Bilateral Hydrosalpinges Research Articles

Bilateral hydrosalpinges, what to do :Salpingectomy or salpingoplasty? Result of a 480 cases continuous series

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

A retrospective analysis of ovarian response to gonadotropins after laparoscopic unilateral or bilateral salpingectomy for hydrosalpinges.

Background and AimsWe compared the effects of unilateral and bilateral salpingectomy for hydrosalpinx on ovarian function, oocyte retrieval, and embryogenesis.MethodsWe retrospectively examined the hospital records of 109 women with unilateral hydrosalpinx and 57 women with bilateral hydrosalpinges who had undergone in vitro fertilization (IVF) treatment (280 oocyte retrieval cycles) between January 2011 and December 2018. We compared age at oocyte retrieval, level of anti‐Müllerian hormone (AMH) measured within 1 year of oocyte retrieval, duration of infertility, number of previous IVF treatments, level of follicle stimulating hormone, total gonadotropin dose, number of oocytes retrieved, fertilization rate, blastocyst formation rate, and peak serum estrogen concentration. This study was approved by the institutional review board.ResultsOf the women with unilateral hydrosalpinx, no significant differences were observed in ovarian response, rate of fertilization or rate of blastocyst production between the 21 women (24 cycles) who had undergone unilateral salpingectomy and the 88 women (146 cycles) who had not. Of the women with bilateral hydrosalpinges, the 13 (24 cycles) who had undergone bilateral salpingectomy had slightly lower AMH levels and significantly fewer oocytes retrieved (5.5 ± 3.9 vs 8.3 ± 5.5; P = .0068) than the 44 women (86 cycles) who had not had a salpingectomy. Women who had undergone bilateral salpingectomy also had significantly lower peak serum estrogen concentrations than those who had not undergone salpingectomy (1876.1 ± 765.9 vs 2489.5 ± 1551.4; P = .009).ConclusionIn women with hydrosalpinx, bilateral salpingectomy may reduce ovarian function and response to gonadotropins, especially the number of oocytes retrieved. Unilateral salpingectomy does not have these effects.

Surgical Removal of Hydrosalpinx Improves Endometrium Receptivity by Decreasing Nuclear Factor-Kappa B Expression.

Although physiologic amount of inflammation is necessary for successful implantation, pathological inflammation inhibits the expression of receptivity molecules and genes. Because hydrosalpinges is an inflammatory disease, adverse effects of hydrosalpinges on implantation may be in part mediated by disturbed endometrial expression of nuclear factor-kappa B (NF-κB), a dimer implicated in inflammation. We examined the expression of NF-κB p65 (Rel A) during the window of implantation in the endometrium of infertile women (n = 14) with uni or bilateral hydrosalpinges prior to and following salpingectomy and of fertile controls (n = 14) by immunohistochemistry. We assessed the influence of salpingectomy on NF-κB p65 expression by comparing pre- and post-operative endometrial samples. To evaluate the intensity of endometrial NF-κB p65 (Rel A) immunoreactivity, H-score method was used. We showed a decrease in NF-κB p65 expression in 13 out of the 14 post-salpingectomy endometrial samples. The mean NF-κB p65 level was significantly higher in the endometrium of women with hydrosalpinges before salpingectomy compared with control cases without hydrosalpinges (3.94 ± 6.2 vs 2.18 ± 0.7, p < .02). Salpingectomy decreased the mean endometrial NF-κB p65 levels in both unilateral and bilateral hydrosalpinges (2.87 ± 1.1). When we compared the endometrial NF-κB p65 levels of the post-salpingectomy samples with their age-matched fertile controls, we did not observe any significant difference. After salpingectomy, the mean H-score of endometrial NF-κB p65 expression significantly decreased to a level similar to that of the fertile group (2.87 ± 1.1 vs 2.18 ± 0.7, p > .64). NF-κB p65 expression was detected in cytoplasmic and membranous parts of luminal and glandular epithelial cells of endometrium obtained before salpingectomy. Both epithelial and stromal components of the endometrium showed decreased staining for NF-κB p65 compared with the pre- and post-salpingectomy samples. The decreased NF-κB p65 (Rel A) immunoreactivity was predominantly localized to luminal and glandular epithelial cells. Uni or bilateral hydrosalpinges causes pathological endometrial inflammation. Improvement in pathological inflammation following salpingectomy in women with hydrosalpinges may be in part mediated by the downregulation of endometrial NF-κB p65 (Rel A) expression.

Comparison of the ongoing pregnancy rate of in vitro fertilisation following tubal occlusion by microcoil placement versus laparoscopic tubal ligation for hydrosalpinges

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

Unilateral hydrosalpinx is more likely to be associated with negative Igg chlamydia antibodies and bilateral hydrosalpinges more likely to be associated with positive levels

Purpose: To determine if previous exposure to chlamydia, as evidenced by positive serology, is associated with a greater degree of detectable hydrosalpinges, and to determine if positive serology is more associated with bilateral than unilateral hydrosalpinges. Materials and Methods: Retrospective study evaluating all patients who had either a unilateral or bilateral hydrosalpinges detected by laparoscopy. The group was further defined by these women in this group who had serum chlamydia antibody tests and transvaginal pelvic sonography (TVS). Results: Prior exposure to chlamydia infection as evidenced by positive serology was detected in 31 of 39 (79.4%) women . All eight women with negative serology had a unilateral hydrosalpinx, of which only one could be detected by TVS. Whereas 29.4% of 17 women with unilateral hydrosalpinges and positive serology were detectable by TVS, 35.7% of the 25 hydrosalpinges of the 14 women with positive serology and bilateral hydrosalpinges could be detected by TVS. TVS correctly identified 16 of the 53 (30.2%) hydrosalpinges seen by laparoscopy. TVS identified 15 of the 39 (38.5%) women who had at least one hydrosalpinges. Conclusions: Ultrasound alone will detect less than 50% of hydrosalpinges, since women negative for chlamydia exposure are more likely to have smaller unilateral hydrosalpinges not detected by ultrasound. Future studies are needed to determine if salpingectomy may not be needed to improve fecundity.

SAT-240 Type B Insulin Resistance Resulting in Hyperthecosis in a Postmenopausal Woman

Type B insulin resistance is characterized by autoantibodies to the insulin receptor, inducing severe insulin resistance requiring administration of suprapharmacologic doses of exogenous insulin for treatment. A case report by Declue, Shah, Marchese and Malone (1) described a young woman who carried a presumptive diagnosis of ovarian hyperthecosis and was subsequently found to have type B insulin resistance. However, once she was treated with antibody depletion therapy and circulating insulin levels normalized, the serum testosterone level normalized, indicating that the presumed diagnosis of hyperthecosis was incorrect. We present the case of a 49 year old African American woman who developed type B insulin resistance at the age of 45, requiring upwards of 1800 units of insulin daily. Simultaneously, she developed oligomenorrhea; excessive hair growth on the chin, chest, upper abdomen and upper thighs; and biochemical androgen excess with a serum total testosterone level of 275 ng/dL. At the age of 46, the type B insulin resistance was treated with two infusions of rituximab, dexamethasone, and cyclophosphamide. Her insulin requirements dropped precipitously, to the point where she currently requires only oral metformin; her current HbA1c is 6.1%. Her serum testosterone level, however, has remained elevated at 67 ng/dL, indicating a persistent hyperandrogenic state. Symptoms of a postmenopausal state were confirmed by a highly elevated serum FSH level of 44.1 mIu/mL; she is presently amenorrheic. A transvaginal ultrasound revealed a right ovarian volume of 19.3 mL and a left ovarian volume of 12.4 mL; 3 anechoic follicles were noted on the left, the largest of which measured 14.5 x 14.0 x 15.0 mm; 2 anechoic follicles were noted on the right, the largest of which measured 18.9 x 21.5 x 16.8 mm; bilateral hydrosalpinges were identified. A CT scan of the adrenals was normal. A presumptive diagnosis of hyperthecosis has been made, and the patient has been referred for bilateral oophorectomy. We postulate that, in this patient, the exposure of the ovaries to extremely high circulating insulin resulted in stimulation of the ovarian thecal cells and, ultimately, in autonomous function, yielding a clinical state of hyperthecosis. Reference: (1) Brown RJ, Joseph J, Cochran E, Gewert C, Semple R, Gorden P. Type B Insulin Resistance Masquerading as Ovarian Hyperthecosis. J Clin Endocrinol Metab. 2016;102(6):1789-1791.

Pyosalpinges after hysterosalpingography in a patient with lower genital tract infection and managed by laparoscopic surgery in a resource low tertiary hospital case report and literature review

BackgroundPyosalpinges (a complication of pelvic inflammatory disease) is infection of the fallopian tubes and the morbidity associated with it has major health implications. We are reporting a case of pyosalpinges diagnosed after hysterosalpingography and managed by laparoscopic surgery at the Douala General Hospital, Cameroon.Case presentationA 29-year-old single woman, an assistant nurse of the Douala tribe in Cameroon. She is G1P0010 and came to our attention because of secondary infertility of three years duration. She has a history consistent with four lifetime sexual partners, self-medication for chlamydia trachomatis infection and induced abortion by dilatation and aspiration. Furthermore, she is HIV positive and had an ultrasound scan suggestive of bilateral hydrosalpinges. After a hysterosalpingography examination she developed painless muco-purulent vaginal discharge and bilateral adnexal tenderness on bimanual examination suggestive of pyosalpinges. Vaginal and cervical cultures isolated Ureaplasma urealyticum and Gardnerella vaginalis sensitive to ofloxacin and metronidazole, respectively.At laparoscopy, bilateral pyosalpinges, pelvic adhesions and peri-hepatic adhesions were found. Bilateral salpingectomy with adhesiolysis including lysis of perihepatic adhesions and peritoneal toileting was done. She was discharged from hospital 72 h later and her hospital stay was uneventful. She was counseled for in-vitro fertilization and to register in the national HIV treatment programme. Her husband was prescribed ofloxacin empirically.ConclusionAntimicrobial prophylaxis should be given to patients prior to HSG, especially those with a history of chlamydia or evidence of hydrosalpinges. There should also be universal STI testing in high risk and HIV positive patients or the danger for suboptimal antibiotic usage in areas where self-medication is common.In resource-low tertiary hospitals where computed tomography or magnetic resonance imaging is not readily available and/or affordable, clinical examination and pelvic ultrasound remains the key diagnostic tool. Surgical treatment is the best option for pyosalpinges and when plausible, laparoscopic surgery is the treatment of choice. Laparotomy is the mainstay in most hospitals in Cameroon. The parent of the patient did not consent to histo-pathologic examination.

Evaluation of Laparoscopic Intervention versus Ultrasound Guided Aspiration of Bilateral Hydrosalpinges on Endometrial LIF mRNA Expression Level and Pregnancy Outcome after IVF-ET Cycle

Background : Hydrosalpinx is a common gynecological dis­ease. 30% of infertile women undergoing in vitro fertilization-embryo transfer (IVF-ET) have hydrosalpin­x. Leukemia inhibitory factor (LIF) mRNA expression level is lower in the endometrium during the implantation window in the presence of bilateral hydrosalpinges. If the hydrosalpinx is removed, LIF mRNA expression returns to normal values. Objectives: This study was designed to evaluate laparoscopic intervention of bilateral hydrosalpinges versus transvaginal ultrasound guided aspiration on LIF mRNA expression level during implantation window and pregnancy outcome after IVF-ET cycle. Methodology : Sixty patients who had bilateral hydrosalpinges were classified into two groups; 30 women underwent laparoscopic salpingectomy or proximal tubal occlusion and 30 women underwent transvaginal ultrasound guided aspiration. Determination of LIF mRNA expression level in endometrial samples was performed preoperatively and in the 3 rd postoperative cycle. In addition, pregnancy outcome was evaluated in the first IVF-ET cycle. Results: Endometrial LIF mRNA expression level in laparoscopic group significantly increased postoperatively than transvaginal ultrasound guided aspiration group with a significant difference (P=0.03). In addition, there is increased levels in patients undergoing laparoscopic and ultrasound guided aspiration groups after treatment than before with a significant difference (P=0.005) and (P =0.04); respectively. As regards pregnancy outcome, it is more favorable in laparoscopic group than ultrasound guided aspiration with statistically significant difference (P=0.013). Conclusion: Our findings showed that endometrial LIF mRNA expression level was increased and pregnancy outcome was more favorable after laparoscopic inter­vention versus transvaginal ultrasound guided aspiration for treatment of bilateral hydrosalpinges patients. , Egypt

Uterotubal junction prevents chlamydial ascension via innate immunity.

Ascension to the oviduct is necessary for Chlamydia to induce tubal infertility. Using the Chlamydia muridarum induction of hydrosalpinx mouse model, we have demonstrated a significant role of the uterotubal junction in preventing chlamydial ascending infection. First, delivery of C. muridarum to either side of the uterotubal junction resulted in significant reduction in live organisms from the tissues on the opposite sides. However, the recovery yields remained similar among different sections of the uterine horn. These observations suggest that the uterotubal junction may function as a barrier between the uterine horn and oviduct. Second, deficiency in innate immunity signaling pathways mediated by either MyD88 or STING significantly compromised the uterotubal junction barrier function, permitting C. muridarum to spread freely between uterine horn and oviduct. Finally, transcervical inoculation of C. muridarum led to significantly higher incidence of bilateral hydrosalpinges in the STING-deficient mice while the same inoculation mainly induced unilateral hydrosalpinx in the wild type mice, suggesting that the STING pathway-dependent uterotubal junction plays a significant role in preventing tubal pathology. Thus, we have demonstrated for the first time that the uterotubal junction is a functional barrier for preventing tubal infection by a sexually transmitted agent, providing the first in vivo evidence for detecting chlamydial infection by the STING pathway.

Technical Video: Bilateral Tubal Adhesiolysis With Cuff Salpingostomy

Study ObjectiveTo show the steps involved in a bilateral tubal adhesiolysis and cuff salpingostomy. DesignTechnical video showing tubal adhesiolysis and cuff salpingostomy in a step-by-step approach. SettingMinimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, UK, a tertiary referral unit for complex gynecologic endoscopic surgery. InterventionsA 38-year-old woman presented with left-sided pelvic pain and primary infertility for 13 years. An ultrasound scan showed bilateral hydrosalpinges with suspected adnexal adhesions. Hysterosalpingography did not show spill of dye. After counseling, she opted to have tubal adhesiolysis and bilateral cuff salpingostomy. ConclusionTubal surgery for occlusion has become less popular because of the superior success rates of assisted reproductive techniques. As a result, tubal surgery may eventually become a historic operation. However, in cases of distal tubal blockage after adhesionlysis and cuff salpingostomy or neosalpingostomy, pregnancy rates up to 35% have been reported in the literature. Furthermore, performing a bilateral salpingectomy instead in these cases renders a patient entirely dependent on assisted reproductive techniques for tubal factor infertility. Therefore, a bilateral cuff salpingostomy should be considered in a select group of patients.

Essure a novel option for the treatment of hydrosalpinx: a case series and literature review

Objective: The aim of this study is to evaluate the use of hysteroscopic Essure device placement for the treatment of hydrosalpinx (HS)-related infertility in patients with laparoscopic contraindications and compared their pregnancy outcomes following IVF–ICSI treatment with those patients having had laparoscopic tubal occlusion (LTO).Patients: From 2008 to 2014 a total of 50 patients were diagnosed with unilateral or bilateral hydrosalpinges: 29 patients had laparoscopic contraindications and were treated hysteroscopically and 21 patients were treated with laparoscopical salpingectomy.Results: Of the 29 patients who underwent treatment with Essure®, 21 began a cycle of in vitro fertilization (IVF), and 13 finished in embryo transfer that resulted in seven clinical pregnancies. Furthermore, in the group of women treated with salpingectomy, 17 started an IVF cycle that resulted in 12 clinical pregnancies. The clinical pregnancy rate per patient with an IVF cycle started was 33.3% and 70.6%, the live-birth rate per patient was 14.3% and 52.9%, the miscarriage rate was 57.1% and 18.2%, and the implantation rate was 16.3% and 34.1% for hysteroscopy and laparoscopy, respectively.Conclusion: Essure® placement is an alternative method for occlusion of hydrosalpinges before IVF. Monitoring the live-birth rate confirms that this option may be considered when laparoscopy is impossible or contraindicated.

Hysteroscopic tubal electrocoagulation versus laparoscopic tubal ligation for patients with hydrosalpinges undergoing in vitro fertilization

ObjectiveTo investigate the use and success rate of hysteroscopic tubal electrocoagulation for the treatment of hydrosalpinx-related infertility among patients undergoing in vitro fertilization (IVF) who have laparoscopic contraindications. MethodsA prospective study was conducted among patients who had unilateral or bilateral hydrosalpinges identified on hysterosalpingography and vaginal ultrasonography, and who were undergoing IVF at a center in Cairo, Egypt, between January 1, 2013, and October 30, 2014. All patients who had contraindications for laparoscopy were scheduled for hysteroscopic tubal electrocoagulation (group 1); the other patients underwent laparoscopic tubal ligation (group 2). For all patients, hysterosalpingography was performed 3 months after their procedure to evaluate proximal tubal occlusion. ResultsAmong 85 enrolled patients, 22 underwent hysteroscopic tubal electrocoagulation and 63 underwent laparoscopic tubal ligation. The procedure was successful in terms of tubal occlusion for 25 (93%) of 27 hydrosalpinges in group 1, and 78 (96%) of 81 hydrosalpinges in group 2 (P=0.597). No intraoperative or postoperative complications were reported. ConclusionHysteroscopic tubal electrocoagulation was found to be a successful treatment for hydrosalpinges before IVF when laparoscopy is contraindicated.

Proximal occlusion of hydrosalpinges by Essure® before assisted reproduction techniques: a French survey

ObjectivesTo study the feasibility and results (live-birth and complication rates) of placement of Essure® microinserts before assisted reproductive technology (ART) treatment of women with hydrosalpinx when laparoscopy should be avoided.Study design National survey of 45 French hospital centres providing ART reporting a retrospective analysis of 43 women with unilateral or bilateral hydrosalpinges and Essure® placement. The results of the following ART cycle were studied for 54 embryo transfers. ResultsThe placement success rate reached 92.8% (65/70 tubes), and the mean number of visible intrauterine coils was 1.61 (range: 0–6). Pyosalpinx occurred in one case, and expulsion of the device into the uterus in two others. Of 43 women, 29 (67.4%) had a total of 54 fresh or frozen embryos transferred. The clinical pregnancy rate was 40.7% (22/54) and the live-birth rate 25.9% (14/54). The implantation rate was 29.3% (27/92). ConclusionEssure® placement is an effective method for occlusion of hydrosalpinges before IVF. Monitoring the live-birth rate confirms that this option is the strongest in cases when laparoscopy is impossible or contraindicated.

Rare case of a paratubal cystadenoma with bilateral hydrosalpinges in an infertile woman

ObjectiveSerous tumors can occur on the surface of the ovaries and—rarely—as primary tumors on the peritoneal surface. However, the origin of extraovarian serous tumors is unknown. An unusual case of a serous tumor is presented here. Case reportA 34-year-old nulligravid woman presented for evaluation of her primary infertility, with acute abdominal pain. At laparoscopy, a paratubal cyst, independent of the ovaries, was found to be associated with bilateral hydrosalpinges. The final pathology diagnosis was of a benign paratubal serous cystadenoma. ConclusionWe present an unusual case of a paratubal serous cystadenoma with bilateral hydrosalpinges in an infertile woman, which was resected laparoscopically..

Can laparoscopic removal of Essure device before embryo transfer correct poor reproductive outcome pattern in IVF? A case report

Objective: This report describes a successful surgical approach to multiple in vitro fertilization (IVF) failures in the setting of hydrosalpinges, which had been previously treated with Essure inserts. Materials and Methods: A non-smoking 33-year-old Caucasian G2 P0020 (body mass index: BMI = 22) attended for second opinion. Her history was significant for bilateral hydrosalpinges having been noted on hysterosalpingogram two years earlier. This was managed by hysteroscopic placement of Essure inserts bilaterally. One year later, and now with Essure in situ, the patient completed three IVF cycles elsewhere. Her first and third IVF attempts resulted in biochemical pregnancy, while human chorionic gonadotropin (hCG) was negative after the second cycle. Upon presentation at the authors’ center and before beginning a fourth IVF cycle, further testing and surgical removal of the Essure devices was recommended. Results: Repeat hysteroscopy was unremarkable; laparoscopic bilateral salpingectomy and extirpation of Essure implants was accomplished without difficulty. Following menses, the patient initiated IVF with three embryos transferred. At day 60, a single intrauterine pregnancy was identified with positive cardiac activity (rate >100/min). Her obstetrical course was uneventful; a healthy 4,195 gram male infant was delivered (breech) by Cesarean at 40 weeks’ gestation. Conclusion: Essure inserts comprise inner fibers of polyethylene terephthalate, a stainless steel coil, and a nickeltitanium coil. The product received FDA approval as a contraceptive in 2002 although its use for hydrosalpinx remains off-label. While successful outcomes with IVF following Essure placement have been reported, this is the first description of pregnancy and delivery from IVF after Essure removal. Essure may be considered for sterilization when laparoscopy is contraindicated, but experience with its use specifically for treating hydrosalpinges before IVF is limited. This observed association between prior poor IVF outcomes and Essure with subsequent delivery after surgical Essure removal is the first of its kind to be reported, and warrants further investigation.

ICSI pregnancy outcomes following hysteroscopic placement of Essure devices for hydrosalpinx in laparoscopic contraindicated patients

This study investigated the use of hysteroscopic Essure device placement for the treatment of hydrosalpinx-related infertility in patients with laparoscopic contraindications and compared their pregnancy outcomes following assisted conception treatment with those of patients having had laparoscopic tubal ligation. A total of 102 infertile patients were diagnosed with unilateral or bilateral hydrosalpinges: 26 patients had laparoscopic contraindications and were treated hysterscopically and 76 patients were treated laparoscopically. In total, 66 intracytoplasmic sperm injection (ICSI) and 39 frozen embryo transfer (FET) procedures were performed. In the hysteroscopy group, 13 ICSI and eight FET in 16 patients resulted in 10 pregnancies (pregnancy rates 47.6% per transfer and 62.5% per patient), and in the laparoscopy group, 53 ICSI and 31 FET embryo transfers in 54 patients resulted in 36 pregnancies (pregnancy rates 42.9% per transfer and 66.7% per patient). Live birth rates per assisted reproduction procedure were 23.8% (5/21) in the hysteroscopy group and 32.1% (27/84) for the laparoscopy group. The hysteroscopic placement of Essure devices to isolate hydrosalpinx prior to assisted conception treatment produced pregnancy outcomes comparable to those produced following laparoscopic tubal ligation. The live birth rates indicate that a larger, more comparative, prospectively randomized study is required.Infertile patients with tubal disease require surgical treatment before they can continue with fertility treatment. There are two main surgical methods that can be used, hysteroscopic and laparoscopic, the latter being the standard surgical method. However, some patients have disease that makes the use of laparoscopy inappropriate. For these patients the placement of Essure® devices by hysteroscopic surgery maybe the most suitable treatment method. One hundred and two patients were diagnosed with unilateral or bilateral hydrosalpinges – tubal disease. Twenty six patients had to have hysterscopic surgery and 76 patients had laparoscopic surgery. After their tubal surgery some patients continued to have fertility treatment, 66 ICSI and 39 frozen embryo transfers (FET) were performed. Thirteen ICSI and 8 FET embryo transfers in 16 patients from the hysteroscopy group resulted in 10 pregnancies, a 47.6% per transfer and 62.5% per patient pregnancy rate. Fifty three ICSI and 31 FET embryo transfers in 54 patients from the laparoscopic group resulted in 36 pregnancies, a 42.9% per transfer and 66.7% per patient rate. Live birth rates per ART procedure were 23.8% (5/21) in the hysteroscopic group compared with 32.1% (27/84) for the laparoscopic group. The hysteroscopic placement of Essure® devices for tubal disease prior to fertility treatments resulted in pregnancy outcomes that were comparable to the outcomes obtained following laparoscopic surgery.

Pre-HSG microbial isolates from endocervical swabs in infertile women in Ilorin, Nigeria

Background: Genital infections contribute significantly to infertility by causing tubal disease in our environment. This can be worsened by any instrumentation of the genital tract such as hysterosalpingography (HSG), which is the most common and affordable investigation by infertile couples for tubal factor. Materials and Methods: A prospective study of 53 women who presented for HSG on account of infertility was done in a radio-diagnostic centre In Ilorin, Nigeria. Endo-cervical swabs were taken aseptically prior to standardized HSG in all clients. The swabs were sent for microscopy, culture, and antibiotic sensitivity and the HSG findings of patients were documented. Results: The age ranged between 25 and 52 years with a mean of 34.26 + 5.762 years. Both fallopian tubes were patent in 10 patients and blocked in 14 cases. There were 14 cases of unilateral hydrosalpinx and 10 (18.9) bilateral hydrosalpinges. Either pelvic or cervico-uterine cavity adhesions were observed in 35 (66.0%) of the cases. Mild to heavy growth occurred in 67.9% of the cases. Gram stain was positive in 54.7% of cases. The most common organism was Staphylococcus spp (28.3%). Forty-five percent of yields were sensitive to more than two antimicrobials. There was statistical significant relationship between the presence of pathogens in the endo-cervix and the frequency of tubal disease (x 2 = 2.71, P ≤ 0.05). Conclusion: There was a positive or significant statistical relationship between presence of pathogens in the cervix and tubal disease. Pre-HSG endo-cervical swab for microscopy, culture and sensitivity is advisable to prevent genital infections after HSG.

Hysteroscopic hydrosalpinx occlusion with Essure device in IVF patients when salpingectomy or laparoscopy is contraindicated

ObjectiveTo evaluate, in patients with hydrosalpinges, the effect on in vitro fertilization (IVF) outcome of the insertion by hysteroscopy of an intratubal blocking device, in cases where laparoscopic salpingectomy or laparoscopy was contraindicated. Study designA prospective interventional case series study was conducted in fifteen women with unilateral (N=6) or bilateral hydrosalpinges (N=9) submitted for IVF. In all of them, laparoscopic salpingectomy was contraindicated. Hysteroscopic insertion of the Essure intratubal device in a consultation room setting was performed. IVF results were compared with those of women where hydrosalpinx was treated by laparoscopic salpingectomy (48 women, 76 cycles). ResultsThere were no complications during or immediately after the procedure in any of the patients. There were four pregnancies from 16 embryo-transfers with own oocytes, one spontaneous pregnancy after unilateral Essure insertion, and one pregnancy after oocyte donation. In one case the hydrosalpinx grew and pelvic inflammatory disease developed 6months after the insertion, requiring bilateral adnexectomy. Although not of statistical significance, IVF pregnancy rates were somewhat lower than in the laparoscopic salpingectomy group, which was attributed to the lower ovarian reserve before Essure insertion. ConclusionThe hysteroscopic insertion of the Essure intratubal device prior to IVF is a reasonable option in cases where laparoscopic salpingectomy is contraindicated. Larger series are required to assess pregnancy outcome.

Unilateral Hydrosalpinx Is More Likely to Be Associated with Negative IgG Chlamydia Antibodies and Bilateral Hydrosalpinges Are More Likely to Be Associated with Positive Levels

Tubal infection with the gonococcus or Chlamydia will frequently damage the fallopian tubes and cause a hydrosalpinx. Some hydrosalpinges are large enough to be seen by ultrasound and some only by hysterosalpingogram or laparoscopy. Some studies have suggested that large hydrosalpinges that can be seen by ultrasound are most likely associated with low pregnancy rates even with in vitro fertilization-embryo transfer (IVF-ET) but is corrected by salpingectomy.

Essure® hydrosalpinx occlusion prior to IVF-ET as an alternative to laparoscopic salpingectomy

To investigate the success rate of proximal tubal occlusion with Essure(®) devices in subfertile women with unilateral or bilateral hydrosalpinx and to observe the results of subsequent treatment with IVF-ET and/or frozen embryo transfer. Prospective, single-arm, clinical study in 20 women with unilateral or bilateral hydrosalpinges (all visible on transvaginal ultrasound) due to undergo IVF-ET and/or frozen embryo transfer. In all patients, laparoscopy was considered to be contraindicated due to extensive pelvic adhesions. In all patients the Essure(®) devices were placed in an ambulant setting without any complications. Proximal tubal occlusion was confirmed by hysterosalpingography in 19 out of 20 patients (95%) and in 26 of 27 treated tubes (96%). After 45 embryo transfer procedures in 19 patients, 18 pregnancies with 12 live births, 6 miscarriages and 1 immature delivery (probably related to cervical insufficiency leading to chorioamnionitis and subsequent rupture of the membranes) were observed. Essure(®) devices are effective in inducing proximal tubal occlusion in subfertile patients with hydrosalpinges. After artificial reproductive treatments a cumulative live birth rate per patient of 63% and a cumulative live birth rate per transfer of 27% were achieved. The latter was related to the large proportion of patients with severe endometriosis.