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PubMed1989

Hysterosalpingography versus laparoscopy in tubal infertility: comparison based on findings at laparatomy.

One hundred ten infertile women underwent hysterography (HSG) and laparoscopy at the Obafemi Awolowo University, Nigeria. Both techniques showed normal tubal patency in 62 (56.4%) women and abnormal pelvic pathology in 48 (43.6%). All 48 women underwent laparotomy for tuboplasty. At laparotomy, HSG and laparoscopic assessments were compared. Both techniques were comparable in the diagnosis of intratubal and distal tubal occlusion. However, laparoscopy was superior in the diagnosis of non-tubal factors and proximal tubal occlusion (P less than 0.002). It is suggested that laparoscopy should be the first procedure in the investigation of tubal infertility and only followed by HSG if the results show some abnormality.

Adult↗
PubMed1989

Radionuclide hysterosalpingography for measurement of human oviductal function.

A clinical method is described and claimed to evaluate the active transportation capacity of the luminal epithelium lining the human uterus and fallopian tube. After intracervical application of technetium-labelled human albumin spheres at 1-2 days before ovulation this radioactivity could be followed by gamma-camera when moved in ad ovarian direction. This method is called radionuclide hysterosalpingography (RN-HSG). The results were compared to the findings at normal hysterosalpingography (HSG). By use of this method it was possible to verify active passage in cases of tubal spasm at HSG, lack of transport in cases of normal patent oviducts at HSG as well as presence or absence of active transport through sactosalpinges with or without fimbrial passages to the abdominal cavity as seen at normal HSG. Congruent findings between HSG and RN-HSG was observed in 49%. The studied oviducts were found to be patent with normal HSG but lacked transportation capacity when studied by RN-HSG in 41%. The clinical use of this method is discussed in view of the selection of patients for different forms of in vitro fertilization and egg transfer (IVF-ET).

Adult↗
PubMed1984

Ciliogenesis following salpingostomy of rabbit hydrosalpinges.

Twenty-five artificially induced hydrosalpinges were studied in New Zealand white rabbits. Hydrosalpinges had been created after 2-16 wk occlusion of both the fimbrial end and the ampullary isthmic junction (A.I.J.), using either Ethilon 8/0 or tantalum clips. Their diameters ranged from 4 to 12 mm, being larger in the clipped oviducts. In hydrosalpinges larger than 6 mm diameter, a salpingostomy was done and ampullary biopsies were taken and prepared for scanning electron microscopy, and 1-micron sections and ultrathin sections for transmission electron microscopy. The changes observed were those found in previous work (Vásquez et al., 1981). Post-salpingostomy biopsies were taken from 10 patent oviducts at different intervals of time, ranging from 2 days to 8 wk. Ciliogenesis was observed between the 2nd and 3rd wk after salpingostomy.

Animals↗
PubMed1988

An experimental study of tubo-ovarian function following restoration of patency in hydrosalpinges.

The recovery of tubal function after restoration of patency in mechanically induced hydrosalpinges was studied in twenty sexually mature rabbits by correlating the morphological lesions of tubal damage and adhesion formation with the ovulatory function, pregnancy rate and nidation index at 2 and 4-8 weeks postoperative intervals. Two weeks after hydrosalpinx correction no implantations occurred although the oviducts had a patency rate of 63% and no or slight adhesions were present. From four weeks after hydrosalpinx correction implantations occurred. Morphological studies showed a partial or complete recovery of mucosal lesions in this group of rabbits. The number of ovulations correlated with the presence or absence of a moderate degree of postoperative adhesion formation.

Animals↗
PubMed1994

Reduced pregnancy outcome in patients with unilateral or bilateral hydrosalpinx after in vitro fertilization.

In a retrospective study, we compared 118 patients with hydrosalpinx and 157 patients with bilateral salpingectomy entering an established in vitro fertilisation programme between 1988 and 1992. Patients with unilateral or bilateral hydrosalpinx had a lower clinical pregnancy rate, a higher miscarriage rate, and a lower ongoing pregnancy rate than patients with absent Fallopian tubes.

Adult↗
PubMed1985

Prolapsed fallopian tube masquerading as adenocarcinoma of the vagina in a postmenopausal woman.

A postmenopausal patient with vaginal prolapse of the fallopian tube presented with an erroneous diagnosis of adenocarcinoma of the vaginal apex. Failure to consider fallopian tube prolapse in the differential diagnosis of vaginal adenocarcinoma led to an upper vaginectomy and subsequent complication of a ureterovaginal fistula. The differential diagnosis of adenocarcinoma of the vagina in the postmenopausal patient and the management of vaginal prolapse of the fallopian tube are discussed.

Adenocarcinoma↗
PubMed2005

ECHOVIST-200 enhanced hystero-sonography: a new technique in the assessment of infertility.

Tubal occlusion is one of the most common causes of infertility. Therefore, examination of tubal patency is a very important diagnostic tool. Our aim was to determine whether hysterosalpingo-contrast sonography is able to show tubal patency, whether it has any side effects and what role this technique may have in the future. Echovist-200 hysterosalpingo-contrast sonographic examinations have been used in our service in 195 cases since 1998. We found tubal patency in 157 cases (84.4%), and unilateral or bilateral occlusions in 34 instances (12.5%). In four cases we could not visualize the tubes because they were too long. In the last mentioned cases we performed a laparascopy-dye test for the control of our results. The most common side effect during the check-up procedure was abdominal pain. This the patients tolerated well. We did not experience any other serious side effect. Comparing our results with those reported from abroad, we found them similar to the latter. According to our experience, the HyCoSy method for the evaluation of infertility is quick and well tolerated.

Adolescent↗
PubMed2004

A prospective evaluation of the effects of salpingectomy on endometrial lymphocyte clusters in patients with hydrosalpinges.

OBJECTIVE: To investigate the effect of hydrosalpinges on embryo implantation. DESIGN: Prospective study. SETTING: Private fertility and university hospitals. PATIENT(S): Eighteen patients with unilateral or bilateral hydrosalpinges who underwent salpingectomy. INTERVENTION(S): Pre- and posttreatment endometrial biopsies for immunohistochemical evaluation. MAIN OUTCOME MEASURE(S): Pre- and posttreatment lymphocyte populations in endometrial samples, evaluated by immunohistochemical identification. RESULT(S): Endometrial samples from pretreatment exhibited small lymphocytic clusters of CD3+, CD8+, CD4+, granzyme B positive, and CD56+. After salpingectomy, the numbers of cluster lesions were significantly decreased. CONCLUSION(S): Because a characteristic distribution of lymphocytes in endometrium with hydrosalpinges was found, activation of T/NK (natural killer) lymphocytes in endometrium might be involved in the impairment of embryo implantation in cases of hydrosalpinges.

Adult↗
PubMed2005

Ovarian pregnancy resulting from cornual fistulae in a woman who had undergone bilateral salpingectomy.

OBJECTIVE: To report a case of ovarian pregnancy following in vitro fertilization-embryo transfer (IVF-ET) treatment for which the cornual fistulae was the most probable explanation of the cause. DESIGN: Case report. SETTING: University department and assisted reproduction unit. PATIENT(S): A 29-year-old woman with primary infertility. INTERVENTION(S): Hydrosalpinx of the bilateral fallopian tubes has been noted in patients who have decreased pregnancy rates in the IVF-ET treatment cycles. Salpingectomy before IVF cycles has been suggested to increase the pregnancy rate. We report a patient who presented with bilateral hydrosalpinx for whom bilateral salpingectomy was performed before IVF treatment. MAIN OUTCOME MEASURE(S): Clinical pregnancy. RESULT(S): The treatment cycle resulted in a primary ovarian pregnancy and required laparoscopic operation. A cornual fistulae was found that have might led to ectopic implantation of the embryos. CONCLUSION(S): Ovarian pregnancy may be an unexpected complication of those receiving bilateral salpingectomy before IVF treatment. The presence of cornual fistulae after salpingectomy was probably the cause of the ectopic pregnancy.

Adult↗
PubMed2005

Effects of interstitial fallopian tube polyps on isthmic tubal diameter.

OBJECTIVE: To study the apparent association between interstitial fallopian tube polyps and isthmic tubal dilatation. DESIGN: Retrospective clinical study. SETTING: Tertiary academic medical center. PATIENT(S): Sixty-five patients with normal hysterosalpingograms and 40 patients with interstitial tubal polyps (25 unilateral and 15 bilateral). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Proximal, medial, and distal isthmic diameters were measured digitally and normalized according to an internal standard. Polyp volumes were measured and divided into four groups according to increasing volume (<2 mm3, 2-5 mm3, 6-12 mm3, >12 mm3). RESULT(S): There was a significant increase in proximal isthmic tubal diameter in patients with interstitial polyps. Mean diameter increased from 0.6 mm to 0.9 mm. There was no significant change in more distal isthmic diameters. Larger polyps tended to be associated with larger luminal diameters. CONCLUSION(S): Interstitial fallopian tube polyps are associated with a significant increase in proximal isthmic luminal diameter as determined on hysterosalpingography. Although these polyps are nonobstructing and thus thought by most investigators not to affect fertility, their association with altered luminal diameter and perhaps altered function might be of clinical interest.

Fallopian Tube Diseases↗
PubMed2006

Pregnancy outcome in patients with early recurrent abortion following laparoscopic tubal corneal interruption of a fallopian tube with hydrosalpinx.

OBJECTIVE: To investigate the outcome of pregnancy following laparoscopic unilateral tubal fulguration of hydrosalpinges in patients with recurrent spontaneous early abortion. DESIGN: Prospective randomized controlled trial. SETTING: University tertiary center. PATIENT(S): Thirteen patients with history of unexplained recurrent early spontaneous abortion and a unilateral hydrosalpinx diagnosed by sonography and hysterosalpingography in whom other causes of abortion were excluded. INTERVENTION(S): The treatment group (group I) consisted of seven women who underwent laparoscopic unilateral tubal fulguration. The control group (group II) consisted of six patients for whom no surgical intervention was performed. MAIN OUTCOME MEASURE(S): Continuation of pregnancy over first trimester. RESULT(S): Six patients in the treatment group and five in the control group conceived. Five patients in the treatment group and none in the control group had pregnancy beyond the first trimester and finally reached 36-40 weeks gestational age (P=.02). CONCLUSION(S): Laparoscopic tubal fulguration improves pregnancy outcome in selected patients with previous recurrent early abortion and a unilateral hydrosalpinx.

Abortion, Habitual↗
PubMed2006

Salpingectomy increases peri-implantation endometrial HOXA10 expression in women with hydrosalpinx.

OBJECTIVE: To determine whether women with hydrosalpinx would have diminished endometrial HOXA10 expression and whether salpingectomy would reverse HOXA10 suppression. The homeobox gene HOXA10 is a transcription factor that is necessary for embryo implantation; its expression in human endometrium correlates with receptivity and implantation. Increased endometrial HOXA10 expression may be one mechanism by which salpingectomy results in increased implantation rates in IVF. DESIGN: Prospective clinical trial. SETTING: Academic medical center. PATIENT(S): Women with unilateral or bilateral hydrosalpinx. INTERVENTION(S): Expression of HOXA10 was examined prospectively during the midluteal phase in endometrium obtained from infertile women (n = 9) with hydrosalpinges before and after salpingectomy, as well as from fertile controls (n = 6). Quantitative HOXA10 mRNA expression was determined by real-time reverse-transcription polymerase chain reaction, and HOXA10 protein expression was determined by immunohistochemistry. MAIN OUTCOME MEASURE(S): Expression of HOXA10 mRNA and protein. RESULT(S): Expression of HOXA10 mRNA was significantly lower in infertile women with hydrosalpinges, compared with the case of fertile controls. Salpingectomy resulted in a statistically significant, 15-fold increase in endometrial HOXA10 expression. Immunohistochemical analysis confirmed the quantitative real-time reverse-transcription polymerase chain reaction findings. Increased HOXA10 expression was evident in both glandular epithelial cells and endometrial stroma. CONCLUSION(S): HOXA10 is necessary for implantation. Here, we demonstrate decreased HOXA10 expression in response to hydrosalpinx fluid as a potential molecular mechanism for diminished implantation rates. Salpingectomy restores endometrial HOXA10 expression. This may be one mechanism by which salpingectomy results in augmented implantation rates in IVF.

Adult↗
PubMedDate not supplied

Reproductive performance after selective tubal catheterization.

STUDY OBJECTIVE: To evaluate the reproductive performance of women after selective tubal catheterization. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University teaching hospital. PATIENTS: Ninety-eight infertile women with hysterosalpingographic findings of proximal tubal occlusion. INTERVENTION: Hysterosalpingography and selective tubal catheterization. MEASUREMENTS AND MAIN RESULTS: Repeat hysterosalpingography examination before selective tubal catheterization in 98 patients revealed bilateral tubal patency in 14 patients and patency of one of the tubes in 12 others (12.2%). True proximal tubal occlusion was encountered in 72 patients (139 tubes). Successful recanalization of both tubes was achieved in 25 patients (34.7%), and successful recanalization of at least one tube was achieved in 44 patients (61.1%). Of the 72 patients who underwent selective tubal catheterization, 23 patients conceived. The cumulative probability of conception was 28%, 59%, and 73% at 12, 18, and 24 months of follow-up, respectively. The median procedure-conception interval was 16.2 months. CONCLUSION: One-quarter of patients diagnosed with bilateral proximal tubal occlusion on hysterosalpingography do not have tubal obstruction. Among those with true occlusion, selective tubal catheterization leads to an overall pregnancy rate of 31.9%.

Adult↗