Tubal Damage Research Articles

O-125 How to evaluate the tubal function before and during surgery

Abstract Role of assessment of Fallopian tubes in the modern era of highly effective ART remains essential. Both prior to deciding if ART is needed to exclude tubal damage and also in those where ART is needed to exclude hydrosalpinges. The question remains how one should assess tubal function. It is now well established that not all patients needed invasive surgical techniques to assess fallopian tubes. Clinical history of pelvic infection or positive test for STI such as chlamydia and a baseline scan are soft markers indicating the need for an early tubal assessment. Non surgical techniques are the first line approach for tubal assessment such as HyCoSy ( HyFoSy) or HSG. Surgical method such as laparoscopy and dye test are generally recommended when results are inconclusive or pathology has been observed where surgery is indicated. These methods can check tubal patency but not tubal function. Where as tubal function can be assessed either with falloposcopy during laparoscopy or Fertiloscopy through transvaginal route by looking inside the fallopian tube.

Detection of Chlamydial Heat Shock Protein 60 and 10 Antibody among Female Infertility.

Of the many sexually transmitted pathogens, Chlamydia trachomatis is increasingly being associated with long-term sequelae such as infertility, apart from causing genital tract infections. Many inflammatory responses directed against chlamydial infection can cause tubal damage resulting in infertility. For example, chlamydial heat shock protein 60 (cHSP60) and cHSP10 along with humoral immune response. The aim of our study is to detect the presence of immunoglobulin G (IgG) antibodies against Major Outer Membrane Protein (MOMP), cHSP60, and cHSP10 among female infertility. A total number of 230 female infertility patients attending the Outpatient Department of Reproductive Medicine, SRIHER, were included in the study. Detailed history documented in the proforma. Serological detection of C. trachomatis IgG antibody against MOMP, cHSP60, and cHSP10 antibody was done by enzyme-linked immunosorbent assay (ELISA). C. trachomatis IgG antibody against MOMP was detected in 15 (6.5%) of 230 females. High seropositivity to cHSP60 antibodies was detected among females of tubal factor infertility (TFI). Our study showed that cHSP60 antibodies (3.4%) were more common than cHSP10 (2.6%). Our study suggest cHSP60 or cHSP10 antibody detection by ELISA along with TFI is helpful for diagnosis and early institution of therapy. The accuracy of TFI prediction could be increased by the detection of anti-MOMP and cHSP60 over cHSP10 among secondary infertility than primary. The most probable reason for high seropositivity among secondary infertility patients may be due to repeated infection and chronicity because of longer active sexual life.

Efficacy of 2D/3D HyCoSy with new contrast medium lignocaine and saline comparing with HSG - A single centre prospective study

Tubal patency significantly impacts female infertility, with a substantial portion of cases linked to tubal damage. This hinders gamete and embryo transfer. While laparoscopic chromo-pertubation is the gold standard, its invasiveness prompts the search for alternatives. Common methods for assessing tubal health are Hysterosalpingography (HSG) and Hysterosalpingo Contrast Sonography (HyCoSy).The objective of this study is to assess and compare the efficacy of a budget-friendly 2D/3D HyCoSy method using a unique contrast agent with traditional HSG for diagnosing tubal patency in women with infertility issues.A prospective observational study was conducted within a single clinical setting over a five-year duration. A total of 117 infertile women underwent assessment using both the 2D/3D HyCoSy and HSG techniques.Participants had a mean age of 27.7 years (standard deviation: 4.2, range: 19-45 years). The diagnostic accuracy of 2D/3D HyCoSy was determined with a sensitivity of 91.86%, specificity of 89.18%, a positive predictive value of 90.40%, and a negative predictive value of 90.82%. Comparative analysis revealed that when evaluating tubal patency in both tubes collectively with HyCoSy, the sensitivity, specificity, and overall accuracy were 91.86%, 89.18%, and 90.59%, respectively. The study findings demonstrated that employing 2D/3D HyCoSy with lignocaine gel proved to be a superior diagnostic approach compared to HSG for assessing tubal patency in women experiencing infertility.

Advances in Mesenchymal Stem Cell Research Applications for Female Infertility-Mechanisms, Efficacy Parameters, Challenges and Future Roadmap.

Infertility affects approximately 15-20% of couples globally, with female factors contributing to nearly half of cases. Conditions such as polycystic ovary syndrome, endometriosis, tubal damage and premature ovarian failure are leading causes of female infertility. Current treatments like in vitro fertilization (IVF) have limitations and risks. Mesenchymal stem cells (MSCs) have shown therapeutic potential due to their ability to differentiate, secrete trophic factors, and exhibit immunomodulatory and anti-inflammatory properties. They have been demonstrated to repair and regenerate reproductive organs in various preclinical models of infertility related conditions. MSCs have reduced endometriotic lesions, regenerated lost follicles in premature ovarian failure (POF) models, and promoted tubal repair in damage models. Some clinical and preclinical studies have reported improved outcomes with MSC therapy in endometriosis and premature ovarian failure patients. This review discusses the properties and sources of MSCs, their mechanisms of action, preclinical evidence for applications in conditions like POF, polycystic ovary syndrome (PCOS), endometriosis, Asherman syndrome, and preeclampsia, and preliminary clinical data on MSC therapy for female infertility management.

Forensic Analysis of Eighteen Tubal Pregnancy-Related Medical Damage.

To analyze the cases of medical damage after misdiagnosis of tubal pregnancy, to explore the causes of medical damage, the causal relationship between medical malpractice and the damage consequences, as well as the causative potency, in order to provide evaluation ideas for forensic identification of such cases. Eighteen cases of forensic identification of tubal pregnancy related medical damage were collected and retrospectively analyzed from the aspects of age, maternity history, fertility requirements, risk factors, diagnosis and treatment, medical malpractice, damage consequences, and causative potency. All 18 cases were tubal pregnancy, of which 17 cases had medical malpractice, resulting in 14 cases of affected tubal resection, 2 cases of hemorrhagic shock death, 1 case of intrauterine fetal death and affected tubal resection. The other case had the consequence of affected tubal resection, but there was no malpractice in the treatment. Correct diagnosis is helpful to make appropriate treatment plan, prevent disease progression and reduce serious adverse consequences and the occurrence of medical disputes. Scientific and reasonable analysis of the causal relationship between medical malpractice and damage consequences and the causative potency is of great significance to the successful settlement of medical disputes.

Determinants of Pregnancy Outcomes After Assisted Reproductive Therapy: A Sample From the West Bank, Palestine.

Background Infertility is a public health issue with a significant impact on the well-being of affected couples. Aim This paper aims to detect the determinants of pregnancy and their outcome after assisted reproductive therapy (ART) in a sample of Palestinian society. Methods A retrospective observational study was carried out at Razan Medical Center for Infertility. Subjects were assigned into twelve categories based on the type of infertility (primary versus secondary), the cause of infertility, and the treatment modality. Age at marriage, age at presentation, duration of infertility, in addition to regularity of menstruation, were also studied. Biochemical pregnancy was considered the endpoint for the purpose of the analysis. Results We reviewed the files of 459 subjects diagnosed with infertility. 79.74% had primary infertility while 20.26% had secondary. 28.85% were found to be infertile due to anovulation, 2.86% due to endometriosis, 16.74% attributed to male factor, and 3.3% had tubal damage. 13.43% of cases were multifactorial while 34.80% were idiopathic. Four biochemical markers were assessed in our study:thyroid-stimulating hormone (TSH) (x̄=2.32±2.46), luteinizing hormone (x̄=6.71±4.90), follicle-stimulating hormone (FSH) (x̄=6.59±6.11), and human prolactin (x̄=41.88±6.50). The menstrual cycle was regular in 70.58% of subjects, in contrast to 29.41% with irregular cycles. The female mean age at presentation was 22.76±5.58, while their mean age of marriage was 22.76±4. The mean duration of infertility was 3.97±6.87 years. Patients were treated via three modalities - ovarian stimulation (2.2%), intrauterine insemination (29.58%), and intracytoplasmic sperm injection (68.21%) - with a success rate of 51.85%. Of the studied factors, only diagnosis, follicle-stimulating hormone, and treatment modality had a significant impact on the outcome, with p-values of 0.040, 0.003, and <.0.001, respectively. Conclusions There is a strong relationship between diagnosis prior to intervention, level of FSH, and treatment modality and successful outcome of ART.

Exosomal microRNAs in tubal fluid may be involved in damage to tubal reproductive function associated with tubal endometriosis

Research questionWhat is the effect of tubal endometriosis on tubal epithelial ultrastructure and is there a differential expression of exosomal microRNAs (miRNAs) in tubal fluid which may affect tubal infertility? DesignHuman fallopian tube epithelium and tubal fluid samples were obtained from patients with and without tubal endometriosis. Scanning electron microscopy and transmission electron microscopy were used to assess ultrastructural changes. Exosomal miRNAs in tubal fluid were extracted for microarray. ResultsEpithelial damage was visualized in the tubal endometriosis group using electron microscopy. The number of organelles decreased (P = 0.0314), and organelle structure was destroyed. A total of 14 differentially expressed exosomal miRNAs were detected in tubal fluid (fold change >2 and P < 0.05). Four miRNAs (miR-1273f, miR-5699-5p, miR-6087 and miR-6747-5p) were validated by quantitative real-time polymerase chain reaction. Bioinformatic analysis showed that most of the target genes participated in embryo transport, regulation of cell communication, anatomical structure morphogenesis and immune system processes. ConclusionsTubal endometriosis results in damage to the tubal epithelial ultrastructure in human specimens and the presence of differentially expressed exosomal miRNAs in tubal liquid. These findings help to clarify the pathogenesis of tubal endometriosis-associated infertility and the mechanisms driving tubal epithelial ultrastructure damage in tubal endometriosis.

Successful laparoscopic resection of fallopian tube abscess caused by Escherichia coli in a 12-year-old adolescent virgin:a case report and review of the literature

BackgroundUpstream infection with vaginal flora can develop into tubal endothelial damage and tubal edema, which can lead to tubal obstruction and fallopian tube abscess if left untreated. Fallopian tube abscess in adolescent virgins is very rare, it may lead to long-term or even lifelong complications once it occurred.Case presentationA 12-year-old adolescent virgin with no history of sexual intercourse and previous physical fitness who presented with lower abdominal pain with nausea and vomiting for 22 h, body temperature up to 39.2 °C. Laparoscopic surgery revealed an abscess in the left fallopian tube, the left fallopian tube was surgically removed, successfully treated, and the pus was cultured for escherichia coli.ConclusionIt is important to consider possibility of tubal infection in young.

Tubal Blockage Surgery: A Retrospective Cohort Study on Clinical Characteristics and Reproductive Outcomes Within Six Years.

Introduction and objectives This research undertakes a comprehensive evaluation of demographic information and medical antecedents, in addition to intraoperative observations, for patients diagnosed with tubal obstruction. Furthermore, we delineate the therapeutic procedures implemented to achieve bilateral tubal patency. The overarching objective of this study is to ascertain the efficacy of the aforementioned therapeutic procedures and to establish an optimal timeframe before the necessity for exogenous intervention becomes apparent. Material and methods This study conducted a retrospective analysis of patients diagnosed with infertility due to tubal obstruction at the Oradea County Clinical Hospital, spanning a six-year period from 2017 through 2022. We evaluated numerous factors, including demographic data of the patients, intraoperative observations, and the exact site of the obstruction within the fallopian tubes. Additionally, we monitored patients post-procedure to assess their potential for fertility following the intervention. Our study involved a comprehensive examination of 360 patients in total. The primary objectives of our research were to provide clinicians with significant insights regarding the likelihood of spontaneous conception subsequent to surgical interventions and to propose guidelines on establishing an adequate waiting period prior to recommending other interventions. We employed a mix of descriptive and inferential statistical methods to analyze the data amassed. Results This study encompassed an initial patient population of 360 included in the study following specific exclusion criteria; the remaining 218 patients constituted the study cohort. The mean±SD age of the patients was 27.9±4.4. Out of the entire cohort, 47 patients presented with minimal adhesions, while 117 patients exhibited blockages in one fallopian tube. A total of 54 patients were diagnosed with bilateral tubal defects. Post-intervention, patients were monitored and it was noted that 63 patients achieved pregnancy. The correlation analysis indicated the significant impact of tubal defect characteristics and patient age on fertility outcomes. The most favorable fertility outcomes were observed to be influenced by factors such as patient age and blockage location, while a higher body mass index (BMI) was found to exert a negative impact on fertility. Temporal analysis revealed that 52 patients conceived within the initial six months post-intervention, whereas only 11 patients became pregnant in the subsequent months. Conclusions Our research indicates that age, parity, and tubal damage severity predict tubal intervention success. Fimbriolysis was the most successful, while outcomes for salpingotomy varied. Conception significantly declined12 months post-intervention, suggesting this is a reasonable waiting limit for a successful pregnancy.

Analysis of the Effect of Female Genital Tuberculosis on Ovarian Reserve Parameters.

Female genital tuberculosis (FGTB) is a known cause of female infertility. Worldwide incidence is 5%-10% and annual burden in India is around 4%-7%. It is known to cause tubal and endometrial damage. However, the effect on ovarian damage is poorly known. The availability of ovarian markers has contributed to an improved understanding of ovarian reserve in FGTB. The aim of this study was to assess ovarian reserve by measuring anti-Mullerian hormone (AMH) and antral follicle count (AFC) amongst infertile women and analyse the effect of GTB on ovarian reserve parameters. This was a prospective study at a tertiary referral centre for infertility for 18 months. A total of 133 infertile women who underwent diagnostic hysterolaparoscopy and cartridge-based nucleic acid amplification test testing of an endometrial biopsy were included in the study. AMH and AFC of all the infertile women were assessed and compared between cases with and without FGTB. Independent t-test was used to find the outcome differences in the distribution of values. P < 0.05 was considered statistically significant. Fifty-eight (43.6%) cases were diagnosed with FGTB (Group I), and 75 (56.3%) cases were without FGTB (Group II). The mean AMH level 1.88 ng/ml (±1.52) and mean AFC 9.0 (±5.50) were significantly lower (P < 0.001) in Group I than in Group II with AMH 3.57 ng/ml (±2.93) and AFC 12.50 (±6.0). In women with prolonged infertility and low ovarian reserve, FGTB should be ruled out. Early diagnosis and treatment of GTB may prevent further decline of ovarian reserve and improve the reproductive outcome.

Factors Affecting Infertility in Women of Reproductive Age in the IVF Programme

Approximately 8-10% of couples are facing some kind of infertility problem. Infertility is defined as a couple's inability to achieve pregnancy over an average of one year without using birth control methods and while engaging in normal sexual intercourse. Primary and secondary infertility are the two types of infertility. The high percentage of female reproductive age factors influencing infertility, as well as existing studies on infertility-related factors in women, piques the researcher's interest in studying the factors that influence infertility in women. This study is an observational descriptive-analytic with a chi-square design based on secondary data collected from medical records. The majority (37,6%) of infertile women in this study were within the 31-35 age group. Most of the infertile women are primary infertile type women (81%). Indications that cause infertility include an indication of tubal damage, uterine disorders of the endometrium, and ovulation problems. In this case, researchers used these three indications to examine infertility factors in women of reproductive age. Based on the study results, 25% of indications of tubes, 21.7% of endometrial indications, and indications of ovarian problems were calculated by looking at AMH (Anti Müllerian Hormone) and AFC (Antral Follicle Count) values. In this study, the researchers looked for a correlation between increasing age in reproductive women with increasing AMH and AFC levels. Based on random sampling, there was a significant correlation between the increasing reproductive age of women and decreasing AMH and AFC values in women of reproductive age who underwent therapy at Bunda International Clinic, Morula IVF Jakarta.

Spontaneous bilateral tubal pregnancy - case report and review of diagnostic and treatment difficulties

Introduction. Spontaneous bilateral ectopic pregnancy is a rare condition easily overlooked or misdiagnosed. We present a case of spontaneous bilateral tubal ectopic pregnancy and discuss the difficulties in diagnosing and treating such patients. Case outline. A 39-years-old patient with a history of irregular and abundant menstrual cycles complained of pelvic pain and light bleeding after 55 days of amenorrhea. Ultrasound revealed enlarged uterus with a myoma and a heterogenic formation with echogenic ring sign beside the left ovary. Free fluid with clots was present in the pelvis. As the patient was hemodynamically unstable and ectopic pregnancy was suspected, emergency laparotomy was performed. During the surgery we found that both tubes were significantly edematous, dilated, and livid in their ampullary regions. On the left tube anterior wall rupture 15 ? 8 mm was noticeable, while right tube was intact with bleeding from its abdominal ostium. Even though the patient was not informed about the possibility of bilateral salpingectomy, after thorough consideration and due to the extent of tubal damage bilateral salpingectomy was eventually performed. Histopathological analysis confirmed the presence of decidua, partially viable and partially necrotic chorionic villi, and trophoblastic tissue in both right and left tubes. Conclusions. Careful preoperative and intraoperative examination of both Fallopian tubes as well as the whole abdominal and pelvic cavity should be mandatory during every assessment of patients with ectopic pregnancy.

Frequency of Pelvic Inflammatory Disease in Infertile Patients

Aim: Frequency of pelvic inflammatory disease in women presenting with infertility Study design: Cross sectional research Setting: Obstetrics/Gynaecology Deptt., Services Hospital, Lahore from 20-10-2017 to 20-04-2018. Methods: One hundred married females with Infertility (Primary/Secondary) were included in the study. Patients with H/o intrauterine contraceptive devices usage, diabetes, male factor Infertility and H/O pelvic surgery were excluded. All women were taken complete history and detailed physical and gynecological examination and HVS was sent to laboratory for culture. Results: Age was from 20 to 35 years with mean ± SD 29.41±2.35 yrs, mean±SD of weight 70.09±12.66kg, mean±SD height 1.54±0.09 meters, mean ± SD of BMI 29.67±5.09 Kg/m2 and mean±SD duration of Infertility was 2.5±0.97 years. Majority of the patients were from 0-2 parity (92%). Primary infertility was found in 64% women while secondary infertility was 36%. Pelvic Inflammatory Disease was found in 27% patients. Conclusion: Tubal damage before and during the index episode of PID is correlated with infertility. Keywords: Infertility, Pelvic inflammatory disease, Frequency

Is There Still a Place for Reconstructive Surgery in Distal Tubal Disease?

Tubal diseases account for 25–40% of female factor infertility. Mainly, they involve the distal part of the fallopian tube, and hydrosalpinx is the most severe manifestation. Usually, the management decision is made between reconstructive surgery and ART, depending on the severity of the tubal damage, patient age, ovarian reserve, and seminogram, as well as financial, religious, ethical, and psychological factors. Estimated live-birth rates after corrective surgery range from 9% to 69%. The success rate of IVF is about 30% live-birth rate per cycle initiated in women across all ages with tubal factor infertility. Surgery offers a long-term cure and patients may attempt conception many times but are burdened with perioperative adverse events. IVF bypasses potential complications of operative treatment; however, this has its own unique risks. The effectiveness of reconstructive surgery versus ART has not been adequately evaluated. The success of fertility management depends on a thorough interpretation of existing data and careful patient selection. The presented review provides updates on the most recent progress in this area.

Heterotopic pregnancy

Heterotopic pregnancy is defined as a condition when intrauterine and extra uterine pregnancy occur simultaneously. It is a life-threatening condition that requires immediate and accurate diagnostics and treatment. It is difficult to diagnose and easily missed. The incidence in the general population is estimated to be 1 in 30,000. With the advent of Assisted Reproduction Techniques (ART) and ovulation induction, the overall incidence of heterotopic pregnancy has risen to approximately 1 in 3,900 pregnancies. Other risk factors include a history of pelvic inflammatory disease (PID), tubal damage, pelvic surgery, uterine Mullerian abnormalities, and prior tubal surgery. Heterotopic pregnancy is a potentially fatal condition, rarely occurring in natural conception cycles. Most commonly, heterotopic pregnancy is diagnosed at the time of rupture when surgical management is required. We present a case of a 30-year-old secondi gravida with history of one spontaneous abortion and pelvic inflammatory disease, who conceived spontaneously and at her fifth week of amenorrhea, was presented to the emergency department with acute pain in lower abdomen, moderate vaginal bleeding and weakness. Laboratory tests and transvaginal ultrasonography revealed the diagnosis of heterotopic pregnancy.

Chlamydia Trachomatis Infection Amonginfertile Women At The University College Hospital, Ibadan

Background: Chlamydia trachomatis infection is reported as the commonest cause of tubal and pelvic infection and by proxy, the commonest cause of tubal damage and female infertility. Serotypes D-K are known to cause sexually transmitted genital tract and neonatal infection. Testing for the presence of Chlamydia trachomatis has been revolutionized by the development of monoclonal antibodies. This study sought to determine the prevalence of Chlamydia trachomatis infection among infertile women at the University College Hospital Ibadan and to determine the diagnostic value of Chlamydia antibody testing.&#x0D; Methodology: A cross-sectional study conducted among two hundred and seventy-three women with infertility attending the gynaecology clinic of the University College Hospital Ibadan. Hysterosalpingography (HSG) was performed on all patients as part of their routine evaluation for infertility. Venous blood was obtained to detect Chlamydia Ig G antibodies using the diagnostic bio-probe (DIA.PROBE) enzyme-linked immunoassay (ELIZA) for the quantitative determination of IgG antibodies specific to chlamydia trachomatis.&#x0D; Results: Positive test results for Chlamydia trachomatis were recorded amongst 136 women, giving a prevalence of 49.8%. 46(33.8%) women with normal tubal appearance and 90(66.2%) with tubal disease tested positive for Chlamydia antibodies. Bilateral tubal blockage was seen in 77(28.2%), while left and right tubal blockages were seen in 35(12.8%) and 21(7.7%) respectively. The accuracy of Chlamydia antibody testing in predicting tubal patency revealed a sensitivity of 67.7% and positive predictive value of 66.1% using HSG as the gold standard. Chlamydia trachomatis infection was found to be associated with age at sexual debut, history of ectopic pregnancy and previous history of abortion (P&lt;0.05).&#x0D; Conclusion: This study revealed a high prevalence of Chlamydia trachomatis amongst infertile women especially those with tubal disease. Risk factors associated with the infection such as early age of sexual debut, ectopic pregnancy and abortion further support the role of infectious morbidity especially with Chlamydia trachomatis.

Chlamydia Trachomatis Infection Amonginfertile Women At The University College Hospital, Ibadan

Background: Chlamydia trachomatis infection is reported as the commonest cause of tubal and pelvic infection and by proxy, the commonest cause of tubal damage and female infertility. Serotypes D-K are known to cause sexually transmitted genital tract and neonatal infection. Testing for the presence of Chlamydia trachomatis has been revolutionized by the development of monoclonal antibodies. This study sought to determine the prevalence of Chlamydia trachomatis infection among infertile women at the University College Hospital Ibadan and to determine the diagnostic value of Chlamydia antibody testing.&#x0D; Methodology: A cross-sectional study conducted among two hundred and seventy-three women with infertility attending the gynaecology clinic of the University College Hospital Ibadan. Hysterosalpingography (HSG) was performed on all patients as part of their routine evaluation for infertility. Venous blood was obtained to detect Chlamydia Ig G antibodies using the diagnostic bio-probe (DIA.PROBE) enzyme-linked immunoassay (ELIZA) for the quantitative determination of IgG antibodies specific to chlamydia trachomatis.&#x0D; Results: Positive test results for Chlamydia trachomatis were recorded amongst 136 women, giving a prevalence of 49.8%. 46(33.8%) women with normal tubal appearance and 90(66.2%) with tubal disease tested positive for Chlamydia antibodies. Bilateral tubal blockage was seen in 77(28.2%), while left and right tubal blockages were seen in 35(12.8%) and 21(7.7%) respectively. The accuracy of Chlamydia antibody testing in predicting tubal patency revealed a sensitivity of 67.7% and positive predictive value of 66.1% using HSG as the gold standard. Chlamydia trachomatis infection was found to be associated with age at sexual debut, history of ectopic pregnancy and previous history of abortion (P&lt;0.05).&#x0D; Conclusion: This study revealed a high prevalence of Chlamydia trachomatis amongst infertile women especially those with tubal disease. Risk factors associated with the infection such as early age of sexual debut, ectopic pregnancy and abortion further support the role of infectious morbidity especially with Chlamydia trachomatis.&#x0D;

Association between Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma genitalium, and Trichomonas vaginalis and Secondary Infertility in Cameroon: A case-control study.

ObjectiveData on the prevalence and etiology of infertility in Africa are limited. Secondary infertility is particularly common, defined as the inability of a woman to conceive for at least one year following a full-term pregnancy. We describe a prospective study conducted in Cameroon designed to test the hypothesis of an association between common treatable sexually transmitted infections (STI): Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV) and secondary infertility in women.MethodsIn this case-control study, we enrolled women in Fako Division, Cameroon between November 2017 and December 2018 with secondary infertility (cases) or current pregnancy (controls). We conducted a baseline survey to collect sociodemographic, and sexual and medical history information. Nucleic acid amplification testing using Aptima (Hologic, San Diego, CA, US) was performed on endocervical swabs for CT, NG, MG, and TV. Multivariable logistic regression was used to assess the relationship between active STI and secondary infertility.ResultsA total of 416 women were enrolled: 151 cases and 265 controls. Compared to controls, cases were older (median age 32 vs 27 years) and had more lifetime sexual partners (median 4 vs 3) (p<0.001). Cases were more likely to report dyspareunia, abnormal menses, prior miscarriage, and ectopic pregnancy (all p<0.05). STI positivity was not significantly different among cases and controls (2.7% vs 5.4% for CT, 1.3% vs 2.9% for NG, 6.0% vs 7.0% for MG, respectively), with the exception of TV which was more common in pregnant controls (0.7% vs 5%; p = 0.02).ConclusionStudy findings did not support an association between active STI and secondary infertility in Cameroon. Given high rates of pre-existing tubal damage, routine STI screening and treatment in younger women may be more impactful than costly STI testing during infertility assessments.

Decreased occurrence of endometriosis in women with Chlamydia trachomatis infection.

Despite abundant reports on the risk role of uterine outflow tract obstruction in endometriosis, information on the occurrence of endometriosis in women with Chlamydia trachomatis infection causing fallopian tube obstruction is unknown. We investigated the role of Chlamydia trachomatis infection with or without fallopian tubal patency in the occurrence of endometriosis. This is a retrospective case-controlled cohort study with 539 women who had laparoscopic surgery for several indications during the period between January, 2003 and June, 2010. Women with ectopic pregnancy, uterine anomaly, chromosomal abnormality, primary amenorrhea, and perimenopausal women were excluded. Endometriosis was diagnosed by laparoscopic inspection and confirmed by histopathology. Tubal patency was diagnosed by HSG or laparoscopic chromopertubation test. Presence of chlamydia infection was examined by RT-PCR and serological test. Two-hundred and seven women were enrolled. Eighty-six (41.5%) women had chlamydia infection. Tubal patency and occurrence of endometriosis were significantly decreased among women with chlamydia infection comparing to women without it (P=.005 and P=.0008, respectively). Even among women with patent tube, laparoscopic detection of endometriosis was significantly decreased in chlamydia infected comparing to non-infected women (P=.02). Multiple logistic regression model revealed that previous history of chlamydia infection significantly decreased the occurrence of endometriosis, and was independent of age, menstrual status, parity and tubal patency (odds ratio .44; 95% confidence interval .24-.80; P=.007). A decreased occurrence of peritoneal endometriosis was observed in women with Chlamydia trachomatis infection. The possible impairment of retrograde menstrual flow by chlamydia-infected tubal damage may decrease the risk of endometriosis.

Role of ultrasonographic parameters for predicting tubal involvement in infertile patients affected by endometriosis: A retrospective cohort study

IntroductionTransvaginal ultrasound is fundamental for the mapping of endometriosis, and the imaging criteria have been clearly described for different organs study. However, no specific ultrasonographic signs of tubal endometriosis have been reported, with the exception of hydrosalpinx, which is the expression of an extreme tubal damage and obstruction. The detection of tubal pathology in infertile patients is fundamental, therefore the aim of the study was to evaluate incidence of tubal endometriosis in infertile patients, and to analyze ultrasonographic signs useful for detection of this condition. Material and methodsIt is a single-center, retrospective cohort study. All 500 consecutive infertile women who underwent laparoscopic surgery for endometriosis were included. The preoperative workup included transvaginal ultrasound and was compared to intraoperative findings and histologic study. ResultsThe incidence of tubal endometriosis in our study was 8%. Using hydrosalpinx as the ultrasonographic marker for tubal involvement the overall pooled, sensitivity and specificity of TVU were 12% (95%CI, 5–23%) and 99% (95%CI, 98–100%), respectively.If at least one ultrasonographic parameter like hydrosalpinx, periadnexal adhesions or ovarian cyst was considered as a sign of tubal endometriosis, a sensitivity, VPN and specificity were 94% (95% IC, 85–98%), 97% (95%IC, 93–99%) and 31% (95%CI, 27–36%), respectively. DiscussionHydrosalpinx as ultrasonographic sign alone is characterized by a high specificity but low sensitivity for detection of tubal endometriosis; its sensitivity can be improved by the addition of other markers such as endometrioma and/or periadnexal adhesions.