfertile women who had undergone diagnostic hysterolaparoscopy (DHL) was conducted between February 2014 and June 2021. Methods: Histopathological evidence, acid‐fast bacilli (AFB), culture and GeneXpert MTB/RIF assay were used to diagnose female genital tuberculosis (FGTB). Various hysteroscopic and laparoscopic findings were analysed, and a binary logistic regression assessed associations between these findings and positive diagnostic outcomes. Main outcome measures: Various hysteroscopic and laparoscopic findings correspond to tubercular manifestation. Results: Of the 16,784 patients, 1083 had hysteroscopy and laparoscopy findings suggestive of tuberculosis, and 309 were diagnosed with FGTB based on diagnostic tests. Logistic regression identified variables strongly predictive of positive status outcomes; tuberculous abdomino‐pelvic adhesions of various grades, isthmo‐ampullary block, tubercle, tubo‐ovarian mass, tuberculous hydrosalpinx, complete tubal destruction, tubal diverticula and rigid tube emerged as strong predictors. Conclusions: Logistic regression‐derived predictors, alongside specific laparoscopic and hysteroscopic findings, can enhance diagnostic accuracy and clinical decision‐making to start antitubercular therapy in subfertile women. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Obstetrics & Gynecology is the property of Galenos Yayinevi Tic. LTD. STI 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.)

Terminal tubal obstruction with formation hydrosalpinx results in cellular deciliation, hormone receptor depletion and intraluminal scarring. Fluid secretion, blood flow, and muscular contractility are similarly progressively affected to varying degrees. Intraluminal epithelial damage is best assessed by salpingoscopy or microsalpingoscopy and extratubal pathology by laparoscopy. Hydrosalpinges with severe intratubal pathology require excision and IVF management for fertility. Restorative salpingostomy can be considered at a single endoscopic procedure when salpingoscopy severity scale indicates mild or no significant change. The role of reproductive surgery should be considered complementary to IVF allowing infertile couples the possibility of recurring natural conception.

Purpose: Our study aimed to investigate the best time to manage hydrosalpinx to improve pregnancy outcomes during in vitro fertilization–embryo transfer (IVF–ET). Methods: Patients with hydrosalpinx who received IVF treatment were analyzed retrospectively. And two groups were included to compare the effects of different timing treatment of hydrosalpinx on IVF pregnancy outcomes, "Proximal Tubal Occlusion First Group" (Group Ligation-COH) and "Oocyte Retrieval First Group" (Group COH-Ligation). The main outcome measures included: ovarian response indexes, laboratory indexes and clinical pregnancy outcomes. Univariate and multivariate Logistic regression analysis was performed for outcome indicators, and the odds ratios (OR) and 95% confidence interval (CI) were used. Results: A total of 1490 patients were included (n = 976 Ligation-COH and n = 514 COH-Ligation). The Gn starting dose and MII rate in group Ligation-COH were significantly higher than those in group COH-Ligation (203.33 ± 58.20 vs. 203.33 ± 58.20, 81.58% vs. 80.28%, P < 0.05). The number of oocytes obtained and the number of available D3 embryos in group COH-Ligation were higher than those in group Ligation-COH (15.10 ± 7.58 vs. 13.45 ± 6.42, 10.92 ± 5.81 vs. 9.94 ± 5.15, P < 0.05). Although the number of ET cycles per IVF cycle in group COH-Ligation was higher than that in group Ligation-COH (1.88 ± 1.00 vs. 1.48 ± 0.70, P < 0.05), the biochemical pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, live birth rate and cumulative live birth rate in group Ligation-COH were significantly higher than those in group COH-Ligation (60.83% vs. 46.27% for biochemical pregnancy, 55.69% vs. 38.5% for clinical pregnancy, 26.18% vs. 17.74% for multiple pregnancy, 47.08% vs. 25.26% for live birth, 69.47% vs. 47.47% for cumulative live birth, P < 0.05), and the miscarriage rate in group Ligation-COH was lower than that in group COH-Ligation (10.47% vs. 17.20 for early abortion, 4.49% vs. 15.86% for late abortion, P < 0.05). In logistic regression analysis, after adjustment for age and multiple factors, the above results were still statistically significant differences (P < 0.001). For elderly patients, the clinical pregnancy rate, multiple birth rate and live birth rate in group Ligation-COH were also higher than those in group COH-Ligation (P < 0.001). No significant differences were detected for patients with diminished ovarian reserve. Conclusions: For the choice of ligation operation time, we recommend that patients choose tubal ligation first and then ovulation induction and oocyte retrieval treatment. [ABSTRACT FROM AUTHOR]

It is unclear whether clinical background differs between endometriosis in adolescent patients with obstructive Müllerian anomalies and those without anomalies. The aim of the study is to identify the difference in clinical characteristics of endometriosis in patients with or without obstructive Müllerian anomalies. The study involved 12 patients aged under 24 years old who underwent primary surgery for obstructive Müllerian anomalies and 31 patients aged under 24 years old who underwent surgery for ovarian endometrioma. A total of 6 out of 12 cases with obstructive Müllerian anomalies developed endometriosis (4 Herlyn–Werner–Wunderlich syndrome, 2 non-communicating functional uterine horn, 2 cervical aplasia). The age at surgery was significantly younger in endometriosis with obstructive Müllerian anomalies, compared with those without obstructive Müllerian anomalies (17.8 ± 4.4 vs. 23.1 ± 1.3, p = 0.0007). The rate of endometrioma was 50.0% and the rate of hydrosalpinx was significantly higher (66.7% vs. 0%, p = 0.0002) in the group of obstructive Müllerian anomalies. The recurrence rate of endometriosis was 20.0% in the group of anomalies and 25.9% in the group of those without anomalies. Adolescent patients with obstructive Müllerian anomalies more easily developed endometriosis and co-occurred with higher rate of hematosalipinx. [ABSTRACT FROM AUTHOR]

Abstract Background Interstitial pregnancy may still happen even after ipsilateral salpingectomy, resulting in massive hemorrhage. Therefore, the purpose of the study is to identify risk factors associated with interstitial pregnancy following ipsilateral salpingectomy and discuss possible prevention. Methods We conducted a retrospective cohort study in a single, large, university-affiliated hospital. Data of 29 patients diagnosed with interstitial pregnancy following ipsilateral salpingectomy from January 2011 to November 2020 were assigned into the case group (IP group). Whereas there were 6151 patients with intrauterine pregnancy after unilateral salpingectomy in the same period. A sample size of 87 control patients was calculated to achieve statistical power (99.9%) and an α of 0.05. The age, BMI and previous salpingectomy side between the two group were adjusted with PSM at a ratio of 1:3. After PSM, 87 intrauterine pregnancy patients were successfully matched to 29 IP patients. Results After PSM, parous women were more common and intrauterine operation was more frequent in the IP group compared with control group (P

Hydrosalpinx is a fluid occlusion and distension of the fallopian tubes, often resulting from pelvic inflammatory disease, which reduces the success of artificial reproductive technologies (ARTs) by 50%. Tubal factors account for approximately 25% of infertility cases, but their underlying molecular mechanisms and functional impact on other reproductive tissues remain poorly understood. This proteomic profiling study applied sequential window acquisition of all theoretical fragment ion spectra mass spectrometry (SWATH-MS) to study hydrosalpinx cyst fluid and pre- and post-salpingectomy endometrial fluid. Among the 967 proteins identified, we found 19 and 17 candidate biomarkers for hydrosalpinx in pre- and post-salpingectomy endometrial fluid, respectively. Salpingectomy significantly affected 76 endometrial proteins, providing insights into the enhanced immune response and inflammation present prior to intervention, and enhanced coagulation cascades and wound healing processes occurring one month after intervention. These findings confirmed that salpingectomy reverses the hydrosalpinx-related functional impairments in the endometrium and set a foundation for further biomarker validation and the development of less-invasive diagnostic strategies for hydrosalpinx. [ABSTRACT FROM AUTHOR]

To explore suggestions for clinicians on the most effective treatment for hydrosalpinx undergoing IVF-ET. We reviewed 936 women with hydrosalpinx and 6715 tubal infertile women without hydrosalpinx who underwent IVF/ICSI between January 2014 and August 2019 in our center. Hydrosalpinx patients received different treatments including laparoscopic surgery (only salpingectomy and proximal tubal occlusion/ligation were included), ultrasonic-guided aspiration and hysteroscopic tubal occlusion. Outcomes were analyzed by One-way ANOVA, Chi-Square test and logistic regression. The live birth rate (LBR) of laparoscopic surgery was significantly higher compared with hydrosalpinx aspiration (48.3% vs 39.6%, p =.024). The cumulative live birth rate (CLBR) of subsequent laparoscopic surgery was significantly higher compared with subsequent hysteroscopic occlusion (65.1% vs 34.1%, p =.001) and no subsequent treatment (65.1% vs 44.9%, p <.005). Subsequent laparoscopic surgery significantly improved the CLBR of hydrosalpinx patients who received ultrasonic-guided aspiration and didn't get clinical pregnancy in fresh cycles (Odds Ratio (OR) =1.875; 95%CI = 1.041–3.378, p =.036). Laparoscopic surgery leads to significantly higher LBR than ultrasonic-guided aspiration and significantly higher CLBR than hysteroscopic occlusion and no treatment. [ABSTRACT FROM AUTHOR]

To assess whether post-hysterosalpingography evaluation was associated with pregnancy rate and to identify independent risk factors for pregnancy success after salpingostomy in patients with hydrosalpinx. A retrospective analysis was conducted on the clinical data of 47 patients diagnosed with hydrosalpingography (HSG) in our hospital from 2015 to 2018. These patients received laparoscopic surgery and another salpingography within 2 months after surgery. According to the fallopian tube conditions evaluated by HSG before and after surgery, the patients could be divided into two groups. According to the pregnancy rate and postoperative HSG of patients with hydrosalpinx after laparoscopy, the total pregnancy rate of the tubal improved group was 65.62%, while that of the non-improved group was 20%, with statistical significance (p < 0.05). We found that hysterosalpingography after salpingostomy in patients with hydrosalpinx can provide reference for clinical treatment and improve the prognosis of patients. Postoperative HSG improvement was an independent risk factor for pregnancy rate in patients with hydrosalpinx after laparoscopic surgery. What is already known on this subject? Fallopian tube obstruction is an important cause of female infertility. Current studies have shown that most spontaneous pregnancies in patients with hydrosalpinx after salpingostomy occur within 18 months, however, pregnancy rates and outcomes vary from report to report. What do the results of this study add? Many studies have shown that hydrosalpinx reduces the success rate of natural pregnancy and embryo transfer, but the mechanism of hydrosalpinx affecting pregnancy remains unclear. This study explored the mechanism of successful pregnancy through hysterosalpingography after salpingostomy in patients with hydrosalpinx. What are the implications of these findings for clinical practice and/or further research? To evaluate the prognosis of patients with hydrosalpinx after laparoscopic salpingostomy by hysterosalpingography (HSG), and to reflect the improvement according to the postoperative pregnancy rate of the patients. To provide clinical personalized treatment plan. [ABSTRACT FROM AUTHOR]

Background: Interstitial pregnancy may still happen even after ipsilateral salpingectomy, resulting in massive hemorrhage. Therefore, the purpose of the study is to identify risk factors associated with interstitial pregnancy following ipsilateral salpingectomy and discuss possible prevention. Methods: We conducted a retrospective cohort study in a single, large, university-affiliated hospital. Data of 29 patients diagnosed with interstitial pregnancy following ipsilateral salpingectomy from January 2011 to November 2020 were assigned into the case group (IP group). Whereas there were 6151 patients with intrauterine pregnancy after unilateral salpingectomy in the same period. A sample size of 87 control patients was calculated to achieve statistical power (99.9%) and an α of 0.05. The age, BMI and previous salpingectomy side between the two group were adjusted with PSM at a ratio of 1:3. After PSM, 87 intrauterine pregnancy patients were successfully matched to 29 IP patients. Results: After PSM, parous women were more common and intrauterine operation was more frequent in the IP group compared with control group (P<0.05). There was only one patient undergoing IVF-ET in the IP group as compared with 29 cases in the control group (3.4% vs. 33.3%, P<0.05). Salpingectomy was performed on 5 patients in the IP group and 4 patients in the control group due to hydrosalpinx (P<0.05). Logistic regression indicated that hydrosalpinx was the high risk factor of interstitial pregnancy following ipsilateral salpingectomy (OR = 8.175). Conclusions: Hydrosalpinx appears to be an independent factor contributing to interstitial pregnancy following ipsilateral salpingectomy in subsequent pregnancy. [ABSTRACT FROM AUTHOR]

Abstract Background Hydrosalpinx may decrease implantation and pregnancy rates after embryo transfer. Laparoscopic tubal ligation after embryo freeze and before frozen-thawed embryo transfer (FET) is effective at improving reproductive outcomes for hydrosalpinx patients. This study is to find out the optimal interval between laparoscopic tubal ligation and FET. Methods We retrospectively analyzed 259 infertile women who performed laparoscopic tubal ligation for embryo freeze and FET. Participants were divided into three groups, based on the interval between laparoscopic tubal ligation and FET. Group I: 60 days. Outcomes of cleavage-stage and blastocyst-stage embryo FET were analyzed respectively. Results There was no significant difference in clinical pregnancy rate, live birth rate, implantation rate, biochemical pregnancy rate, ectopic pregnancy rate, miscarriage rate and preterm birth rate among the three groups, in both cleavage-stage and blastocyst-stage embryo FET cycles. In cleavage-stage embryo FET cycle, singleton gestational age was significantly younger in group III (38.11 ± 2.28 weeks) compared with group I (39.29 ± 1.06 weeks, P = 0.001) and group II (38.96 ± 1.05, P = 0.026). Singleton birth weight was significantly heavier in group II (3.65 ± 0.32 Kg) compared with group I (3.38 ± 0.29 Kg, P = 0.001) and group III (3.35 ± 0.60 Kg, P = 0.004). Twin birth weight was significantly heavier in group III (2.72 ± 0.43 Kg) compared to group I (2.23 ± 0.67 Kg, P = 0.002). In blastocyst-stage embryo FET cycles, twin gestational age was significantly younger in group II (34.07 ± 3.18 weeks) compared with group I (35.56 ± 2.27 weeks, P = 0.049) and group III (36.50 ± 1.47 weeks, P = 0.005). Twin birth weight was significantly heavier in group III (2.71 ± 0.39 Kg) compared to group II (2.39 ± 0.67 Kg, P = 0.009). Conclusions The duration of the interval between laparoscopic tubal ligation and FET does not affect the reproductive outcomes; however, it may affect the neonate outcomes to some extent.

Hydrosalpinx is a common condition in women of reproductive age that correlates with infertility. A ureterocele is a dilatation of the terminal ureter within the bladder and/or urethra that occurs seldomly in adults, but can sonographically be mistaken for a hydrosalpinx. We report of a 29-year-old patient (G2/P1) who was referred in our department with secondary infertility and suspicion of hydrosalpinx. Intraoperatively, no hydrosalpinx could be visualized. Postoperatively, an intravesical cystic mass was detected, alongside a second-degree urinary retention. Sonographically, a double kidney on the left side and an accentuated calyx system could be diagnosed. Ureteroceles seem to represent a rare but still possible differential diagnosis in suspected hydrosalpinx, given the similar sonographic presentation of both conditions. [ABSTRACT FROM AUTHOR]

Objective·To compare the pregnancy outcomes of infertile women with bilateral severe hydrosalpinx receiving neosalpingostomy or salpingectomy.Methods·The single-center prospective cohort study from 2005 to 2012 focused on pregnancy outcomes of infertile women aged 20‒40 years, with bilateral severe hydrosalpinx, undergoing bilateral neosalpingostomy or salpingectomy in International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine. The choice for treatment was based on a shared decision approach, and the participants were divided into the neosalpingostomy group and salpingectomy group. After registration of baseline characteristics, including age, birth place, reproductive history, preoperative hysterosalpingography results, surgical findings, and pregnancy outcomes, women were followed up on an annual basis until July 2020 for the occurrence of live birth by outpatient follow-up or telephone questionnaire. Intention-to-treat analysis and per-protocol analysis were applied to compare the pregnancy outcomes. Kaplan-Meier analysis and COX proportional hazard model were used to analyze the reproductive outcomes. In addition, subgroup analysis was performed based on age stratification. The main outcome measures were live birth rate, cumulative live birth rate, and factors affecting live birth. Secondary outcome measures included the mode of conception, time to live birth, biochemical pregnancy rate, clinical miscarriage rate, and ectopic pregnancy rate.Results·A total of 113 women were included in the analysis, 58 women underwent bilateral neosalpingostomy, and 55 women underwent bilateral salpingectomy. The study demonstrated that in infertile women with bilateral severe hydrosalpinx, bilateral salpingectomy achieved higher cumulative live birth rate than bilateral neosalpingostomy (76.36% vs 62.07, HR=2.18,95%CI 1.37‒3.45). In the neosalpingostomy group, 34.48% (20/58) live births were obtained after in vitro fertilization treatment, and 27.59% (16/58) live births were obtained through spontaneous conception which mainly occurred within 3 years after initial neosalpingostomy, while all live births in the salpingectomy group were obtained after assisted reproductive therapy. However, the risk of ectopic pregnancy was higher in the neosalpingostomy group than that in the salpingectomy group (20.69% vs 1.82%, P

Abstract 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/m2). 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.

Adnexal torsion is a common gynecological emergency and a significant cause of acute pelvic pain in women. Hydrosalpinx-induced torsion of the adnexa is a rare situation and requires prompt and accurate management. Twenty-three years old nulliparous woman admitted in our structure for acute pelvic pain. The ultrasound revealed an enlarged right ovary with an adnexal cystic mass. We suspected the diagnosis of a right adnexal torsion due to cystic ovarian mass. Laparotomy revealed torsion of the right adnexa and a second large mass appearing to be a hydrosalpinx. Diagnosis of adnexal torsion is difficult and is based on a range of arguments obtained by anamnesis, clinical examination, ultrasonography and other investigations. Early diagnosis is important for preserving tubal and ovarian function, given the risk of ovarian necrosis in young women. Laparoscopy is the gold standard for diagnosing and treating adnexal torsion. The treatment can be conservative or radical, consisting of detorsion of the twisted adnexa, with or without adnexectomy.

Aims To explore suggestions for clinicians on the most effective treatment for hydrosalpinx undergoing IVF-ET.Materials and Methods We reviewed 936 women with hydrosalpinx and 6715 tubal infertile women without hydrosalpinx who underwent IVF/ICSI between January 2014 and August 2019 in our center. Hydrosalpinx patients received different treatments including laparoscopic surgery (only salpingectomy and proximal tubal occlusion/ligation were included), ultrasonic-guided aspiration and hysteroscopic tubal occlusion. Outcomes were analyzed by One-way ANOVA, Chi-Square test and logistic regression.Results The live birth rate (LBR) of laparoscopic surgery was significantly higher compared with hydrosalpinx aspiration (48.3% vs 39.6%, p = .024). The cumulative live birth rate (CLBR) of subsequent laparoscopic surgery was significantly higher compared with subsequent hysteroscopic occlusion (65.1% vs 34.1%, p = .001) and no subsequent treatment (65.1% vs 44.9%, p

To assess whether post-hysterosalpingography evaluation was associated with pregnancy rate and to identify independent risk factors for pregnancy success after salpingostomy in patients with hydrosalpinx. A retrospective analysis was conducted on the clinical data of 47 patients diagnosed with hydrosalpingography (HSG) in our hospital from 2015 to 2018. These patients received laparoscopic surgery and another salpingography within 2 months after surgery. According to the fallopian tube conditions evaluated by HSG before and after surgery, the patients could be divided into two groups. According to the pregnancy rate and postoperative HSG of patients with hydrosalpinx after laparoscopy, the total pregnancy rate of the tubal improved group was 65.62%, while that of the non-improved group was 20%, with statistical significance (p

Background: Hydrosalpinx may decrease implantation and pregnancy rates after embryo transfer. Laparoscopic tubal ligation after embryo freeze and before frozen-thawed embryo transfer (FET) is effective at improving reproductive outcomes for hydrosalpinx patients. This study is to find out the optimal interval between laparoscopic tubal ligation and FET. Methods: We retrospectively analyzed 259 infertile women who performed laparoscopic tubal ligation for embryo freeze and FET. Participants were divided into three groups, based on the interval between laparoscopic tubal ligation and FET. Group I: <30 days; Group II: 31– 60 days; Group III: >60 days. Outcomes of cleavage-stage and blastocyst-stage embryo FET were analyzed respectively. Results: There was no significant difference in clinical pregnancy rate, live birth rate, implantation rate, biochemical pregnancy rate, ectopic pregnancy rate, miscarriage rate and preterm birth rate among the three groups, in both cleavage-stage and blastocyst-stage embryo FET cycles. In cleavage-stage embryo FET cycle, singleton gestational age was significantly younger in group III (38.11 ± 2.28 weeks) compared with group I (39.29 ± 1.06 weeks, P = 0.001) and group II (38.96 ± 1.05, P = 0.026). Singleton birth weight was significantly heavier in group II (3.65 ± 0.32 Kg) compared with group I (3.38 ± 0.29 Kg, P = 0.001) and group III (3.35 ± 0.60 Kg, P = 0.004). Twin birth weight was significantly heavier in group III (2.72 ± 0.43 Kg) compared to group I (2.23 ± 0.67 Kg, P = 0.002). In blastocyst-stage embryo FET cycles, twin gestational age was significantly younger in group II (34.07 ± 3.18 weeks) compared with group I (35.56 ± 2.27 weeks, P = 0.049) and group III (36.50 ± 1.47 weeks, P = 0.005). Twin birth weight was significantly heavier in group III (2.71 ± 0.39 Kg) compared to group II (2.39 ± 0.67 Kg, P = 0.009). Conclusions: The duration of the interval between laparoscopic tubal ligation and FET does not affect the reproductive outcomes; however, it may affect the neonate outcomes to some extent. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical characteristics of isolated fallopian tube torsion (IFTT). Methods: The clinical data of 27 IFTT patients, admitted to Peking University Third Hospital during January 2017 to December 2021, were retrospectively analyzed. Results: ①Clinical characteristics: 22 women of childbearing age, and 7 women experienced the onset of IFTT during pregnancy. Twenty-four patients presented with abdominal pain as the primary symptom, and 3 patients were diagnosed IFTT during surgery. ② Examination, surgery and pathology: All patients underwent preoperative ultrasound examination, suggested tortuosity or cystic anechogenicity in the adnexal area. More specifically, 21 patients were operated laparoscopic surgery, while 6 patients underwent laparotomy. The choice of whether to preserve the fallopian tube depends on patient′s fertility requirements and where the torsion site. Of the 16 patients who had given birth, 2 cases of mesosalpinx cyst torsion preserved fallopian tubes, and the rest of them underwent salpingectomy. In the 11 cases who did not give birth, salpingectomy was performed in 3 patients of hydrosalpinx who scheduled to undergo assisted reproductive technology assisted pregnancy, and the rest of them were preserved fallopian tubes. The pathological findings were consistent with preoperative ultrasonography, suggesting hydrosalpinx or benign cysts in the fallopian tubes. ③There were seven IFTT patients during pregnancy, two were diagnosed during the second trimester pregnancy and five in the third trimester pregnancy. One patient was operated laparoscopic surgery, while the other six underwent laparotomy. However, all seven patients presented mesosalpinx cyst torsion. Three patients were treated with mesothelial cystectomy, with the fallopian tube retained, while four patients were treated with salpingectomy. All neonates showed good outcome. Conclusions: If women of childbearing age with hydrosalpinx and mesosalpinx cysts report sudden abdominal pain, the possibility of IFTT should be considered. Early diagnosis and treatment can avoid fallopian tube torsion and necrosis to preserve the patient′s ability to conceive naturally. The decision to keep the fallopian tube should be determined according to the patient′s fertility requirements and the site and degree of fallopian tube torsion. [ABSTRACT FROM AUTHOR]

Acute abdomen in women of child-bearing age remains a diagnostic dilemma. Etiology of acute abdominal pain may be due to obstetric, gynecological, gastrointestinal, or genitourinary causes. Early diagnosis and decision on conservative management versus emergency laparotomy/laparoscopy should be made in cases with acute abdomen as a lifesaving approach. We report a rare case of acute abdomen with hemoperitoneum due to rupture of hydrosalpinx.

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 Pgp3W234Amutant 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. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 11-year-old nonverbal girl with a genetic anomaly who presented to the emergency department with symptoms of fever, abdominal pain, and increased urinary frequency. Topics discussed include the diagnosis and management of bilateral hydrosalpinx with concurrent tubal torsion in a presexual female population, as well as the challenges in diagnosing and treating adnexal pathology in bedridden patients.

Malignant peritoneal mesothelioma is a rare and extremely malignant tumor. It is difficult for clinicians to diagnose early for its insidious onset and lack of specific clinical manifestations, laboratory indicators and imaging characteristics. At present, the accurate diagnosis dependes on the pathological examination and immunochemistry. In this paper, we report a case of malignant peritoneal mesothelioma found by the laparoscopic surgery due to "hydrofallopian tube". This is a female patient of childbearing age who had primary infertility for 3 years. The patient had no history of asbestos exposure, unclear etiology, atypical clinical manifestations. The diagnosis of malignant peritoneal mesothelioma was very difficult before histopathological examination. We analyze retrospectively the medical records of the patient and review of the previous literature. We explore the etiology, diagnosis and treatment of malignant peritoneal mesothelioma and enhance clinicians′ comprehension. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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) 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. 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. [ABSTRACT FROM AUTHOR]

Isolated fallopian tube anomalies are a rare group of disorders, usually observed in otherwise asymptomatic patients. If symptomatic, the patients may present with infertility or unspecified abdominal pains. Various aetiologies have been proposed to explain this phenomenon, ranging from congenital to vascular events. Diagnosis is very challenging because in most cases those abnormalities are not easily seen on ultrasound, computed tomography, or even magnetic resonance imaging. The most objective and certain diagnosis, however, can be obtained through laparoscopy with an associated histopathological examination performed if necessary. Management of this rare group of disorders remains unclear - because the number of cases is relatively small, there is no consensus on treatment. We present a case of a 22-year-old woman with no relevant clinical history and no sexual activity with large bilateral hydrosalpinx that developed as a result of bilateral distal fallopian tube segmental absence with associated occlusion and concomitant endometriotic implants in the vicinity of the left ovarian fossa and the peritoneum of the rectouterine pouch. To our best knowledge, only a few similar cases have been described in the literature. We summarise the available descriptions of this group of pathologies, present theories that have been proposed to explain this phenomenon, and provide various classifications of those disorders. [ABSTRACT FROM AUTHOR]

Background and Aim: Even though the fallopian tubes are commonly encountered surgical specimens in histopathology, there exists a paucity of data that describe the incidence and types of pathologies that can be encountered in the fallopian tubes. The present study was taken up as a small attempt to bridge this gap and describe the various fallopian tube lesions which can be encountered in routine practice. Materials and Methods: The fallopian tubes that were received, either separately or as a part of other gynecological specimens, during the 5-year study were included. Specimens were routinely fixed, processed and sectioned. The Sectioning and Extensively Examining the Fimbriated End of the fallopian tube protocol for grossing was used in cases associated with malignancies. Results: A total of 5256 fallopian tubes were received from 3258 patients during the study. The age ranged between 12 and 70 years. The most common clinical indication for salpingectomy in the present study was uterus related (51.9%). Of the total 5256 fallopian tubes examined, 29.8% tubes showed some pathology. The most common clinically diagnosed tubal pathology, in the present study, was tubal ectopic gestation. The most common clinically undiagnosed finding was hydrosalpinx. Conclusion: It is essential to extensively gross and microscopically examine all fallopian tube specimens to identify precursor lesions and help in patient workup and treatment. [ABSTRACT FROM AUTHOR]

Objective: This research was conducted to clarify the clinical background, incidence, radiologic characteristics, and surgical and pathologic diagnosis of isolated fallopian-tube torsion (IFTT), with its potential classification into 3 subtypes. Materials and Methods: This retrospective observational study of 19 cases of IFTT was for a 15-year time period. For a comparative study, records for 19 consecutive recent cases of tubo-ovarian torsion were extracted. IFTT cases were classified into 3 subtypes based on laparoscopic findings: Type 1 (organoaxial form), wherein IFTT occurs along the longitudinal axis without a leading mass; Type 2 (organoaxial form), wherein IFTT occurs along the longitudinal axis with a leading mass; and Type 3 (mesenteroaxial form), wherein IFTT occurs around the short axis. Results: Adnexal torsions were confirmed via laparoscopic surgery in 183 cases. Tubo-ovarian torsion and IFTT were diagnosed in 164 (89.6%) and 19 (10.4%) cases, respectively. The median diameter of the masses measured by ultrasonography was shorter in IFTT (6.1 cm) than in tubo-ovarian torsion (10.7 cm). IFTT occurred more frequently on the right side (12 cases) than on the left side (7 cases). Tubal conservation was possible by paratubal cystectomy after detorsion. Types 1, 2, and 3 of IFTT were identified in 2, 16, and 1 cases, respectively. Conclusions: IFTT is a challenge in diagnosis and management; however, IFTT should be recognized as a more-frequently encountered condition. Type 2 IFTT with paratubal cyst is the most-frequent; hydrosalpinx can cause Types 1 and 3 IFTT. (J GYNECOL SURG 39:135) [ABSTRACT FROM AUTHOR]

Introduction: To explore the role of IL‐6/JAK/STAT signaling in tubal infertility. Methods: The fimbriae tissues of 14 patients with a history of infertility and hydrosalpinx and 14 patients with no history of infertility and no fallopian tube disease were collected. The tissues were then divided into hydrosalpinx group and control group followed by analysis of the protein expression of key factors in the IL‐6/JAK/STAT signaling by immunohistochemistry and Western blot. Results: Immunohistochemical staining showed significantly higher level of IL‐6, JAK1, p‐JAK1, JAK2, p‐JAK2, STAT1, p‐STAT1, STAT3, and p‐STAT3 in hydrosalpinx group than those in control group with IL‐6 being mainly located in the cytoplasm and p‐JAK2, STAT1, p‐STAT1, STAT3, and p‐STAT3 in the cytoplasm and nucleus. JAK1 and p‐JAK1 was mainly located in the cytoplasm and JAK2 is in the cytoplasm and nucleus without difference of their expression between two groups. Consistently, hydrosalpinx group presented significantly higher protein levels of IL‐6, JAK1, p‐JAK1, JAK2, p‐JAK2, STAT1, p‐STAT1, STAT3, and p‐STAT3 than control group without difference of JAK1, p‐JAK1, JAK2 level. Conclusion: The activation of IL‐6/JAK2/STAT1 and STAT3 signaling pathways are found in the hydrosalpinx in infertile patients, indicating that they might be involved in the pathogenesis of hydrosalpinx. [ABSTRACT FROM AUTHOR]

Objective ·To compare the pregnancy outcomes of infertile women with bilateral severe hydrosalpinx receiving neosalpingostomy or salpingectomy. Methods ·The single-center prospective cohort study from 2005 to 2012 focused on pregnancy outcomes of infertile women aged 20-40 years, with bilateral severe hydrosalpinx, undergoing bilateral neosalpingostomy or salpingectomy in International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine. The choice for treatment was based on a shared decision approach, and the participants were divided into the neosalpingostomy group and salpingectomy group. After registration of baseline characteristics, including age, birth place, reproductive history, preoperative hysterosalpingography results, surgical findings, and pregnancy outcomes, women were followed up on an annual basis until July 2020 for the occurrence of live birth by outpatient follow-up or telephone questionnaire. Intention-to-treat analysis and per-protocol analysis were applied to compare the pregnancy outcomes. Kaplan-Meier analysis and COX proportional hazard model were used to analyze the reproductive outcomes. In addition, subgroup analysis was performed based on age stratification. The main outcome measures were live birth rate, cumulative live birth rate, and factors affecting live birth. Secondary outcome measures included the mode of conception, time to live birth, biochemical pregnancy rate, clinical miscarriage rate, and ectopic pregnancy rate. Results ·A total of 113 women were included in the analysis, 58 women underwent bilateral neosalpingostomy, and 55 women underwent bilateral salpingectomy. The study demonstrated that in infertile women with bilateral severe hydrosalpinx, bilateral salpingectomy achieved higher cumulative live birth rate than bilateral neosalpingostomy (76.36% vs 62.07, HR=2.18,95%CI 1.37-3.45). In the neosalpingostomy group, 34.48% (20/58) live births were obtained after in vitro fertilization treatment, and 27.59% (16/58) live births were obtained through spontaneous conception which mainly occurred within 3 years after initial neosalpingostomy, while all live births in the salpingectomy group were obtained after assisted reproductive therapy. However, the risk of ectopic pregnancy was higher in the neosalpingostomy group than that in the salpingectomy group (20.69% vs 1.82%, P<0.001). No statistically significant differences regarding biochemical pregnancy and clinical miscarriage between the two groups were found. During the subgroup analysis, the cumulative live birth rate of the salpingectomy group (n=51) was significantly higher than that of the neosalpingostomy group (n=48) in women younger than 35 years old (HR=2.25, 95%CI 1.39-3.66), while between two groups of women aged 35 years old or older, there was no statistically significant difference in the cumulative live birth rate (HR=1.60, 95%CI 0.36-7.19). In addition, after adjustment for confounding factors including age, previous abortion history, fibroid, benign ovarian cyst, and endometriosis, COX proportional hazard analysis revealed that salpingectomy was positively correlated to live birth compared with neosalpingostomy (aHR=1.94, 95%CI 1.18-3.18). Conclusion ·For infertile women with bilateral severe hydrosalpinx, neosalpingostomy provides the possibility for spontaneous conception but also brings about certain risk of ectopic pregnancy. Bilateral salpingectomy can achieve higher cumulative live birth rate while receiving postoperative in vitro fertilization treatment. [ABSTRACT FROM AUTHOR]

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/m2). 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. [ABSTRACT FROM AUTHOR]

• Chronic endometritis causes recurrent implantation failure and pregnancy loss. • Conventional chronic endometritis treatment involves the use of strong antibiotics. • Pathological fluid via fallopian tube maybe the cause of chronic endometritis. • Laparoscopically correcting the tube and adhesion improves chronic endometritis. To assess the prevalence of chronic endometritis (CE) in patients with infertility and hydrosalpinx or peritubal adhesions and to examine the effects of laparoscopic surgical correction (LSC) on CE and pregnancy rates post in vitro fertilization and embryo transfer (IVF-ET). This is a retrospective cohort study at private IVF-ET centers. A total of 438 patients, known to have hydrosalpinx (n = 194) or peritubal adhesions (n = 244), and undergoing IVF treatment between April 1, 2018 and September 30, 2020 were included in the study. Hysterosalpingography, magnetic resonance imaging, and transvaginal ultrasonography were used to diagnose the hydrosalpinx or peritubal adhesions. Laparoscopic examination and surgical correction were performed on patients with CE. IVF-ET was performed after recovery from LSC. CE was present in 45.9% of patients (89/194) with hydrosalpinx and 14.3% with peritubal adhesions (35/244). All the 89 patients with CE and hydrosalpinx underwent laparoscopic salpingostomy and/or fimbrioplasty, and 64 (71.9%) further underwent proximal tubal occlusion. All the 35 patients with CE and peritubal adhesions underwent laparoscopic adhesiolysis and/or fimbrioplasty, and 19 (54.3%) further underwent proximal tubal occlusion. CD138 PC levels after LSC decreased to < 5 in 70 of 124 patients (56.5%) in one menstrual cycle and decreased to < 5 in all cases within 6 months. Of the 66 patients who underwent a single blastocyst transfer, 57 delivered (cumulative live birth rate (LBR): 86.3%). The cumulative LBR of patients treated for CE with LSC (86.3%) was significantly different from those given antibiotic therapy (320 patients; 38.4%; p <.0001) and the CD138-negative groups (811; 31.8%; p <.0001). CE is prevalent in patients with hydrosalpinx and/or peritubal adhesions who present with infertility. LSC improved CE without antibiotic therapy, improving the CP and LBR after IVF-ET. [ABSTRACT FROM AUTHOR]

Endometrial receptivity array (ERA)—an objective tool used in assisted reproductive technology—is used for personalized embryo transfer in in vitro fertilization. Hydrosalpinx affects implantation through various mechanisms. However, its effects on ERA are not well established. In this case report, we present the diagnosis and treatment of a 34-year-old nulligravida woman with infertility for two years, obesity, double uterus with unilateral hydrosalpinx and right kidney deficiency. Based on ERA results, endometrial microbiome metagenomic analysis (EMMA), analysis of infectious chronic endometritis (ALICE), and CD138 immunostaining, the patient was treated with hormonal replacement cycle and amoxicillin/clavulanic acid. After one week of amoxicillin/clavulanic acid administration, the vitirified-warmed 4AA blastocyst was transferred to the left uterus—which was absent of hydrosalpinx and easily accessible to transfer and pregnancy was achieved. To the best of our knowledge, this case study is the first one in which we found that there were no differences between the left and right uterus in ERA, EMMA, ALICE, and CD138 immunostainings. Hence, we suggest that hydrosalpinx does not necessarily cause endometrial changes in all cases. Further research to evaluate the effects of hydrosalpinx on implantation with ERA and EMMA/ALICE is warranted.

Plain English summary Our study indicates that interventional embolization of hydrosalpinx is one of the preferred clinical treatments for hydrosalpinx. More studies are warranted to investigate the short- and long-term effects of interventional embolization on the outcomes of pregnant women and neonates, which may provide more information about the management of hydrosalpinx.

Abstract 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

Chlamydia trachomatis is one of the most common sexually infections that cause infertility, and its genital infection induces tubal adhesion and hydrosalpinx. Intravaginal Chlamydia muridarum infection in mice can induce hydrosalpinx in the upper genital tract and it has been used for studying C. trachomatis pathogenicity. DBA2/J strain mice were known to be resistant to the chlamydial induction of hydrosalpinx. In this study, we took advantage of this feature of DBA2/J mice to evaluate the role of antibiotic induced dysbiosis in chlamydial pathogenicity. Antibiotics (vancomycin and gentamicin) were orally administrated to induce dysbiosis in the gut of DBA2/J mice. The mice with or without antibiotic treatment were evaluated for gut and genital dysbiosis and then intravaginally challenged by C. muridarum. Chlamydial burden was tested and genital pathologies were evaluated. We found that oral antibiotics significantly enhanced chlamydial induction of genital hydrosalpinx. And the antibiotic treatment induced severe dysbiosis in the GI tract, including significantly reduced fecal DNA and increased ratios of firmicutes over bacteroidetes. The oral antibiotic did not alter chlamydial infection or microbiota in the mouse genital tracts. Our study showed that the oral antibiotics-enhanced hydrosalpinx correlated with dysbiosis in gut, providing the evidence for associating gut microbiome with chlamydial genital pathogenicity. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the concentrations of the nuclear factor kappa B (NF-κB), tumor necrosis factor-alpha (TNF-α) and interleukin-7 (IL-7) in midluteal phase endometrial samples of infertile patients diagnosed with uni or bilateral hydrosalpinx (HX). PATIENTS AND METHODS: A total of 24 patients who decided to undergo laparoscopic salpingectomy were included in the study. Salpingectomy indications consisted of patients with a diagnosis of hydrosalpinx (n=12) or ectopic pregnancy (n=12). Twelve healthy patients who underwent Pomeroy-type tubal ligation were considered as the second and healthy control group. The diagnosis of hydrosalpinges was made by transvaginal 2D ultrasonography or HSG. All patients in the hydrosalpinges or ectopic pregnancy group underwent laparoscopic salpingectomy. Just before salpingectomy, endometrial samples were obtained from all patients by Pipelle cannula. Endometrial sampling was performed 7-9 days after the LH surge in the control group. IL-7, NF-κB and TNF-α concentrations were measured by ELISA method in the endometrial samples of all three groups. RESULTS: The endometrial IL-7 concentration before salpingectomy of the patients in the hydrosalpinx group was 44.6±6.65 ng/mg wet-tissue. The IL-7 levels of the HX group were significantly higher than those of the patients in the ectopic pregnancy group (19.3±3.06 ng/mg wet tissue versus 44.6±6.65 ng/mg wet tissue, p<0.04). Similarly, IL-7 levels of the HX group were significantly higher than those of the tubal ligation group (6.08±1.48 ng/mg wet tissue vs. 44.6±6.65 ng/mg wet tissue, p<0.03). The endometrial TNF-α concentration of the patients in the hydrosalpinx group was 33.20±5.40 ng/mg wet-tissue. The TNF-α value detected in the hydrosalpinx group was significantly higher than both the TNF-α value in the ectopic pregnancy group (11.8±1.07 ng/mg wet-tissue vs. 33.20±5.40 ng/mg wet-tissue, p<0.01) and the TNF-α value in the tubal ligation group (5.30±1.22 ng/mg wet-tissue vs. 33.20±5.40 ng/mg wet-tissue, p<0.01). The pre-salpingectomy endometrial NF-κB concentration of the patients in the hydrosalpinx group was 6.38±1.40 ng/mg wet-tissue. This value is higher than endometrial NF-κB levels in the ectopic pregnancy group (3.67±0.41 ng/mg wet-tissue vs. 6.38±1.40 ng/mg wet-tissue, p<0.02) and NF-κB levels in the tubal ligation group (1.07±0.38 ng/mg wet-tissue vs. 6.38±1.40 ng/mg wet-tissue, p<0.01). CONCLUSIONS: The presence of hydrosalpinx prevents successful implantation by increasing the levels of endometrial proinflammatory cytokines TNF-α, IL-7 and NF-κB. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to investigate the effect of laparoscopic tubal disconnection for the management of hydrosalpinx before ICSI on ultrasonographic markers of endometrial receptivity, ovarian blood flow and volume. Methods Infertility treatment candidate women were divided into two groups, the hydrosalpinx group (HxG) and the non-hydrosalpinx group, totaling 120 women (nHxG). 60 women in the HxG experienced hydrosalpinx, whereas 60 women in the nHxG had unexplained infertility. LH levels in urine samples were used to identify an LH peak. On cycle day LH+6, the TVUS examination was solely done in the HxG. Laparoscopic tubal disconnection was then carried out. On day LH+6 of the cycle, which came before the ICSI cycle, the same ultrasonographic measurements were then collected in both groups. Outcome measures Uterine a. RI and PI, spiral a. RI and PI, ovarian a. RI and PI, endometrial thickness, pattern and volume, endometrial VI, FI and VFI and ovarian VI, FI, VFI and volume and zone of vascular penetration. Results We found no measurably massive contrasts between the two gatherings in the uterine a. RI and PI, winding a. RI and PI, ovarian a. RI and PI, endometrial thickness and volume (p=0.642), or the nHxG following tubal separation. endometrial VI (p=0.887), FI (p=0.646) and VFI (p=0.652) and ovarian VI (p=0.648), FI (p=0.646), VFI (p=0.638) and ovarian volume (p=0.646), endometrial example and zone of vascular infiltration. Conclusions Laparoscopic tubal disconnection has no significant effect on endometrial, subendometrial, uterine, ovarian blood flow, endometrial and ovarian volumes, endometrial pattern and zone of vascular penetration. [ABSTRACT FROM AUTHOR]

Hydrosalpinx is rare in childhood, and its pathogenesis may differ from that in reproductive‐aged women. Herein, we report a case of hydrosalpinx in a premenarcheal 14‐year‐old girl, which might be caused by thickening of the smooth muscle of the fallopian tube. The patient had recurrent right lower abdominal pain and was referred to our hospital with a suspected adnexal tumor. Laparoscopy revealed a hydrosalpinx with complete obstruction of the fimbria and scar‐like stenosis of the proximal ampulla. Right salpingectomy was performed because of a severe hydrosalpinx. As the patient was a virgin and a vaginal culture showed normal flora, ascending infection to the fallopian tube was not considered to be the cause of the hydrosalpinx. Histopathological examination revealed that the resected fallopian tube had a markedly dilated lumen with no inflammatory cell infiltration. Immunohistochemically, estrogen‐ and progesterone‐positive smooth muscle proliferation was found at the isthmus of the fallopian tube. [ABSTRACT FROM AUTHOR]

Hydrosalpinx is a fluid occlusion and distension of the fallopian tubes, often resulting from pelvic inflammatory disease, which reduces the success of artificial reproductive technologies (ARTs) by 50%. Tubal factors account for approximately 25% of infertility cases, but their underlying molecular mechanisms and functional impact on other reproductive tissues remain poorly understood. This proteomic profiling study applied sequential window acquisition of all theoretical fragment ion spectra mass spectrometry (SWATH-MS) to study hydrosalpinx cyst fluid and pre- and post-salpingectomy endometrial fluid. Among the 967 proteins identified, we found 19 and 17 candidate biomarkers for hydrosalpinx in pre- and post-salpingectomy endometrial fluid, respectively. Salpingectomy significantly affected 76 endometrial proteins, providing insights into the enhanced immune response and inflammation present prior to intervention, and enhanced coagulation cascades and wound healing processes occurring one month after intervention. These findings confirmed that salpingectomy reverses the hydrosalpinx-related functional impairments in the endometrium and set a foundation for further biomarker validation and the development of less-invasive diagnostic strategies for hydrosalpinx.

We describe the case of a 32-year-old female who presented to the emergency department (ED) with a 3-day history of severe epigastric abdominal pain accompanied by nausea, vomiting, and constipation. Past medical history was significant for known right hydrosalpinx and previous pelvic inflammatory disease (PID), without past surgical history. Clinical examination revealed a hemodynamically stable patient with a soft but distended abdomen, tenderness in the epigastric region, without signs of peritonitis. Bloodwork including white blood cell count, electrolytes, and lactic acid was unremarkable. Initial computed tomography (CT) scan of the abdomen and pelvis with contrast demonstrated a small bowel obstruction (SBO) with a transition point in the right lower quadrant, accompanied by mesenteric edema and free fluid. Exploratory laparotomy was performed and revealed obstruction secondary to dense adhesions involving the terminal ileum, appendix, sigmoid colon, and right ovary. Lysis of adhesions, appendectomy, and excision of a right paratubal cyst were performed. Histopathology demonstrated endometriosis of the appendix and a benign paratubal cyst. [ABSTRACT FROM AUTHOR]