Cause Of Secondary Infertility Research Articles

Osseous metaplasia of endometrium: An unusual cause of secondary infertility.

Osseous metaplasia of the endometrium is a rare entity in which there is presence of mature or immature bone tissue in the endometrium. It is a rare disorder that usually leads to secondary infertility and is frequently associated with recurrent miscarriages and can be rarely asymptomatic. We present the case of a patient with endometrial ossification associated with secondary infertility. The patient presented with excessive vaginal discharge and was undergoing evaluation for secondary infertility. Transvaginal sonography showed a hyperechoic elongated lesion in the endometrium suggestive of endometrial calcification with posterior acoustic shadowing. Diagnostic hysteroscopy was done and the endometrial cavity showed multiple white-colored, solid, fan-shaped structures and bony spicules all over the endometrium, which were removed with a hysteroscopic grasper and sent for histopathological examination (HPE). The HPE confirmed the presence of bony trabeculae along with secretory endometrial glands. There have only been a few cases of endometrial osseous metaplasia reported in India and it is usually an overlooked cause of infertility. Although rare, we should consider this as a probable cause of secondary infertility when the characteristic ultrasound features are visualized and that hysteroscopic resection is the gold standard treatment.

Secondary infertility due to necrospermia in men with autosomal-dominant polycystic kidney disease: a report of two cases.

Autosomal-dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease characterized by the formation of numerous cysts in organs other than the kidneys. Although female patients with ADPKD do not have direct fertility problems, infertility in male patients may arise following the formation of cystic lesions in the lower seminal tract, which impair the function of spermatozoa. Generally, the treatment strategy for necrospermia depends on the severity of sperm viability, and intracytoplasmic sperm injection may be offered to patients with necrospermia. We report two cases of secondary infertility in men with ADPKD. These men experienced an inability to reproduce naturally after the previous birth of a child, suggesting a progressive deterioration of semen quality. Semen analysis showed necrospermia in both patients, and transrectal ultrasound revealed marked dilatation of the seminal vesicles bilaterally. The main cause of secondary infertility in male patients with ADPKD is sperm death resulting from progressive dilatation of seminal vesicles. Further research is needed on the appropriate follow-up schedule for men with ADPKD who desire to reproduce naturally.

Bone within the endometrium: An uncommon cause of secondary infertility

Endometrial osseous metaplasia is an uncommon non-neoplastic gynecological condition, resulting in formation of mature or immature bone within the endometrial stroma. Most cases present with secondary infertility following an abortion. Although hysteroscopy is considered gold standard for the diagnosis of this rare entity, ultrasound (USG) plays an important role in its initial diagnosis. It is a challenging diagnosis due to its infrequency and similarity to other uterine pathologies. The characteristic USG appearance showing multiple bone fragments within the endometrium suggests the diagnosis. The current case report aims to highlight the role of USG in the detection and evaluation of the endometrial osseous metaplasia in patients presenting with secondary infertility.

Histological study of telocytes in mice intrauterine adhesion model and their positive effect on mesenchymal stem cells in vitro.

Intrauterine adhesions (IUA), the main cause of secondary infertility in women, result from irreversible fibrotic repair of the endometrium due to inflammation or human factors, accompanied by disruptions in the repair function of endometrial stem cells. This significantly impacts the physical and mental health of women in their childbearing years. Telocytes (TCs), a distinctive type of interstitial cells found in various tissues and organs, play diverse repair functions due to their unique spatial structure. In this study, we conduct the inaugural exploration of the changes in TCs in IUA disease and their potential impact on the function of stem cells. Our results show that in vivo, through double immunofluorescence staining (CD34+/Vimentin+; CD34+/CD31-),as endometrial fibrosis deepens, the number of TCs gradually decreases, telopodesshorten, and the three-dimensional structure becomes disrupted in the mouse IUA mode. In vitro, TCs can promote the proliferation and cycle of bone mesenchymal stem cells (BMSCs) by promoting the Wnt/β-catenin signaling pathway, which were inhibited using XAV939. TCs can promote the migrated ability of BMSCs and contribute to the repair of stem cells during endometrial injury. In addition, TCs can inhibit the apoptosis of BMSCs through the Bcl-2/Bax pathway. In conclusion, our study demonstrates, for the first time, the resistance role of TCs in IUA disease, shedding light on their potential involvement in endometrial repair through the modulation of stem cell function.

#222 : Exosomes Derived of Menstrual Blood Stem Cells Suppress IUA Endometrial Fibrosis Through P65-UBR4-YAP Pathway

Background and Aims: IUA is the second leading cause of secondary infertility in women, and it is urgent to find a new therapeutic method to achieve functional regeneration of endometrial. We previously found that menstrual blood stem cells (MenSCs) transplantation could improve endometrial fibrosis and restore fertility in IUA rats through exosomes (MenSCs-exos). We identified UBR4 as an E3 ubiquitin ligase that was abundantly enriched in MenSCs-exos by mass spectrometry sequencing, however, the role of UBR4 in MenSCs-exos treatment of IUA and the potential molecular mechanism remains unclear. Method: IUA rats and endometrial stromal cells (EndoSCs) of IUA patients were treated with knock-down UBR4 exosomes (EXOUBR4−) and normal exosomes (EXO). HE staining and Masson staining were used to evaluate endometrial morphology and fibrosis area. The expression levels of fibrotic indicators COL I and CTGF were detected. The molecular mechanisms by which UBR4 in MenSCs-exos alleviate EndoSCs fibrosis were then explored using immunofluorescence, western blot, and co-immunoprecipitation. The molecular mechanism of transcription factor P65 regulating the expression of UBR4 were explored using ChIP and dual luciferase. Results: MenSCs-exos could significantly restore the endometrial morphology of IUA rats, increase endometrial thickness and number of glands, and reduce the endometrial fibrosis area, however reducing the content of UBR4 in MenSCs-exos would alleviate its therapeutic effect on IUA rats. UBR4 in MenSCs-exos reduced the expression levels of COL I and CTGF through significantly decreasing the expression level of YAP by specifically ubiquitin-degrading YAP. In addition, P65 could bind to the UBR4 promoter region to transcriptionally promote the expression level of UBR4 in MenSCs. Conclusion: This study clarified that UBR4, as the key molecule in repairing IUA fibrotic endometrium by MenSCs-exos, could inhibit endometrial fibrosis by ubiquitin-degrading YAP, while transcription factor P65 could promote the expression level of UBR4 in MenSCs by directly binding to the UBR4 promoter region.

Retained Intrauterine Fetal Bone Fragments Causing Secondary Infertility: A Review.

Retained intrauterine fetal bone fragments are emerging as a potential yet often overlooked cause of secondary infertility, posing significant challenges for couples who have previously experienced successful pregnancies. This review article explores the association between retained fetal bone fragments and secondary infertility by delving into their impact on fertility, pregnancy outcomes, and diagnostic challenges. The review highlights the underlying mechanisms of fragment retention, including immune response and inflammation, and their detrimental effects on endometrial receptivity and implantation. The diagnostic difficulties and importance of specialized imaging techniques like hysteroscopy for accurate diagnosis are also discussed. The article also provides insights into available treatment options, such as medical management and surgical interventions, focusing on hysteroscopy as the gold standard for diagnosis and treatment. The implications for clinical practice emphasize early diagnosis and intervention to improve fertility outcomes and reduce the emotional burden of secondary infertility. Furthermore, the review discusses preventive strategies and the potential for future research to refine diagnostic methods and explore novel treatments. By recognizing and addressing the impact of retained fetal bone fragments, this review aims to enhance the understanding and management of this condition, providing valuable support to couples seeking to overcome the challenges of secondary infertility on their journey towardparenthood.

Case of retained fetal femur acting as inert intrauterine device

Introduction: Retention of fetal bones is a rare but documented complication after dilation and curettage (D and C). Previous case reports have described instances of retention of multiple fetal bones or bony fragments. Case Report: We are presenting a case of a female with 1.5 years of secondary infertility due to retention of a single, intact, fetal femur bone following a therapeutic abortion 13 years prior. The bone was incidentally identified on follicle check ultrasound and was removed via hysteroscopy. The patient conceived one year later, which progressed to a full-term pregnancy. Conclusion: Retained bony fragments or intact bones should be considered as a possible cause of secondary infertility following therapeutic abortions, emphasizing the importance of ultrasound imaging in preliminary secondary infertility workup.

Management of Infertility caused by Polycystic Ovarian Disease (PCOD) - A Case Report

A 29-year-old Indian woman who is a housewife and has PCOD as her primary cause of secondary infertility from 5 years, has also complained of irregular menstruation cycles and occasional constipation over the same time period. Her ongoing hormonal treatment had included investigative procedures including diagnostic laparoscopy, USG, and HSG, all of which had yielded negative results, and she had ultimately been recommended for IVF. Due to her ongoing hormone treatment, she had to deal with side effects like weight, hirsutism, stress, discomfort, and more. Her prolonged hormonal treatment had resulted in adverse effects like weight, hirsutism, stress, discomfort, etc. According to Ayurveda, PCOD symptoms point to the involvement of Kapha and Vata dushti, which leads to avarodha in Artavavaha srotasa. Virechana is advised in the classical texts of Ayurveda for Yonidosha (gynaecological diseases), while Erandamooladi basti is recommended for balancing Vata dosha. It was successfully treated by Ayurvedic management with Virechana and Basti from Shodhana chikitsa (total 18 days) and Shamana chikitsa (total 21 days), which has produced positive outcomes.

Label-free proteomic analysis and functional analysis in patients with intrauterine adhesion

Intrauterine adhesion (IUA) is one of the principal causes of secondary infertility in women of reproductive age, which seriously affects female reproductive function and quality of life. In recent years, the incidence of IUA has been increasing year by year, but its pathological mechanism has not yet been clarified. This study intended to reveal the pathogenesis of IUA and find new therapeutic targets by analyzing the proteomic differences between intrauterine adhesion tissues and normal human endometrial tissues. In the label-free quantitative proteomics, we identified 789 up-regulated differentially expressed proteins (DEPs) and 539 down-regulated DEPs. These DEPs were further analyzed by Gene Ontology (GO) annotation and enrichment analysis, Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis to preliminarily clarify the biomarkers involved in the pathogenesis of the IUA. The DEPs were further verified by parallel reaction monitoring (PRM) to confirm the results of proteomics. Finally, 7 target proteins may be candidates for treatment and elucidating the pathophysiology of IUA. SignificanceIUA is a fertility complication, which has increasing incidence recently. Until now, only a little research paid attention to the proteomic changes of IUA. This is the first study focused on the comparative analysis of endometrial tissue between IUA patients and normal women. We found 7 key proteins that may become the potential biomarkers of IUA.

Modified Palomo Procedure Is an Effective Intervention for Improving Serum Testosterone Levels and Semen Parameters in Patients With Varicocele: A Prospective Study.

A varicocele can be defined as an abnormal venous dilatation and/or tortuosity of the pampiniform plexus. It is generally reported that varicoceles are present in 15% of the general male population and 35% of men as a cause of primary infertilityand in up to 80% of men as a cause of secondary infertility. Differences in venous drainage anatomy between the left and right internal spermatic veins, venous valve incompetence resulting in venous blood reflux, and increased hydrostatic pressure are the most commonly cited theories. Various surgical and non-surgical techniques are in use for treating patients with varicocele. Here we used a modified Palamoprocedure to treat the patients and observed the outcome. A total of 40 patients with varicocele were recruited for the study. A preoperative evaluation, along with serum testosterone levels and semen analysis, was done. A modified Palomotechnique was used to treat varicocele. A postoperative follow-up with serum testosterone levels and semen analysiswas done to observe improvement. The mean (±SD) left testis size, right testis size, testosterone, sperm concentration, sperm vitality and sperm progressive motility were found statistically significantly higher in patients after surgery as compared to patients before surgery (p<0.05). However, there was statistically insignificant mean difference in semen volume between patients before surgery and patients after surgery (p>0.05). Modified Palomoprocedure can be used to treat varicocele with good improvement in serum testosterone levels and semen parameters.

Secondary Infertility: A Neglected Aspect of Buerger's Disease.

During the gathering of demographic data for the biobank on Buerger's Disease (BD), we found that, after the clinical manifestation of BD, the patients usually became infertile, and the age of their last child was compatible with the time of disease diagnosis. The aim of this study was to evaluate the underlying cause of secondary infertility in BD patients. Anti-sperm antibodies (ASA), testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in the sera of 39 male BD patients were measured and compared with 39 age-matched Caucasian male controls. Six patients declared that they suffered from impotency. The ASA level was positive in 25.6% of the patients and 2.4% of the controls (p= 0.003, CC= 6.96). The mean levels of testosterone in the patients and controls were 393.12±32.9 ng/dl and 354.37±30.9 ng/dl, respectively. The mean levels of LH in the patients and controls were 0.88±0.12 mIU/r and 0.85±0.1 mIU/r, respectively. The mean levels of FSH in the patients and controls were 4.1± 0.35 mIU/r and 3.56±0.33 mIU/r, respectively. No significant difference in the serum levels of testosterone, LH, or FSH was found between the patients and controls (p> 0.05). The spermograms of three ASA-negative patients demonstrated impaired sperm motility. Anti-sperm antibodies, disturbed genital circulation, autonomic dysfunction and sperm motility may be responsible for secondary infertility in Buerger's Disease.

Testicular Sarcoidosis: An Underdiagnosed Manifestation That Poses Unique Challenges

Testicular involvement is a rarely encountered complication of sarcoidosis. There are unique challenges involved when sarcoidosis affects the genitourinary system. These include differentiating the findings from testicular cancer, which often results in invasive procedures such as orchiectomies. It can also be a cause of secondary infertility in men. Additionally, it may also be underdiagnosed. Here, we describe a case where a patient showed a constellation of findings suggestive of sarcoidosis, along with testicular involvement at initial presentation. In this case, the diagnosis was made clinically with supporting laboratory, pathology, and ultrasound findings. The testicular findings were not biopsied, as the patient had easily accessible skin findings to confirm sarcoidosis. His testicular findings are continued to be monitored via ultrasound.

Experimental Zinc Supplementation on Reproductive Hormonal Balance in Female Wister Rats in The Management of Secondary Infertility

Several factors including hormonal and essential elements imbalance have been identified as possible causes of secondary infertility. While some studies have suggested that zinc may have the potential of reversing sub-fertility states, the dynamics of such impact is yet to be fully elucidated. This study evaluated the possible outcome of experimental Zn supplementation in ameliorating infertility in induced secondary infertile Wister rats. A total of 30 female rats each weighing averagely 120g were stratified into six groups: Group 1 – Baseline group; Group 2 – animals induced with secondary infertility using Levonorgestrel (LNG); Group 3 - Secondary infertility and administered 10mgZn/Kg bodyweight (LNG + 10mg Zn/kg bodyweight); Group 4 - LNG+50mgZn/kg; Group 5 -LNG+75mgZn/kg; Group 6 - LNG+100mgZn/kg. Blood zinc and reproductive hormones were measured at pre and post treatment phases using standard laboratory methods. Results were analyzed using appropriate statistical methods. A significant up-regulation of zinc in group 6 at the end of the study (pre-test Zn level= 1.39±0.1 mg/l, post-test Zn = 2.74±0.5 mg/l) and a significant dose dependent increase in the post-treatment progesterone levels in the experimental groups fed with graded doses of zinc (Group 4 = 11.34±2.2mg/l, Group 5 = 12.38±1.9mg/l, Group 6 = 15.9±3.6 mg/l) were observed. There was however a significant dose dependent drop in the FSH levels in the animals fed with different doses of zinc post-treatment. There may be a regulatory effect of zinc on the hypothalamic-pituitary-gonadal-axis through modulation of FSH and progesterone levels in Zn supplemented secondary infertile experimental animals.

Decreased Fertility in Women with Cesarean Scar Syndrome Is Associated with Chronic Inflammation in the Uterine Cavity.

Chronic inflammation in cesarean scar defect contributes to secondary infertility in women with cesarean scar syndrom; however, it remains unclear about the situation of inflammation in uterine cavity in women with cesarean scar syndrome. This ambidirectional cohort study aimed to explore the effect of inflammation in the uterine cavities of women with cesarean scar syndrome on infertility at a single university hospital. The frequency of chronic endometritis in infertile patients was retrospectively compared between the cesarean scar syndrome group and non-cesarean scar syndrome group. The frequency of endometriosis was also investigated in patients with cesarean scar syndrome who underwent laparoscopy. The level of tumor necrosis factor-α and interleukin-1β in the uterine cavity was prospectively evaluated in the cesarean scar syndrome group and in women with a history of cesarean section (control group) using an enzyme-linked immunosorbent assay. There was a significant difference in the incidence of chronic endometritis between the cesarean scar syndrome and non-cesarean scar syndrome groups (65.8% and 46.0%, respectively, p = 0.0315). Endometriosis was detected in 51 (70%) patients with laparoscopy. Tumor necrosis factor-α and interleukin-1β levels in the cesarean scar syndrome group were significantly higher than those in the control group (p = 0.0002 and p = 0.0217, respectively). Our findings suggest that one cause of secondary infertility in women with cesarean scar syndrome is embryo implantation failure-associated chronic endometritis, endometriosis, and chronic inflammation in the uterine cavity.

Secondary Infertility in Port Harcourt: Pattern and Socio-Dermographic Relationship

Background: Secondary Infertility is viewed as a social stigma, especially in Nigeria, due to the high premium placed on procreation. Observation suggests that this condition is on the increase in our environment. Hence, the need to determine the pattern and the relationship between the socio-demographic factors with infective causes of this condition; which will subsequently allow the tailoring of the individual investigation and subsequent treatment.&#x0D; Objective: To determine the prevalence and pattern as well as the relationship between the socio-demographic factors with infective causes of secondary infertility among women who attended the gynaecological clinic of the University of Port Harcourt Teaching Hospital (UPTH) between January 2012 and December 2016&#x0D; Methods: This is a retrospective descriptive study design, based on findings from the folders, admission and outpatient registers, of infertile couples presenting at the gynaecology clinic of the University of Port Harcourt Teaching Hospital, over a five-year period (January 2012 – December 2016). Data were collected from all documented and laboratory findings. The data extracted from the case records were the socio-demographic characteristics of the patient, the duration of infertility as well as the causes. They were analyzed using SPSS version 20.&#x0D; Results: The mean age of women was 33.14±4.93 years. The prevalence of secondary infertility was 12% of all outpatient gynaecological consultation. The mean duration of secondary infertility was 3 years.&#x0D; The infective causes of secondary infertility [recurrent pelvic inflammatory disease(PID), sexually transmitted infections(STI), post abortal sepsis, puerperal sepsis, HIV/AIDS, mumps orchitis were commoner among the 31-40 years’ category, (45.8%), the infective causes were also commoner among women with primary level of education, (62.5%, p-value=0.001) as well as women who were self-employed (49%, p-value=0.041). Recurrent pelvic inflammatory disease was identified in majority of cases (37.1%). Abnormal semen analysis, hyper-prolactinaemia and uterine fibroid, also contributed significantly to infertility; 18.5%, 19.7% and 24.3% respectively.&#x0D; Conclusion: Infective causes are at the root cause of secondary infertility; the more educated the couple, the higher their socioeconomic status, the lesser the impact of infection on secondary infertility.

AYURVEDIC MANAGEMENT OF SECONDARY INFERTILITY DUE TO POLYCYSTIC OVARIAN SYNDROME AND TUBAL BLOCK: A CASE STUDY

Secondary infertility is defined as the inability of a couple to conceive who had at least one prior conception. Ovarian factor and tubal factor are the most frequent causes of secondary infertility in woman. Polycystic Ovarian Syndrome is a common endocrinological disorder and it is characterized by menstrual irregularities and anovulation. It can be correlated with Nashtartava in Ayurveda. Tubal factor infertility occurs when an obstruction in fallopian tube and it can be correlated with Sanga srotodushti of Artavavaha srotas or Beejavaha srotas. A 36 year old female presented with a complaint of secondary infertility a diagnosed case of Polycystic Ovarian Syndrome and tubal block with a history of neonatal death due to preterm delivery at 24 week gestation and husband aged 38 year with normal semen analysis. The present case was treated on Ayurvedic management protocol including shodhana, samana therapies and uttaravasti. Treatment was started with Deepana - Pachana medicines. Then Udwarthanam, Virechanam, Mathra vasti and Uttaravasti were done which removes the srotorodha and helps in proper formation of each dhatu. Uttaravasti is the most effective local treatment in gynaecological disorders. Uttaravasti with hot potency medicine is very effective in treating tubal blockage. The outcome of the treatment resulted in twin pregnancy and delivered two female babies. So the present case signifies the fruitful outcome of Ayurvedic treatment in the field of infertility. &#x0D; Keywords: Secondary infertility, Polycystic Ovarian Syndrome, Tubal block, Nashtartava, Artavavaha srotas, Uttaravasti

Collagen Scaffold with Human Umbilical Cord Mesenchymal Stem Cells Remarkably Improves Intrauterine Adhesions in a Rat Model

Background: Intrauterine adhesion (IUA) is the second leading cause of secondary infertility in women. Research has shown that stem cells can promote endometrial regeneration and that biomaterials are also helpful in tissue regeneration. Therefore, we compared the efficacy of a collagen scaffold combined with either human umbilical cord mesenchymal stem cells (hUCMSC) or estrogen for the treatment of IUA. Methods: The IUA-induced rats were injected with hUCMSCs or estrogen, and with a collagen scaffold. The endometrial glands and amount of fibrosis were assessed using hematoxylin and eosin and Masson staining. The extent of fibrosis and levels of regeneration-related cytokines were examined by real-time quantitative PCR, and the expression levels of the estrogen receptor, KI67 and cytokeratin were analyzed using an immunochemistry assay. In addition, human nuclear antigen (HuNu) and vimentin were examined by immunofluorescence microscopy. Results: The collagen scaffold administered with hUCMSCs markedly increased the number of endometrial glands and reduced the area of fibrosis compared with either the collagen scaffold or hUCMSCs alone. In addition, the collagen scaffold with hUCMSCs significantly regulated the expression levels of fibrosis, estrogen, and differentiation-related genes relative to the collagen scaffold or hUCMSCs alone. Furthermore, the hUCMSCs alone or in combination with the collagen scaffold increased the expression of HuNu and vimentin in the IUA-induced rat model. In addition, protein levels of the p-transcriptional co-activator with PDZ-binding motif, stromal cell-derived factor-1, and C-X-C chemokine receptor type 4 were upregulated in the group that received the collagen scaffold in combination with ­hUCMSCs. Conclusion: Our results suggest that the combination of the collagen scaffold with hUCMSCs may be an alternative approach for treating IUA.

Early Second-Look Hysteroscopy: Prevention and Treatment of Intrauterine Post-surgical Adhesions.

Introduction: Intra-uterine adhesion (IUA) is one of the main causes of secondary infertility. The aim of this study was to evaluate the prevalence of IUA developing in women undergoing hysteroscopic resection for submucous myomas, polyps, and intrauterine synechiae and test the efficacy of second look hysteroscopy for diagnosing and treating post-surgical adhesions.Materials and Methods: We retrospectively collected data from reproductive age women who had a second look office hysteroscopy following hysteroscopic resection for myoma, polyp, or IUA at Foch hospital (Suresnes, France) between 2009 and 2017.Results: Six hundred and twenty two reproductive-age women underwent hysteroscopic resection for myoma, polyp, and/or IUA. Among them, 155 women had a second look hysteroscopy. In this group, 29/155 (18.7%) had IUA formation: 17/83 (20.5%) women who underwent hysteroscopic myomectomy, 5/46 (10.9%) women who underwent hysteroscopic polypectomy, and 7/26 (26.9%) women who underwent hysteroscopic lysis of adhesions. These IUA have been lysed by the office hysteroscopy procedure in 16/29 (55.2%) patients: 11/17 (64.7%), 2/5 (40%), and 3/7 (42.9%) in women who underwent hysteroscopic myomectomy, polypectomy and lysis of adhesion, respectively.Conclusion: IUA is a common complication of hysteroscopic surgery. Second look office hysteroscopy is an easy and effective procedure for diagnosing and removing newly formed IUA. It should be recommended for all women undergoing hysteroscopic resection for myomas, polyps, or IUA.

Infertility caused by salpingitis treated based on theory of kidney deficiency and blood stasis

Infertility caused by salpingitis is one of the main causes of secondary infertility in women. In recent years,the incidence has been increasing year by year. Modern medicine believes that this disease is a complication due to incomplete or delayed treatment of acute and chronic salpingitis,with no satisfactory drug therapy at present. Clinical therapies mainly include surgical treatment,interventional treatment and assisted reproductive technology. After summarizing the experience of predecessors and the clinical practice of treating infertility for many years,the author considers that the disease location is the cell veins,and the nature is mostly mixed of deficiency and excess. Kidney deficiency and blood stasis are the main pathogenesis of infertility caused by salpingitis. Blood stasis is the pathological basis,while kidney deficiency is the fundamental pathogenesis. Long-term kidney deficiency will lead to blood stasis,and blood stasis will aggravate kidney deficiency. Both of them are cause and effect to each other. Infertility caused by salpingitis is difficult to cure. Based on the theory of kidney deficiency and blood stasis,the basic principles of clinical treatment are tonifying kidney and activating blood circulation,removing blood stasis and dredging collaterals. Oral administration with traditional Chinese medicine combined with external therapies,such as enema,external application,acupuncture and moxibustion,have been achieved a good efficacy in repairing fallopian tube function and improving pregnancy rate. Therefore,the treatment of infertility caused by salpingitis based on " kidney deficiency and blood stasis" is worthy of further discussion in both clinical and experimental aspects.

Retained Intrauterine Bony Fragments as a Cause of Secondary Infertility in a Tertiary Level Indian Hospital.

Background:Midtrimester surgical abortions often result in retained intrauterine fetal bones and consequent secondary infertility.Aim:To study the incidence of women presenting with retained intrauterine bones as a cause of secondary infertility in a tertiary level Indian hospital and pregnancy rates following retrieval of these fragments.Setting and Design:Retrospective data analysis in the infertility clinic of PGIMER (Post Graduate Institute of Medical Education and Research), a tertiary level hospital of Northern India.Materials and Methods:Women diagnosed with retained intrauterine bony fragments were subjected to hysteroscopic removal of these fragments. Incidentally diagnosed retained bones on hysteroscopy were also removed. Such women were followed for spontaneous resumption of fertility or were subjected to ovulation induction, and pregnancy rates were noted.Results:Retained fetal bones accounted for 0.28% of all women with infertility and 12% (22/144) of all the uterine causes of infertility requiring an operative hysteroscopic procedure for treatment. Only 5 (27.7%) of 18 women conceived after the hysteroscopic retrieval of bony fragments: three had full-term vaginal deliveries, one had a midtrimester abortion, and one woman is in her third trimester.Conclusion:Despite surgical retrieval, fertility rates may be lower due to inflammatory damage to the endometrium.