Bilateral Fallopian Tube Occlusion Research Articles

Drug resistant miliary tuberculosis after in vitro fertilization

The article describes a clinical case of drug resistant miliary tuberculosis in an immunocompetent woman with a multifetal pregnancy after in vitro fertilization (IVF). Difficulties in diagnosing miliary tuberculosis were due to the late detection of the initial focus of infection, that was endometrial tuberculosis, which generalized after IVF. The rare association of isthmic nodose salpingitis and a borderline ovarian tumor (serous ovarian cystadenoma) was a factor complicating the detection of tuberculosis.Conclusion: In an IVF program with bilateral fallopian tube occlusion, tuberculosis should be considered as a possible cause of this pathology. Endometrial tuberculosis is associated with a risk of repeated implantation failure and generalization of the disease.

Detection of hysteroscopic fluid in the pouch of Douglas: a prospective cohort study about the predictability of bilateral tubal occlusion

PurposeTo determine whether an increase in cul de sac (CDS) fluid after hysteroscopy is predictive of tubal patency.MethodsIn a prospective clinical cohort study, 115 subfertile women undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate. The primary outcome was determining whether an increase in fluid in the pouch of Douglas was reflective of unilateral or bilateral tubal patency. Vaginal sonography before and after hysteroscopy was performed to detect fluid in the pouch of Douglas, directly followed by laparoscopy with chromopertubation.ResultsLaparoscopic chromopertubation revealed bilateral Fallopian tube occlusion in 28 women (24.3%). Twenty-seven/40 patients (67.5%) with no fluid shift had bilateral occlusion during the consecutive laparoscopy (p < 0.001). One/75 patients (1.3%) showing a fluid shift had bilateral occlusion (sensitivity of a present fluid shift for uni- or bilateral patency 85.1%, 95% CI: 81.7–99.9, specificity: 96.4%, 95% CI: 75.8–91.8). Intracavitary abnormalities (odds ratio, OR, 0.038; p = 0.030) and adhesions covering one or both tubes (OR 0.076; p = 0.041) increased the risk for a false abnormal result, i.e., uni- or bilateral tubal patency despite the lack of a fluid shift.ConclusionWhen CDS fluid does not change after hysteroscopy, this is a sensitive test for tubal occlusion and further testing may be warranted. However, if there is an increase in CDS fluid after hysteroscopy, particularly for a patient without fluid present prior, this is both sensitive and specific for unilateral or bilateral tubal patency.

Reversible inhibition of sperm under guidance as an intratubular and reversible contraception in female rats: An experimental study.

BackgroundReversible inhibition of sperm under guidance (“RISUGⓇ”) is a promising intravasal male contraceptive.ObjectiveAn exploratory study was conducted with a concept of non-invasive, transcervical, single-intervention and reversible contraception using RISUGⓇ in females.Materials and MethodsIn this experimental study, 60 adult Wistar albino female rats weighing 150-155 g, 3-4 months old were divided into four groups: group I: sham-operated control; group II: tubal occlusion with RISUG for 90 days; group III: tubal occlusion with RISUGⓇ for 90 days and reversal with dimethyl sulphoxide and group IV: tubal occlusion with RISUGⓇ for 90 days and reversal with 5% NaHCO. Animals were subjected to bilateral fallopian tube occlusion with RISUGⓇ and reversal with DMSO and NaHCO. The estrous cycle, fertility and histology of fallopian tube were evaluated.ResultsGroup I showed 100% fertility during all mating schedules. Animals of experimental groups indicated positive mating, but 0% fertility was evident following 30, 60, and 90 days of tubal occlusion. However, after reversal, fertility steadily increased to normalcy in groups III (50% at 45 days, 80% at 105 days, 100% at 150 and 195 days) and IV (70% at 45 and 105 days, 100% at 150 and 195 days) animals. Group II illustrated disorganized inner cell linings and eosinated RISUGⓇimplant-filled lumen. Reversal groups (III and IV) revealed complete restoration of cellular histo-architecture. Regular estrous cycle was noticed in all experimental groups. ConclusionRISUGⓇ is suitable for single intervention, intratubular, reversible contraception in female rats.

Laparoscopic tuboplasty for mild distal tubal disease

To review tuboplasty techniques for alleviating fallopian tube blockage. A step-by-step explanation of the techniques that comprise tuboplasty-fimbrioplasty, salpingo-ovariolysis, and salpingostomy-with surgical video footage. Academic medical center. A 28-year-old G0 female patient with primary infertility and bilateral fallopian tube occlusion wanting to avoid invitro fertilization. Tuboplasty and its component techniques of fimbrioplasty, salpingo-ovariolysis, and salpingostomy are demonstrated in a stepwise fashion for a case of mild tubal disease. Fimbrioplasty includes identifying the agglutinated or phimosed fimbrial end and gently opening it with fine forceps and blunt microdissection. Salpingo-ovariolysis is demonstrated with video and comprises: 1) surveying the anatomy; 2) applying traction to delineate the adhesions; and 3) transecting the adhesions with microsurgical scissors or electrosurgery. Finally, the steps of a salpingostomy are demonstrated, including: 1) identifying the length of the fallopian tube; 2) performing chromotubation to delineate tubal obstruction; 3) creating a salpingostomy at the terminal end; and 4) suturing open the salpingostomy site circumferentially to evert the edges. Successful restoration of normal tubal anatomy and identification of the location of tubal occlusion to guide salpingostomy site placement. The fallopian tubes were assessed bilaterally and noted to have mild tubal disease and therefore were appropriate for tuboplasty. Normal tubal anatomy was restored bilaterally through salpingo-ovariolysis. Subsequent identification of the area of tubal occlusion bilaterally and salpingostomy were performed to create a patent fallopian tube able to pick up an oocyte from the ovary and facilitate fertilization. Tubal reconstructive surgery remains an important option to offer patients who want to avoid invitro fertilization and who have mild tubal disease.

1931 Laparoscopic Tuboplasty

Video Objective To review tuboplasty techniques for alleviating fallopian tube blockage. Tuboplasty consists of fimbrioplasty, salpingo-ovariolysis and salpingostomy. Setting A 28yo G0 female patient with primary infertility and bilateral fallopian tube occlusion seen at an urban tertiary care hospital. Interventions There are several techniques for alleviating blockages and reconstructing the fallopian tubes which are collectively referred to as tuboplasty. Tuboplasty can be further subdivided into fimbrioplasty, salpingo-ovariolysis, and salpingostomy. Such procedures are performed by experts in tubal reconstruction and with the increasing prevalence of in vitro fertilization, there is less exposure to these techniques. We review a case of bilateral tubal occlusion which was managed with salpingo-ovariolysis and salpingostomy. The steps of salpingo-ovariolysis and salpingostomy are reviewed and demonstrated through video. Studies have reported live birth rates following salpingostomy between 20-37% and in cases of mild tubal disease, live birth rates increase up to 40-60%. Conclusion Tubal reconstructive surgery remains an important option to offer patients who want to avoid in vitro fertilization and who have mild tubal disease.

Population-attributable fraction of tubal factor infertility associated with chlamydia

Chlamydia trachomatis infection is highly prevalent among young women in the United States. Prevention of long-term sequelae of infection, including tubal factor infertility, is a primary goal of chlamydia screening and treatment activities. However, the population-attributable fraction of tubal factor infertility associated with chlamydia is unclear, and optimal measures for assessing tubal factor infertility and prior chlamydia in epidemiological studies have not been established. Black women have increased rates of chlamydia and tubal factor infertility compared with White women but have been underrepresented in prior studies of the association of chlamydia and tubal factor infertility. The objectives of the study were to estimate the population-attributable fraction of tubal factor infertility associated with Chlamydia trachomatis infection by race (Black, non-Black) and assess how different definitions of Chlamydia trachomatis seropositivity and tubal factor infertility affect population-attributable fraction estimates. We conducted a case-control study, enrolling infertile women attending infertility practices in Birmingham, AL, and Pittsburgh, PA, during October 2012 through June 2015. Tubal factor infertility case status was primarily defined by unilateral or bilateral fallopian tube occlusion (cases) or bilateral fallopian tube patency (controls) on hysterosalpingogram. Alternate tubal factor infertility definitions incorporated history suggestive of tubal damage or were based on laparoscopic evidence of tubal damage. We aimed to enroll all eligible women, with an expected ratio of 1 and 3 controls per case for Black and non-Black women, respectively. We assessed Chlamydia trachomatis seropositivity with a commercial assay and a more sensitive research assay; our primary measure of seropositivity was defined as positivity on either assay. We estimated Chlamydia trachomatis seropositivity and calculated Chlamydia trachomatis-tubal factor infertility odds ratios and population-attributable fraction, stratified by race. We enrolled 107 Black women (47 cases, 60 controls) and 620 non-Black women (140 cases, 480 controls). Chlamydia trachomatis seropositivity by either assay was 81% (95% confidence interval, 73-89%) among Black and 31% (95% confidence interval, 28-35%) among non-Black participants (P < .001). Using the primary Chlamydia trachomatis seropositivity and tubal factor infertility definitions, no significant association was detected between chlamydia and tubal factor infertility among Blacks (odds ratio, 1.22, 95% confidence interval, 0.45-3.28) or non-Blacks (odds ratio, 1.41, 95% confidence interval, 0.95-2.09), and the estimated population-attributable fraction was 15% (95% confidence interval, -97% to 68%) among Blacks and 11% (95% confidence interval, -3% to 23%) among non-Blacks. Use of alternate serological measures and tubal factor infertility definitions had an impact on the magnitude of the chlamydia-tubal factor infertility association and resulted in a significant association among non-Blacks. Low population-attributable fraction estimates suggest factors in addition to chlamydia contribute to tubal factor infertility in the study population. However, high background Chlamydia trachomatis seropositivity among controls, most striking among Black participants, could have obscured an association with tubal factor infertility and resulted in a population-attributable fraction that underestimates the true etiological role of chlamydia. Choice of chlamydia and tubal factor infertility definitions also has an impact on the odds ratio and population-attributable fraction estimates.

P17.30 A feasibility study assessing fertility in hiv-serodiscordant couples attempting pregnancy in kisumu, kenya

Background HIV-serodiscordant couples desiring children face the difficult choice between risking transmission through condomless intercourse to become pregnant and the social stigmatisation of being childless. In sub-Saharan Africa, 14.3 million women are HIV-infected and many exercise their reproductive right to achieve pregnancy; however, though often overlooked, fertility problems due to tubal damage, menstrual cycle irregularities, and diminished ovarian reserve may affect these women. Methods A study of female positive/male negative (♀+/♂-) HIV-serodiscordant couples using timed vaginal insemination (TVI) as a safer method of conception was conducted in Kenya. A fertility evaluation was offered to couples unable to achieve pregnancy after six cycles of TVI. Men completed a semen analysis and women a hystero-salpingo-contrast-sonography (HyCoSy) to investigate the uterus, ovaries, and fallopian tubes. Results Fifteen of 23 ♀+/♂- HIV-serodiscordant couples were eligible for fertility evaluations; 14 consented; and seven completed male and female fertility assessments. The mean age of the men and women who completed fertility evaluations was 33.7 (std. dev. = 4.58), and 30 (std. dev. = 5.41) years, respectively. Fertility evaluations determined that three women had bilateral fallopian tube occlusion with one male partner having decreased sperm motility; and four women had unilateral/bilateral fallopian tube patency. Seven couples declined or were unable to complete a full couple evaluation. Of the 14 women evaluated, six (46%) had an HIV RNA viral load (≥400 copies/mL); six (46%) had an undetectable HIV RNA viral load; and two declined serum assessment. Conclusion Amongst HIV-serodiscordant couples attempting to achieve pregnancy, underlying male and/or female factor infertility and inadequate viral suppression may be present. As safer conception interventions are integrated into HIV care programs, a fertility evaluation should be offered, if feasible and available, to HIV-affected individuals/couples planning a pregnancy, to optimise their conception efforts, decrease HIV transmission, and assess their potential to conceive without assistance. Disclosure of interest statement This research was supported in part by a grant from the National Institutes of Health (NIH), University of California San Francisco-Gladstone Institute of Virology and Immunology Centre for AIDS Research (P30 AI027763) and the United Nations jointly sponsored HRP Special Research Programme. O. Mmeje was partly supported by NIH/T32–5T32AI065388–03.

Clinical analysis of transvaginal hydrolaparoscopy in infertile patients

ObjectiveTo evaluate the application of transvaginal hydrolaparoscopy for exploration of the pelvic cavity exploration in infertile women. Study designA total of 510 infertile women were included in this study from May 1st, 2009 to April 30, 2012 in the clinic of the Hebei Research Institute for Family Planning. ResultsIn 495 of 510 of the patients (97.06%), a successful operation was achieved at the first puncture. Of these 495 patients, 286 (57.78%) showed bilateral patency. Completely normal tubo-ovarian and pelvic structures were observed only in 79 patients (15.96%): 16 patients (3.23%) had bilateral tube obstruction, 18 (3.64%) had hydrosalpinx, and 8 (1.62%) had fimbrial stenosis. Pelvic abnormalities occurred in 240 patients (44.04%), including bilateral and/or unilateral tubo-ovarian adhesions in 80 patients (16.16%) and 160 (32.32%) found with adhesions in other parts of the pelvic cavity. Pelvic endometriosis was found in 82 patients (16.57%) and 19 (3.84%) had two or more lesions in the pelvic cavity. In addition, 9 cases (1.82%) of ovarian cysts, 7 (1.41%) of bilateral vesicular appendices and 43 cases (6.69%) of a unilateral vesicular appendix were observed. In addition, convoluted tubes such as bent or twisted tubes were found in 4 cases of bilateral fallopian tube occlusion patients (0.81%) and 17 cases of unilateral tubal occlusion patients (3.43%). ConclusionsTransvaginal hydrolaparoscopy is a feasible, safe, and cost-effective microinvasive technique. This technique can be considered as an alternative procedure for evaluating female infertility.

Before Conception Laparoscopic Cervical Cerclage Using Cerclage Tape

To evaluate the feasibility and safety of laparoscopic transabdominal cervico-isthmic cerclage (LTCC) before conception using Mersilene tape Clinical practice since Dec. 2008 to Dec. 2010. Teaching Hospital. Seven cases were performed LTCC who had 31 times second Trimester miscarriage. Three patients had the history of previous failed vaginal cervical cerclage. LTCC was performed using Mersilene tape at the level of the internal cervical os in the non-pregnancy period. The laparoscopic approach enabled placement of a suture with no morbidity, and rapid patient recovery in seven cases. One year after surgery one case had delivered a live baby by cesarean section in 38w gestation, birth weight 3600gm. Six cases didn't pregnant yet in whom 1 case suffered from bilateral fallopian tube occlusion. Laparoscopic cervical cerclage is feasible and effective as well as technically feasible and safe for a surgeon trained in laparoscopic suturing methods.

Feasibility of dynamic MR-hysterosalpingography for the diagnostic work-up of infertile women

Tubal disturbances often contribute to infertility. Conventional hysterosalpingography (HSG) is considered as standard in the assessment of the patency of the fallopian tubes, but requires ionizing radiation and is restricted to the imaging of endoluminal structures. To evaluate dynamic magnetic resonance-HSG (dMR-HSG) in the diagnostic work-up in patients with infertility. Thirty-seven consecutive infertile women underwent dMR-HSG: 20 ml of gadolinium-polyvidone solution (18.4 mM Dotarem 1:20 with polyvidone) were injected intracervically through a 5-Charriere balloon catheter while acquiring five consecutive flash-3D T1-weighted MR sequences with fat saturation. Two experienced readers assessed image quality and anatomic-pathologic correlations prospectively. The relevance of results was evaluated in the clinical context of each patient. Patient comfort was evaluated with a standardized questionnaire. dMR-HSG was successfully completed in 33/37 patient with an average study time of 45 min. In 4 of 37 patients the catheter became dislodged during the examination, resulting in two complete diagnostic failures. Failure in another two patients was due to preliminary termination because of excessive pain and discomfort during the application of the contrast solution. The uterine cavity was completely visualized and bilateral fallopian tube patency was confirmed by dMR-HSG in 27 of 33 patients. Bilateral tubal occlusion was diagnosed in one of the remaining six patients and was confirmed by laparoscopy. Successful selective tubal catheterization was performed in one additional patient with unilateral and one patient with bilateral fallopian tube occlusion. In three cases, the catheter became dislocated at the end of the examination without demonstration of tubal patency. Since all three patients refused diagnostic laparoscopy and conventional HSG, possible bilateral occlusions of the fallopian tubes could not be further assessed. dMR-HSG with cervical cannulation and intracavitary gadolinium injection is feasible and allows assessment of the uterus, the fallopian tubes, and extra-uterine pelvic structures, while avoiding all ionizing radiation in infertile women aiming at pregnancy.

Contrast Infusion Sonography in the Post-Essure Setting

Study Objective To compare contrast infusion sonogram (CIS) to hysterosalpingogram (HSG) for use as a 3-month confirmation test after Essure. Design Pilot study (Canadian Task Force classification II-2). Setting Healthy women in an academic multispecialty group. Patients Seventeen women desiring permanent sterilization who had had successful bilateral Essure placement within 12 weeks. Intervention Contrast infusion sonography was performed and immediately followed by an HSG at the same appointment, between 1 and 12 weeks after Essure placement. Measurements and Main Results To determine how well microinsert location and tubal status can be assessed with CIS, an adaptation of hysterosalpingo contrast sonography (HyCoSy), when compared with sequential HSG. Tubal occlusion rate within 4 to 8 weeks after Essure placement was also noted. All microinserts were readily identified with ultrasound, and location was accurately determined. In all patients (100%) with at least 1 tube patent on HSG, patency was also demonstrated on CIS by visualizing real-time flow in the tube or the presence of dye in the cul-de-sac or adnexa. There were no significant adverse events, and pain ratings were similar for both tests. The majority (88%) of patients felt strongly that they would prefer to have a 3-month confirmation test performed in the gynecologist’s office rather than an unfamiliar radiologic facility. Tubal occlusion was noted on both CIS and HSG in 82% of patients before 12 weeks. Conclusion Based on this pilot study with a small sample, CIS, an adaptation of HyCoSy, has comparable accuracy to HSG in the post-Essure setting. The safety, convenience, and comfort of an in-office test using ultrasound and a non-iodine-based dye would be a welcome alternative to HSG. There was also a high rate of bilateral fallopian tube occlusion noted on HSG at 4 weeks after Essure.

Effectiveness of IVF for Unexplained Infertility and Minimal to Mild Endometriosis-associated Infertility

Objective: to evaluate the relative effectiveness of in vitro fertilization (IVF) for unexplained infertility and minimal to mild endometriosis-associated infertility with patent fallopian tubes and compare it to its effectiveness in infertile patients with a complete bilateral fallopian tube occlusion, as questioned by the Canadian Royal Commission on New Reproductive Technologies.Methods: patients were consecutively enrolled between 1992 and 2000 at PROCREA, a private tertiary human reproduction centre. Three groups of infertile patients treated with in vitro fertilization were historically compared: 192 IVF cycles performed for unexplained infertility, 112 IVF cycles for minimal to mild endometriosis-associated infertility with patent normal fallopian tubes, and 285 IVF cycles for bilateral fallopian tube occlusion. The main outcomes measured were rates of fertilization, implantation, and clinical pregnancy.Results: a significant difference between fertilization rates was found across groups (p < 0.0005). Clinical pregnancy rates per started cycle (defined as a pregnancy with a positive fetal heart) were 29.6 percent, 30.4 percent, and 28.1 percent for the first, second, and third group respectively.Conclusion:in vitro fertilization is as effective for treating unexplained infertility and minimal to mild endometriosis-associated infertility as it is for treating infertility caused by a complete bilateral fallopian tube occlusion.

Sterilization with Methyl Cyanoacrylate–induced Fallopian Tube Occlusion from a Nonsurgical Transvaginal Approach in Rabbits

To evaluate a nonsurgical, nonhormonal sterilization procedure performed with use of transvaginal microcatheterization techniques and methyl cyanoacrylate (MCA) as a sclerosing agent Seventeen adult virgin female rabbits underwent bilateral fallopian tube cannulation through a nonsurgical transvaginal approach with use of a coaxial catheter system with fluoroscopic guidance. Fourteen of the rabbits underwent bilateral fallopian tube occlusion with direct MCA injection; the remaining three rabbits were separated as controls. Three of the rabbits with occlusions were killed as temporal histologic controls. The remaining 11 rabbits with occlusions and the initial three controls underwent 6 months of mating trials. All 17 rabbits were killed. Gross inspection was performed and histologic specimens of their fallopian tubes were obtained. None of the 11 rabbits with occlusions that underwent mating became pregnant. All three control rabbits became pregnant. Histologic examination of the occluded fallopian tubes demonstrated long-segment tubal wall fibrosis with varying degrees of occlusion. No peritoneal abnormalities were identified. Histologic findings for the three control animals were normal. With use of a nonsurgical transcervical coaxial catheter system, MCA can be placed directly into fallopian tubes without difficulty. MCA administration leads to fallopian tube fibrosis and occlusion. A 100% nonpregnancy rate was demonstrated. Further investigation may lead to a safer, more convenient, and less expensive form of permanent sterilization.