Fallopian Tube Occlusion Research Articles

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.

Short communication: Evaluation of tubal patency in repeat breeder Holstein cows

Aim of study: To evaluate tubal patency in repeat breeder Holstein cows with the purpose of estimating the frequency of oviduct obstruction as a cause of the repeat breeding syndrome.Area of study: Lugo (NW Spain)Material and methods: In 50 repeat breeding cows, a solution of the dye phenol-sulphon-phthalein (PSP) was instilled into one uterine horn with the aid of a balloon catheter. Urine was collected 15, 25 and 45 min post-PSP infusion. Urine of a reddish color was used as indicator of tubal patency, as the PSP had passed across the oviduct into the abdominal cavity and was eliminated in urine. The other oviduct was evaluated on a different day.Main results: Of the 50 cows tested, 44% had some degree of oviduct obstruction: 4% had bilateral oviduct occlusion, 20% unilateral oviduct occlusion, 16% bilateral oviduct stenosis and 4% unilateral oviduct stenosis. No significant relationship could be established between tubal impermeability and postpartum reproductive or metabolic diseases.Research highlights: Tubal stenosis or occlusions were frequent and they are likely to contribute to the repeat breeding syndrome in dairy cows; thus, tubal patency should be routinely evaluated in repeat breeders. The PSP test is easy to perform, well tolerated by animals, and allows evaluating both oviducts separately.

Hysteroscopic Assessment of Tubal Patency: A Randomized Comparison between the Flow and Parryscope Techniques

To evaluate the accuracy of the "Parryscope" and "flow" techniques for hysteroscopic assessment of tubal patency. Prospective randomized clinical trial. From May to October 2019, women with subfertility undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate in the study. The primary outcome was accuracy of Fallopian tube patency relative to the gold standard of laparoscopic chromopertubation. Sixty women with subfertility. Hysteroscopy with either the "Parryscope" or the "flow" techniques for tubal assessment, directly followed by laparoscopy with chromopertubation. Hysteroscopic prediction of fallopian tube patency was possible in a statistically significant manner in both study groups (p <0.05). The Parryscope technique achieved higher sensitivity (90.6%, 95% CI: 61.7-98.4) and specificity (100%, 95% CI: 90.0-100.0) than the flow technique (sensitivity: 73.7%, 95% CI: 48.8-90.9 and specificity: 70.7%, 95% CI: 54.5-83.9). Using the Parryscope technique to determine if air bubbles traverse the ostia can provide valuable additional information during hysteroscopy and is more accurate in predicting fallopian tubal occlusion than the flow method.

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.

Influence of a mannose-binding lectin gene polymorphism and exposure to Chlamydia trachomatis on fallopian tube obstruction in Brazilian woman.

Factors influencing fallopian tube occlusion in women with a lower genital tract infection remain incompletely elucidated. We evaluated whether a polymorphism in the mannose-binding lectin (MBL) gene at codon 54 influences the occurrence of fallopian tube blockage in relation to exposure to Chlamydia trachomatis. In a case-control study at The Hospital das Clínicas, University of São Paulo, Brazil, 75 women with hysterosalpingography-documented tubal occlusion and 75 women with patent fallopian tubes were analyzed for detection of single-nucleotide polymorphism in codon 54 of the MBL gene and for IgG anti-C. trachomatis antibodies in their sera. Both groups were matched for age, race, and sexual variables. Prior exposure to C. trachomatis, as evidenced by the presence of IgG antibodies, was comparable in both groups. Detection of the polymorphic MBL allele was more prevalent in women with blocked tubes (p < 0.01), regardless of whether or not there was evidence of prior chlamydial exposure. The level of MBL-related innate immunity influences the consequences of infection by C. trachomatis or other microbes.

B cell activation factor (BAFF) induces inflammation in the human fallopian tube leading to tubal pregnancy

BackgroundTubal pregnancy is recognized as one of the most common ectopic pregnancy types. Salpingitis may result in tubal pregnancy by causing fallopian tube occlusion and hydrosalpinx. B cell activation factor (BAFF) is a proinflammatory cytokine that helps regulate both innate and adaptive immune responses. Our previous study firstly showed that BAFF immunostaining appeared on the cellular membrane and in the cytoplasm of tubal epithelial cells, and both BAFF protein and mRNA in human inflamed fallopian tubes had higher expression levels than those in normal fallopian tubes. This study aimed to elucidate the association between the expression of BAFF gene and the inflammation in the human fallopian tube leading to tubal pregnancy.MethodsWe examined 70 patients undergoing salpingectomy for salpingitis (n = 35) and tubal pregnancy (n = 35). Twenty patients with benign uterine diseases undergoing complete hysterectomy and salpingectomy were recruited into control group. BAFF mRNA and protein in tissue samples were detected by qPCR and Western blotting methods. Furthermore, serum levels of BAFF, tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 were measured using ELISA kits.ResultsWe found statistically significantly elevated expressions of BAFF mRNA or protein in whole tissue samples, and serum levels of BAFF, TNF-α and IL-6 in whole blood samples from patients with salpingitis and tubal pregnancy, in comparison to the control group.ConclusionBased on the results, high expression of BAFF gene might induce inflammation in the human fallopian tube, suggesting its possible role in the tubal pregnancy process.

Unilateral agenesis of the right ovary and fallopian tube in an infertile patient with a normal uterus

Introduction. Unilateral ovarian and Fallopian tube agenesis is an extremely rare anomaly that is usually associated with uterine and renal anomalies. This anomaly is usually incidentally detected during laparoscopy or laparotomy performed for other indications. We have reported a rare case of unilateral ovarian and Fallopian tube agenesis in an infertile patient with a normal uterus. Case report. A 34-yearold infertile patient was admitted to our clinic for laparoscopy and hysteroscopy, indicated for the right Fallopian tube occlusion and an endometrial polyp. The patient underwent laparoscopy and hysteroscopy. Unilateral right ovarian and Fallopian tube agenesis was diagnosed during laparoscopy. Upon exploration of peritoneal surfaces, omentum and intestinal serosa, neither ectopic nor remnant tissues of the ovary or Fallopian tube were found. Renal anomalies were not identified on the ultrasound examination. The hormone panel and karyotype were normal. Her partner?s semen analysis was normal. The patient conceived spontaneously one year later. Serial ultrasound examinations showed normal fetal intrauterine growth and development. The patient vaginally delivered a live, female newborn at 40 weeks? gestation, weighing 3,350 grams, 53 cm long, with 9/10 Apgar scores at birth. The patient and her newborn were discharged home on the third postpartum day. Conclusion. Unilateral ovarian and Fallopian tube agenesis is rarely associated with a normal uterus. Laparoscopy is the gold standard in the diagnosis of ovarian and Fallopian tube agenesis. Unless other obstetric indications are present, this anomaly is not specific and it is not an indication for a Caesarean section, and vaginal delivery is a possibility at term pregnancy.

РЕПРОДУКТИВНАЯ ФУНКЦИЯ ЖЕНЩИН, ПЕРЕНЁСШИХ В ДЕТСТВЕ РАСПРОСТРАНЁННЫЙ АППЕНДИКУЛЯРНЫЙ ПЕРИТОНИТ

Objective: To study the reproductive function of women in the long-term period after surgical treatment of diffuse appendicular peritonitis (DAP) in childhood. Methods: From the 163 operated girls fertility function was studied in 115 in the long-term period, including 62 patients in the control group and 53 in the main group. In the main group, intra-operative abdominal ozone therapy was used to prevent adhesive process; introduction of ozone-oxygen mixture through micro-irrigator and ultra-phonophoresis or electrophoresis on the anterior abdominal wall in the early postoperative period. Results: It has been established that the history of DAP in childhood was not reliably affected the cyclicality of the menstrual cycle in a long-term period, although there was a decrease in the frequency of this indicator to the main group to 15.1% compared to the control group – 27.4% (p&gt;0.05). In relation for painful menstruation, the difference between groups was statistically significant (18.9% vs. 38.7%, p&lt;0.05). In addition, in the control group more than twice as often cases of ectopic pregnancies, miscarriages and premature births were registered (48.4% vs. 22.6%, p&lt;0.05) and infertility was more common (29.0% vs. 13.2%, р&lt;0.05). Of the 25 women with infertility who suffered from DAP in childhood, 23 were underwent hysterosalpingography. At the same time, against the background of the normal hormonal status tubal-peritoneal form of infertility was diagnosed associated with the adhesive process in the small pelvis. At 11 (47.8%) observations occlusion of fallopian tubes occurred, and in 10 of them the process was right-handed Conclusion: Improving the comprehensive treatment of children with DAP has significantly reduced its negative impact on the reproductive system of girls. Keywords: Appendicular peritonitis, complications, girls, reproductive function, intra-operative ozone therapy, tubal infertility.

The effect of unilateral tubal block diagnosed by hysterosalpingogram on clinical pregnancy rate in intrauterine insemination cycles: systematic review and meta-analysis.

Fallopian tube occlusion is a common cause of infertility, but the effect of unilateral tubal block (UTB) on pregnancy rates (PR) after controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) remains controversial. To evaluate PR after COH-IUI among infertile women with proximal and distal UTB diagnosed by hysterosalpingogram (HSG), compared against women with bilateral patent tubes experiencing unexplained infertility. We searched EMBASE, MEDLINE, Google Scholar, Cochrane Library, and PUBMED from inception to 14 January 2018. Studies that report PR/cycle or cumulative PR among women with UTB and controls were included. Two authors independently selected and extracted study characteristics and data. Methodological quality was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Among 2965 patients and 5749 IUI cycles across ten studies, no significant difference in PR/cycle (odds ratio, OR = 0.88; 95% confidence interval, 95% CI = 0.69-1.12) and cumulative PR (OR = 0.80, 95% CI = 0.62-1.04) was observed. Patients with proximal UTB demonstrated similar PR/cycle (OR = 1.06, 95% CI = 0.68-1.66) and cumulative PR (OR = 1.10, 95% CI = 0.75-1.62), compared with controls, whereas patients with distal UTB had significantly lower cumulative PR (OR = 0.49, 95% CI = 0.25-0.97, P = 0.04). Patients with proximal block also demonstrated significantly improved cumulative PR, compared with patients with distal block (OR=2.41, 95% CI = 1.37-4.25, P = 0.002). Infertile patients with proximal UTB diagnosed by HSG can expect similar pregnancy rates after COH-IUI, compared with those with bilateral tubal patency and unexplained infertility, whereas patients with distal UTB have lower odds of pregnancy. These differences may reflect inherent diagnostic limitations of HSG or differences in underlying pathologies. Meta-analysis evaluates pregnancy outcomes after COH-IUI in women with unilateral tubal block diagnosed by HSG.

Advances in permanent contraception: intrauterine administration of combined polidocanol plus doxycycline foam stimulates permanent fallopian tube occlusion in baboons

Advances in permanent contraception: intrauterine administration of combined polidocanol plus doxycycline foam stimulates permanent fallopian tube occlusion in baboons

Use of Hysterosalpingo-Foam Sonography for Assessment of the Efficacy of Essure Hysteroscopic Sterilization.

Hysterosalpingo-foam sonography (HyFoSy) has been suggested to be a possible less invasive alternative to hysterosalpingography (HSG), which is the reference standard for confirmation of tubal occlusion after Essure (Bayer AG, Leverkusen, Germany) hysteroscopic sterilization. The purpose of our study was to evaluate the accuracy of HyFoSy compared to HSG for confirmation of tubal occlusion after Essure hysteroscopic sterilization. A prospective study included 90 patients who underwent Essure hysteroscopic sterilization. Twelve weeks after the sterilization, 2-dimensional transvaginal ultrasonography was performed to assess the microinsert position and was followed by HyFoSy and HSG for evaluation of tubal occlusion. Patients with patent fallopian tubes on HSG were scheduled for additional HSG procedures at 3-month intervals until tubal occlusion was documented. Of 90 enrolled patients, 86 patients with 170 fallopian tubes underwent the complete imaging protocol. Tubal occlusion was evaluated by HyFoSy as an index test and HSG as a reference standard. The accuracy of HyFoSy was 97.1% (95% confidence interval [CI], 93%-99%). The sensitivity and specificity were 100% (95% CI, 97%-100%) and 54.6% (95% CI, 23%-83%), whereas the positive and negative predictive values were 97.0% (95% CI, 93%-99%) and 100% (95% CI, 42%-100%), respectively. No long-term complications were reported for HyFoSy or HSG. Given that the concordance rate for tubal occlusion between HyFoSy and HSG was not 100%, an occluded fallopian tube on HyFoSy should be confirmed by HSG, which remains the reference standard for confirmation of tubal occlusion after Essure hysteroscopic sterilization.

Pregnancy After Tuboplasty As A Recanalization Procedure Following Tubal Ligation

Objective To determine the rate of pregnancy in patients with recanalization by tuboplasty after tubal ligation. Study design Descriptive case series. Place & Duration of study Bahawal Victoria Hospital / Quaid-e-Azam Medical College Bahawalpur, from January 2008 to December 2017. Methodology This study included all patients who underwent tuboplasty after tubal ligation. During the study period 150 patients requested for reversal of tubal ligation via tuboplasty, out of whom 29 were included found most suitable for this procedure. Tuboplasty was done via open abdominal approach. Patients were followed up for one year to observe the pregnancy rate in this cohort of patients. Results Twenty nine patients underwent tuboplasty of whom 3(10.34%) were lost to follow up two months after surgery. Twenty (76.9%) women conceived in this series. Six (23.07%) patients did not conceive even after one year of tuboplasty. Hysterosalpingography (HSG) was then performed on these six patients. Three (50%) had bilaterally patent tubes, 2 (33.33%) had unilateral occlusion of fallopian tubes while 1 (16.6%) had bilateral tubal occlusion on HSG. Conclusions Success rate of pregnancy after tuboplasty in women who underwent bilateral tubal ligation was good if most suitable candidates were selected and an effective technique was used for tubal recanalization. It is an alternative to ICSI (Intra-cytoplasmic Sperm Injection) and IVF (In-vitro Fertilization) on account of lower cost and lack of religious conflicts. Key words Bilateral tubal ligation, Tuboplasty, Pregnancy rate.

Pressure dynamics in the non-gravid uterus: intrauterine pressure cannot confirm tubal occlusion after non-surgical permanent contraception

ObjectiveThe objective was to determine if intrauterine pressure can distinguish bilateral tubal occlusion (BTO) from unilateral or bilateral tubal patency (TP) in women following a permanent contraception procedure. Study designWe used a small inline pressure sensor to continuously monitor intrauterine pressure during hysterosalpingogram (HSG) in a cross-sectional study that enrolled women having HSGs for any indication. The primary outcome was the peak intrauterine pressure compared between women with BTO and TP as verified by HSG. ResultsWe enrolled 150 subjects, of which 111 (74.0%) provided usable pressure readings. Of these, 98/111 (88.3%) had TP, and 13 (11.7%) had BTO. There was no difference in peak intrauterine pressure for subjects with TP (mean 293.8±58.7 mmHg) compared to those with BTO (292.7±71.3 mmHg, p=.95). Among parous women, peak intrauterine pressure in subjects with BTO (311.9±78.0 mmHg) was higher but not significantly different from subjects with TP (282.7±49.2 mmHg, p=.20). In linear regression analysis, peak intrauterine pressure was not associated with age, body mass index, gravidity or having at least one prior live birth. ConclusionsMeasurement of peak intrauterine pressure does not distinguish between women with patent and blocked fallopian tubes. This approach would not be clinically useful to verify occlusion following permanent contraception. ImplicationsPeak intrauterine pressure does not differ between women with patent and occluded fallopian tubes and cannot be used to confirm tubal occlusion after nonsurgical permanent contraception.

MicroRNA expression profiling in endometriosis-associated infertility and its relationship with endometrial receptivity evaluated by ultrasound.

To investigate the microRNA expression profiling in endometriosis-associate infertility, and relationship between the microRNA expression and endometrial receptivity evaluated by ultrasound. First, miRNA expression profiling difference of ectopic endometrium between 8 endometriosis patients and 6 endometriosis-free patients were compared. Bioinformatics analyses detected 61 differentially expressed (DE) known miRNAs and 57 DE novel miRNAs. Next, other 24 patients were selected for checking the microRNAs in differential expression by RT-PCR. Among them, case and control groups include 14 endometriosis and 10 endometriosis-free infertility patients, respectively. Last, endometrial receptivity of other 20 endometriosis patients was evaluated by ultrasound. In this group of patients, 12 had high endometrial receptivity, in which infertility is caused by fallopian tube occlusion, and 8 had low endometrial receptivity. The study compared endometrial miRNAs expression between two groups, and also evaluated the relationship between the endometrial miRNAs expression and the endometrial receptivity. First, study indicated that "proteinaceous extracellular matrix," "laminin binding" and "extracellular matrix binding" were enriched in 6 up-regulated miRNA targets, while "cell proliferation" was enriched in the 4 down-regulated miRNA targets. Second, 10 miRNAs in different expression (miR-1304- 3p, miR-544b, miR-3684, miR-494-5p, miR-4683, miR-6747-3p; miR-3935, miR-4427, miR-652-5p, miR-205-5p) were detected by RT-PCR, and the results showed statistically significant differences between 2 groups in all 10 miRNAs. Third, the expression levels of miR-1304-3p, miR-494-5p, and miR-4427 were different between the two groups with different endometrial receptivity. But for the miR-544b, there was no statistically significant difference between two groups. The study provided a comprehensive understanding to the current knowledge in the field of miRNAs in endometriosis and the relationship between them and the endometrial receptivity. miRNAs could be used as diagnostic biomarkers and therapeutic agents for this disease. The combination of ultrasound and miRNAs detection could be a better choice for the diagnosis of infertility in the future.

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.

Hysterosalpingographic (HSG) Pattern of Infertility in Women of Reproductive Age.

Background:Infertility is a complex disorder with significant medical, psychological and economic problems.Aims:The aim of the study is to evaluate the structural abnormalities of the uterus and fallopian tubes in infertile women as elucidated by hysterosalpingography.Setting and Design:A retrospective study, conducted at the Radiology and Obstetric and Gynaecologic Departments of a tertiary health care institution.Materials and Methods:Evaluation of all consecutive patients in whom hysterosalpingographic (HSG) was performed for infertility between July 2013 and June 2015 in the Department of Radiology. For the biodata, indications for the investigation and the HSG findings were obtained.Statistical Analysis:The data were analyzed using IBM Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) for Windows, version 20 software.Results:A total of 299 patients were evaluated. Of these, 250 were for infertility with primary and secondary infertility constituting 18.4 and 81.6%, respectively. Seventy percent of the cases for infertility had abnormalities on the HSG. Normal uterine cavity was found in 123 (49.2%) cases. Uterine filling defects were the most common uterine abnormality. Fallopian tube occlusion, loculated contrast material spillage and hydrosalpinx were more common on the right, and bilateral tubal occlusion was seen only in 11.2%. All cases of intravasation were associated with either unilateral or bilateral fallopian tube blockage or irregularity of the uterus.Conclusion:There was a high incidence of tubal disease in the women presenting with infertility. This was commonly as a result of infection and inflammatory process. This study showed that HSG is very vital in detecting birth canal pathologies; hence, the facility for this important procedure, especially fluoroscopy, should be made available in the health centres for adequate assessment of the women with infertility.

Comparison of hysterosalpingography and laparoscopy in evaluation of female infertility

Background and Objectives: Laparoscopic surgery (LS) is the most important diagnostic technique for the detection of causes of infertility; however, this method is accompanied by some setbacks. Given the noninvasive nature and cost-effectiveness of hysterosalpingography (HSG), it is widely used as the first-line approach for the evaluation of the patency of the fallopian tubes and uterine anomalies in female infertility. Herein, we aimed to compare the diagnostic values of HSG with LS in the assessment of patency of the fallopian tubes and peritoneal disease in infertile women.Materials and Methods: This prospective, cross-sectional study was performed on 115 infertile women admitted to the Department of Obstetrics and Gynecology in Fatemiyeh Teaching Hospital, Hamedan, Iran, during March 2011- September 2012. Tubal patency, peritubal adhesion, uterine anomalies, and tubo-ovarian abscess (TOA) findings in HSG were compared with laparoscopic findings. Data was analyzed using McNemar's test and Cohen's Kappa. Results: The sensitivity, specificity, and accuracy of HSG for the detection of unilateral and bilateral tubal occlusion were 75%, 91.2%, 89.5%, 75%, 97.2%, and 96.6%, respectively. Furthermore, false-positive and false-negative rates of HSG for the detection of unilateral and bilateral tubal occlusion were 8.7% and 25%, respectively. The accuracy of HSG in detecting uterine anomalies and hydrosalpinx were 93.3% and 93.9%, respectively. Peritubal adhesion and TOA were detected in 61% of the cases with normal HSG. In addition, of the nine cases of bilateral tubal occlusion detected by HSG, six cases were confirmed to have bilateral occlusion using laparoscopy. The comparison between HSG and LS techniques showed a significant difference in diagnosis of distal fallopian tube occlusion (P=0.021) and unilateral fallopian tube occlusion (P<0.001) among infertile women. The comparison between HSG and LS techniques demonstrated a significant difference in diagnosis of TOA (P<0.001) and peritubal adhesion (P=0.033).Conclusion: It seems that the findings of HSG regarding occlusion, hydrosalpinx, and uterine anomalies are reliable. However, due to its low sensitivity in detecting peritubal adhesion, performing LS before initiation of treatment in these patients is necessary to rule out adhesion and to confirm tubal patency.

Bioengineering Strategies to Treat Female Infertility.

Bioengineering strategies have demonstrated enormous potential to treat female infertility as a result of chemotherapy, uterine injuries, fallopian tube occlusion, massive intrauterine adhesions, congenital uterine malformations, and hysterectomy. These strategies can be classified into two broad categories as follows: (i) Transplantation of fresh or cryopreserved organs into the host and (ii) tissue engineering approaches that utilize a combination of cells, growth factors, and biomaterials that leverages the body's inherent ability to regenerate/repair reproductive organs. While whole organ transplant has demonstrated success, the source of the organ and the immunogenic effects of allografts remain challenging. Even though tissue engineering strategies can avoid these issues, their feasibilities of creating whole organ constructs are yet to be demonstrated. In this article we summarize the recent advancements in the applications of bioengineering to treat female infertility.

Polidocanol induced tubal occlusion in nonhuman primates: immunohistochemical detection of collagen I-V

ObjectiveIntrauterine administration of polidocanol foam (PF) can create fallopian tube occlusion in nonhuman primates. The objective of this study was to determine if PF-induced tubal obstructions contain collagen in the extracellular matrix. Study designWe compared tissue samples of the intramural fallopian tube obtained from previous studies evaluating the effects of intrauterine infusion of 5% PF 2–12 weeks after treatment. Serial sections of the intramural portion of the fallopian tube obtained from representative treated (rhesus macaques, n=7; baboon, n=11) and untreated control (macaque, n=3; baboon, n=5) animals were stained with hematoxylin and eosin to identify tubal occlusion and by immunohistochemistry for collagens Col-I, Col-III and Col-IV. Descriptive results are summarized. ResultsControl animals exhibited histologically normal fallopian tubal epithelium with no staining for Col-1, light staining for Col-III and Col-V in the lamina propria and Col-IV distributed evenly in the extracellular matrix of the lamina propria. Treatment with PF resulted in acute tissue damage confined to the intramural tube; no epithelial damage or occlusion occurred in the tubal isthmus or ampulla. Blockade of the intramural tube demonstrated fibrosis with the epithelium replaced with extracellular matrix that stained strongly for Col-I, Col-III, Col-IV and Col-V. Col-II was undetectable. ConclusionTubal blockage induced by PF resulted in loss of normal epithelium and accumulation of collagens Col-I, Col-III, Col-IV and Col-V at the site of obstruction. The presence of dense collagen staining supports the hypothesis that PF infusion creates lasting tubal obstructions. ImplicationsThis study demonstrates that PF-induced tubal occlusion results in deposition of collagens suggesting the potential for a more lasting blockade. The structural nature of this occlusion supports the development of intrauterine administration of PF as a nonsurgical method of permanent contraception.

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.