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Hao HJ, Wang ZH, Feng L, Zhao XL, Chen X. Which patients with hydrosalpinx will benefit more from reproductive surgery to improve natural pregnancy outcomes?: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e32806. [PMID: 36827021 DOI: 10.1097/md.0000000000032806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The most common tubal disease leading to infertility occurs in the distal region, manifesting as hydrosalpinx. Tubal surgery is an effective alternative treatment. However, subpopulations that benefit the most from tubal repair surgery remain unclear. The objective of this study was to investigate the natural pregnancy outcomes of patients with hydrosalpinx after reproductive surgery and those with different grades of hydrosalpinx. METHODS We searched the major online databases (PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials) to collect observational studies on patients with hydrosalpinx who underwent surgeries to preserve natural fertility from January 2000 to August 2022. The outcome indicators were natural intrauterine pregnancy (IUP) and ectopic pregnancy (EP) rates. Studies on patients with hydrosalpinx who underwent laparoscopic surgeries and those who intended to be conceived naturally were included. Studies on patients with non-hydrosalpinx diseases, those who underwent open surgery, and those who intended to undergo assisted conception were excluded. The Newcastle-Ottawa scale for observational studies was used for quality evaluation. Meta-analysis of a single rate was performed using RevMan5.3 software. RESULTS A total of 10 articles were included in this study, including 1317 patients with hydrosalpinx. Seven studies were retrospective and 3 were prospective. It was found that after surgery for preserving natural fertility function, the IUP and EP rates of patients with hydrosalpinx were 27% (95% confidence interval [CI]: 22-32%) and 4.8% (95% CI: 2.91-8.26%), respectively. In addition, the IUP and EP rates in patients with mild (n = 254), moderate (n = 252), and severe (n = 473) hydrosalpinx were 50.5% (95% CI: 38.65-61.97%), 32.9% (95% CI: 21.88-46.24%), 10.7% (95% CI: 4.76-21.88%), and 7.4% (95% CI: 2.91-19.35%), 9.09% (95% CI: 6.54-13.79%), 8.3%, 8.26% (95% CI: 3.85-18.03%), respectively. CONCLUSION Patients with mild to moderate hydrosalpinx will benefit more from reproductive surgery to improve natural pregnancy outcomes. However, the small sample size in our study needs to be further expanded, and the grouping needs to be more refined, such as grouping based on age. This may provide more guidance in clinical practice.
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Affiliation(s)
- Hong-Juan Hao
- Department of Gynecology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
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Progesterone and Inflammatory Response in the Oviduct during Physiological and Pathological Conditions. Cells 2022; 11:cells11071075. [PMID: 35406639 PMCID: PMC8997425 DOI: 10.3390/cells11071075] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Progesterone has been shown to be a potent suppressor of several inflammatory pathways. During pregnancy, progesterone levels increase, allowing for normal pregnancy establishment and maintenance. The dysregulation of progesterone, as well as inflammation, leads to poor pregnancy outcomes. However, it is unclear how progesterone imbalance could impact inflammatory responses in the oviduct and subsequently result in early pregnancy loss. Therefore, in this review, we describe the role of progesterone signaling in regulating the inflammatory response, with a focus on the oviduct and pathological conditions in the Fallopian tubes.
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Role of ultrasonographic parameters for predicting tubal involvement in infertile patients affected by endometriosis: A retrospective cohort study. J Gynecol Obstet Hum Reprod 2021; 50:102208. [PMID: 34418594 DOI: 10.1016/j.jogoh.2021.102208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/26/2021] [Accepted: 08/16/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Transvaginal 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 METHODS It 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. RESULTS The 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. DISCUSSION Hydrosalpinx 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.
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Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertil Steril 2021; 115:1143-1150. [PMID: 33642065 DOI: 10.1016/j.fertnstert.2021.01.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
This document reviews surgical options for reparative tubal surgery and the factors that must be considered when deciding between surgical repair and in vitro fertilization. This document replaces the document of the same name, last published in 2012 (Fertil Steril 2015;103:e37-43). This document reviews surgical options for reparative tubal surgery and the factors that must be considered when deciding between surgical repair and in vitro fertilization.
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, Alabama
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Capmas P, Suarthana E, Tulandi T. Management of Hydrosalpinx in the Era of Assisted Reproductive Technology: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:418-441. [PMID: 32853797 DOI: 10.1016/j.jmig.2020.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis evaluating the effect of hydrosalpinx on pregnancy outcomes, to compare different types of management of hydrosalpinx and their impact on pregnancy rates as well as on the ovarian reserve. DATA SOURCES Electronic search using Pubmed, EMBASE, Ovid MEDLINE, Google Scholar, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials and including all published studies that examined tubal infertility and its management (assisted reproductive technology or surgery) as well as the effects on ovarian reserve. The following medical subject headings (Mesh) terms combinations were used: "fallopian tube disease," hydrosalpinx," "tubal or salpinx occlusion or obstruction," "in vitro fertilization," "fallopian tube surgery," "salpingectomy," "salpingostomy," "infertility," "subfertility," "sterility" and "ovarian reserve." METHODS OF STUDY SELECTION All randomized trials, cohort, and case controls studies were included. We excluded review articles, meeting abstracts, case series and case reports, and abstracts without access to full texts. The search was limited to trials in humans and published in English. TABULATION, INTEGRATION, AND RESULTS Our electronic search initially retrieved 6354 articles. Finally, 19 studies were included in the quantitative evaluation of the effects of hydrosalpinx: 23 in the qualitative evaluation and 5 in the quantitative evaluation of different types of hydrosalpinx treatments; and 17 in the quantitative evaluation of ovarian reserve. The presence of a hydrosalpinx was associated with decreased rates of implantation and clinical pregnancy, and increased rates of ectopic pregnancy and miscarriage. Management of hydrosalpinx with salpingectomy, tubal occlusion, or hydrosalpinx aspiration led to better in vitro fertilization pregnancy rates. We found no difference in ovarian response to stimulation after salpingectomy except a decrease in antimüllerian hormone compared to no surgery. CONCLUSIONS The presence of hydrosalpinx is associated with decreased pregnancy rate and increased rates of ectopic pregnancy and miscarriage. Management of hydrosalpinx, regardless of the type of treatment, leads to an increased chance of pregnancy.
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Affiliation(s)
- Perrine Capmas
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors); Inserm, Centre of Research in Epidemiology and Population Health, U1018, and Faculty of Medicine, University Paris Sud, Le Kremlin Bicêtre, France (Dr. Capmas)
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors)
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors).
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ATILGAN R, PALA Ş, KULOĞLU T, ŞANLI C, YAVUZKIR Ş, ÖZKAN ZS. Comparison of the efficacy between bilateral proximal tubal occlusion and total salpingectomy on ovarian reserve and the cholinergic system: an experimental study. Turk J Med Sci 2020; 50:1097-1105. [PMID: 32394684 PMCID: PMC7379445 DOI: 10.3906/sag-2002-179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/10/2020] [Indexed: 01/11/2023] Open
Abstract
Background and aim To compare the effects of bilateral proximal tubal occlusion and bilateral total salpingectomy on ovarian reserve and the cholinergic system via rat experiment. Materials and methods Twenty-one adult female rats were randomly divided into the following three groups:G1 (n = 7), sham group;G2 (n = 7), bilateral total salpingectomy group; and G3 (n = 7), bilateral proximal tubal occlusion group. Four weeks later, the abdomen of the rats was opened. The right ovarian tissues were stored in 10% formaldehyde, whereas the left ovarian tissues were stored at –80 °C in aluminum foil. Serum samples were evaluated for antimullerian hormone. The right ovary was used for histological and immunoreactive examination, and the left ovary was used for tissue MDA analysis. Tissue samples were analyzed for MDA levels with spectrophotometric measurement, apoptosis with TUNEL staining, fibrosis score with Mason trichrome staining, ovarian reserve with HE staining, and cholinergic receptor muscarinic 1 (CHRM1) level with immunoreactivity method. Results Compared to G1 and G3, the number of corpus luteum with secondary follicles was significantly lower in G2, whereas the number of ovarian cysts and fibrosis and apoptosis scores increased significantly. The CHRM1 immunoreactivity was significantly lower in G2 than in G1 and G3. Conclusions Compared to the bilateral proximal tubal occlusion performed by using bipolar cautery, bilateral total salpingectomy in rats leads to a significant damage in ovarian histopathology and the cholinergic system.
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Affiliation(s)
- Remzi ATILGAN
- Department of Obstetrics and Gynecology, School of Medicine, Fırat University, ElazığTurkey
| | - Şehmus PALA
- Department of Obstetrics and Gynecology, School of Medicine, Fırat University, ElazığTurkey
| | - Tuncay KULOĞLU
- Department of Histology and Embryology, School of Medicine, Fırat University, ElazığTurkey
| | - Cengiz ŞANLI
- Department of Obstetrics and Gynecology, School of Medicine, Fırat University, ElazığTurkey
| | - Şeyda YAVUZKIR
- Department of Obstetrics and Gynecology, School of Medicine, Fırat University, ElazığTurkey
| | - Zehra Sema ÖZKAN
- Department of Obstetrics and Gynecology, School of Medicine, Kırıkkale University, KırıkkaleTurkey
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Etiology and management of recurrent implantation failure: A focus on intra-uterine PBMC-therapy for RIF. J Reprod Immunol 2020; 139:103121. [DOI: 10.1016/j.jri.2020.103121] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/11/2023]
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Van Voorhis BJ, Mejia RB, Schlaff WD, Hurst BS. Is removal of hydrosalpinges prior to in vitro fertilization the standard of care? Fertil Steril 2019; 111:652-656. [PMID: 30929723 DOI: 10.1016/j.fertnstert.2019.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Bradley J Van Voorhis
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Rachel B Mejia
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - William D Schlaff
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Bradley S Hurst
- Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina
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Harb H, Al-Rshoud F, Karunakaran B, Gallos ID, Coomarasamy A. Hydrosalpinx and pregnancy loss: a systematic review and meta-analysis. Reprod Biomed Online 2019; 38:427-441. [DOI: 10.1016/j.rbmo.2018.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/07/2018] [Accepted: 12/10/2018] [Indexed: 11/24/2022]
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Ng KYB, Cheong Y. Hydrosalpinx - Salpingostomy, salpingectomy or tubal occlusion. Best Pract Res Clin Obstet Gynaecol 2019; 59:41-47. [PMID: 30824209 DOI: 10.1016/j.bpobgyn.2019.01.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/02/2019] [Accepted: 01/21/2019] [Indexed: 12/20/2022]
Abstract
Tubal factors account for approximately 25% of cases of infertility, and the most severe manifestation of tubal disease is hydrosalpinx, accounting for 10-30% of tubal diseases. Hydrosalpinx is a distension or dilatation of the fallopian tube in the presence of a distal tubal occlusion, and the most common cause is pelvic inflammatory disease. Women with hydrosalpinges have lower implantation and pregnancy rates in assisted reproductive technology (ART), due to a combination of mechanical and chemical factors thought to disrupt the endometrial environment. Current guidance is removal of the tube by salpingectomy (preferably laparoscopically) before IVF treatment. Salpingostomy, or distal tubal plastic surgery in the management of hydrosalpinx, is an alternative for women desiring natural conception, although ectopic pregnancy rates as high as 10% have been reported. Proximal tubal occlusion with Essure® devices placed hysteroscopically can be considered particularly in cases of distorted pelvic anatomy or pelvic adhesions making abdominal surgery complex. However, low clinical pregnancy and live birth rates have been reported with the use of these devices before IVF. In this review, we discuss salpingostomy, salpingectomy and tubal occlusion as possible management options for the reproductive women with hydrosalpinx.
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Affiliation(s)
- Ka Ying Bonnie Ng
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK; Department of Obstetrics and Gynaecology, Princess Anne Hospital, Level F, Coxford Road, Southampton, SO16 5YA, UK.
| | - Ying Cheong
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK; Department of Obstetrics and Gynaecology, Princess Anne Hospital, Level F, Coxford Road, Southampton, SO16 5YA, UK
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11
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Tubal restorative surgery for hydrosalpinges in women due to in vitro fertilization. Arch Gynecol Obstet 2018; 297:1169-1173. [PMID: 29445925 DOI: 10.1007/s00404-018-4695-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The study was carried out to clarify the IVF outcome after laparoscopic neosalpingostomy for infertile patients affected by hydrosalpinx stage III. MATERIALS AND METHODS From January 2010 to June 2015, 91 subjects of hydrosalpinx stage III were treated in out center by laparoscopic surgery before IVF cycle. 43 underwent neosalpingostomy (group 1) and the remaining 48 underwent salpingestomy (group 2). We compared these patients and their IVF outcomes after two different surgical techniques. RESULTS There were no significant differences between the two groups, except a higher number of patients with bilaterial hydrosalpinges was noted in the neosalpingostomy group (79.1% vs. 56.3%, respectively). 25 patients with neosalpingostomy and 29 with salpingectomy achieved pregnancy by IVF. The ongoing pregnancy rate per cycle in group 1 and group 2 was 51.1 and 47.2%, respectively. Two cases of ampullary ectopic pregnancies were noted in group 1 and one case of right tube interstitial pregnancy in group 2. No significant difference was observed in live birth rate between the groups (48.9% vs. 45.3%, respectively). CONCLUSIONS The outcomes of IVF after neosalpingostomy were matchable with salpingectomy. For patients desire to preserve fallopian tubes, we recommend laparoscopic neosalpingostomy as an alternative choice to manage moderate hydrosalpinx before IVF.
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Noventa M, Gizzo S, Saccardi C, Borgato S, Vitagliano A, Quaranta M, Litta P, Gangemi M, Ambrosini G, D'Antona D, Palomba S. Salpingectomy before assisted reproductive technologies: a systematic literature review. J Ovarian Res 2016; 9:74. [PMID: 27809927 PMCID: PMC5094031 DOI: 10.1186/s13048-016-0284-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/19/2016] [Indexed: 11/26/2022] Open
Abstract
Salpingectomy is largely used in case of hydrosalpinx in infertile women scheduled for assisted reproductive technologies (ART), whereas there is no consensus on its role in absence of hydrosalpinx. The current is a systematic literature review to collate all available evidence regarding salpingectomy as fertility enhancement procedure before ART in infertile patients. Our primary endpoint was to assess the impact of the surgical procedure on ovarian reserve, and secondary outcomes were to evaluate its benefits and harms on ART outcomes. We identified 29 papers of which 16 reporting data on the impact of tubal surgery on ovarian reserve and 24 (11 previously included) on ART outcomes. Available data suggested an absence of variation in ovarian reserve markers after unilateral salpingectomy while contradictory results were reported for bilateral surgery. Considering ART outcomes, data reported a significant improvement in ongoing pregnancy/live-birth rate in treated subjects without significant reduction in ovarian response to gonadotropin stimulation. In case of tubal disease, a surgical approach based on unilateral salpingectomy may be considered safe, without negative effects on ovarian reserve and ovarian response to controlled ovarian stimulation whilst having a positive effect on pregnancy rate. Data regarding bilateral salpingectomy and ovarian reserve are conflicting. Further trials are needed to confirm both the benefits of salpingectomy before ART and the safety of bilateral salpingectomy on ovarian reserve, and to clarify the role of uni- or bilateral surgery in case of tubal blockage without hydrosalpinx.
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Affiliation(s)
- Marco Noventa
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Carlo Saccardi
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Shara Borgato
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | - Michela Quaranta
- Department of Obstetrics and Gynecology, NHS Trust - Northampton General Hospital, Northampton, United Kingdom
| | - Pietro Litta
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Michele Gangemi
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Guido Ambrosini
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Donato D'Antona
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Stefano Palomba
- Unit of Reproductive Surgery and Medicine, ASMN-IRCCS of Reggio Emilia, Reggio Emilia, Italy.
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Demir B, Bozdag G, Sengul O, Kahyaoglu I, Mumusoglu S, Zengin D. The impact of unilateral salpingectomy on antral follicle count and ovarian response in ICSI cycles: comparison of contralateral side. Gynecol Endocrinol 2016; 32:741-744. [PMID: 27430668 DOI: 10.3109/09513590.2016.1161741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the impact of salpingectomy on the ovarian reserve. Comparisons are made with the contralateral side in patients with unilateral salpingectomy undergoing intracytoplasmic sperm injection (ICSI) cycles. STUDY DESIGN Patients under 40 with unilateral salpingectomy and without history of ovarian surgery were selected for the multicentre retrospective study. Women with bilateral salpingectomy and history of endometriosis were excluded from the study. Antral follicle count, controlled ovarian hyperstimulation (COH) parameters and number of collected oocytes were the main outcome measures of the study. RESULTS A total of 56 patients were eligible for this study. The mean age of the patients was 31.6 ± 4.7 years. The reasons for the salpingectomy were hydrosalpinx (39.3%, n = 22) and ruptured ectopic pregnancy (60.7%, n = 34). The ongoing pregnancy rate per embryo transfer was 30.6%. There was no statistically significant difference between the operated and non-operated sides in antral follicle count (AFC), follicles ≥ 17 mm and 10-17 mm on day of human chorionic gonadotrophin (hCG), or number of aspirated oocytes. In the subgroup analysis, AFC, number of growing follicles on day of hCG and number of collected oocytes were comparable between the ectopic pregnancy group and hydrosalpinx group. CONCLUSION The study suggests that salpingectomy is not associated with detrimental effects on AFC and ovarian response.
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Affiliation(s)
- Berfu Demir
- a Department of Obstetrics and Gynecology , Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara , Turkey
| | - Gurkan Bozdag
- b Department of Obstetrics and Gynecology , Hacettepe University School of Medicine , Ankara , Turkey , and
| | - Ozlem Sengul
- c Department of Obstetrics and Gynecology , Yıldırım Beyazıd University School of Medicine , Ankara , Turkey
| | - Inci Kahyaoglu
- a Department of Obstetrics and Gynecology , Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara , Turkey
| | - Sezcan Mumusoglu
- b Department of Obstetrics and Gynecology , Hacettepe University School of Medicine , Ankara , Turkey , and
| | - Dila Zengin
- b Department of Obstetrics and Gynecology , Hacettepe University School of Medicine , Ankara , Turkey , and
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Gomel V. The place of reconstructive tubal surgery in the era of assisted reproductive techniques. Reprod Biomed Online 2015; 31:722-31. [DOI: 10.1016/j.rbmo.2015.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/25/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
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Chu J, Harb HM, Gallos ID, Dhillon R, Al-Rshoud FM, Robinson L, Coomarasamy A. Salpingostomy in the treatment of hydrosalpinx: a systematic review and meta-analysis. Hum Reprod 2015; 30:1882-95. [PMID: 26082479 DOI: 10.1093/humrep/dev135] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/20/2015] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the chance of natural conception when salpingostomy is used to treat hydrosalpinx?. SUMMARY ANSWER The natural clinical pregnancy rate following salpingostomy is 27%, in the hands of experienced surgeons who publish their results. WHAT IS KNOWN ALREADY Tubal surgery is not commonly offered for women with hydrosalpinges since the advent of assisted conception treatment. This is the first systematic review to investigate natural conception rates following salpingostomy in the treatment of hydrosalpinx. STUDY DESIGN, SIZE, DURATION A systematic review and meta-analysis of 22 observational studies encompasses 2810 patients undergoing salpingostomy and attempting natural conception. PARTICIPANTS/MATERIALS, SETTING, METHODS Literature searches were conducted to retrieve observational studies which reported salpingostomy for hydrosalpinx. Databases searched included MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINAHL, with no language restriction. Only studies that focused on salpingostomy (rather than other tubal conserving surgeries) for the treatment of hydrosalpinx were included. A total of 22 studies matched the inclusion criteria. MAIN RESULTS AND THE ROLE OF CHANCE The pooled natural clinical pregnancy rate from the 22 observational studies (including 2810 patients) was 27% (95% confidence interval (CI): 25-29%) after salpingostomy was performed for hydrosalpinx. The cumulative clinical pregnancy rates were 8.7% (95% CI: 6.6-11.5%) at 6 months, 13.3% (95% CI: 10.6-16.7%) at 9 months, 20.0% (95% CI: 17.5-22.8%) at 12 months, 21.2% (95% CI: 18.6-24.1%) at 18 months and 25.5% (95% CI: 22.2-29.4%) at 24 months after salpingostomy. The pooled live birth rate (10 studies, 1469 patients) was 25% (95% CI: 22-28%) after salpingostomy was performed for hydrosalpinx. The pooled ectopic pregnancy rate (19 studies, 2662 patients) was 10% (95% CI: 9-11%). The pooled miscarriage rate (seven studies, 924 patients) was 7% (95% CI: 6-9%). The included studies scored well on the Newcastle Ottawa quality assessment scale. LIMITATIONS, REASONS FOR CAUTION Strict inclusion criteria were used in the conduct of the systematic review. However, the studies included are clinically heterogeneous in many aspects including patient characteristics, surgical technique and duration of follow-up after salpingostomy. WIDER IMPLICATIONS OF THE FINDINGS The findings of this systematic review suggest that salpingostomy is an alternative treatment strategy to tubal clipping or salpingectomy in patients presenting to fertility services with hydrosalpinx. Further prospective, large and high quality studies are needed to identify the subpopulation that would most benefit from tube conserving surgery. STUDY FUNDING/COMPETING INTERESTS No external funding was either sought or obtained for this study. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J Chu
- Academic Department, School of Clinical and Experimental Medicine, University of Birmingham, 3rd Floor, Birmingham Women's Hospital Foundation Trust, Metchley Park Road, Edgbaston, Birmingham B15 2TG, UK
| | - H M Harb
- Academic Department, School of Clinical and Experimental Medicine, University of Birmingham, 3rd Floor, Birmingham Women's Hospital Foundation Trust, Metchley Park Road, Edgbaston, Birmingham B15 2TG, UK
| | - I D Gallos
- Academic Department, School of Clinical and Experimental Medicine, University of Birmingham, 3rd Floor, Birmingham Women's Hospital Foundation Trust, Metchley Park Road, Edgbaston, Birmingham B15 2TG, UK
| | - R Dhillon
- Academic Department, School of Clinical and Experimental Medicine, University of Birmingham, 3rd Floor, Birmingham Women's Hospital Foundation Trust, Metchley Park Road, Edgbaston, Birmingham B15 2TG, UK
| | - F M Al-Rshoud
- Medical School, Hashemite University, Az Zarqa, Jordan
| | - L Robinson
- Academic Department, School of Clinical and Experimental Medicine, University of Birmingham, 3rd Floor, Birmingham Women's Hospital Foundation Trust, Metchley Park Road, Edgbaston, Birmingham B15 2TG, UK
| | - A Coomarasamy
- Academic Department, School of Clinical and Experimental Medicine, University of Birmingham, 3rd Floor, Birmingham Women's Hospital Foundation Trust, Metchley Park Road, Edgbaston, Birmingham B15 2TG, UK
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16
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Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertil Steril 2015; 103:e37-43. [DOI: 10.1016/j.fertnstert.2015.03.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 01/03/2023]
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17
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Dreyer K, Hompes PG, Mijatovic V. Diagnostic accuracy of hysterosalpingo-foam-sonography to confirm tubal occlusion after Essure® placement as treatment for hydrosalpinges. Reprod Biomed Online 2015; 30:421-5. [DOI: 10.1016/j.rbmo.2014.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/05/2014] [Accepted: 12/15/2014] [Indexed: 12/01/2022]
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Fouda UM, Sayed AM, Abdelmoty HI, Elsetohy KA. Ultrasound guided aspiration of hydrosalpinx fluid versus salpingectomy in the management of patients with ultrasound visible hydrosalpinx undergoing IVF-ET: a randomized controlled trial. BMC WOMENS HEALTH 2015; 15:21. [PMID: 25783650 PMCID: PMC4364312 DOI: 10.1186/s12905-015-0177-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/04/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this study was to compare the efficacy of ultrasound guided aspiration of hydrosalpinx fluid at the time of oocyte retrieval with salpingectomy in the management of patients with ultrasound visible hydrosalpinx undergoing IVF-ET. METHODS One hundred and sixty patients with ultrasound visible hydrosalpinx were randomized into salpingectomy group and aspiration group using computer generated randomization list and sequentially numbered sealed envelopes containing allocation information written on a card. RESULTS The clinical pregnancy rate per started cycle and the implantation rate were non- significantly higher in the salpingectomy group compared with the aspiration group [40% vs. 27.5% (p value = 0.132) and 18.95% vs. 12.82% (p value =0.124), respectively]. In the aspiration group, 34.21% of patients had rapid re-accumulation of the hydrosalpinx fluid (i.e. within first two weeks after embryo transfer). Whereas, the clinical pregnancy rate per transfer cycle and the implantation rate were significantly higher in salpingectomy group compared with the subgroup of patients with rapid re-accumulation of hydrosalpinx fluid [42.67% vs. 19.23% (p value = 0.036) and 18.95% vs. 7.58% (p value = 0.032), respectively], no significant differences were detected between the salpingectomy group and the subgroup of patients with no re-accumulation of hydrosalpinx fluid (42.67% vs. 34% (p value = 0.356) and 18.95% vs. 15.5% (p value = 0.457), respectively). CONCLUSION The small sample size could be the cause of failure of detecting significant increase in implantation and pregnancy rates in salpingectomy group compared with aspiration group. Further larger randomized controlled trials are needed to determine whether salpingectomy is more effective than aspiration of hydrosalpinx fluid or not. Moreover, the data presented in this study suggested that rapid re-accumulation of hydrosalpinx fluid is an obstacle against successful implantation and the cause of lower success rate with ultrasound guided aspiration of hydrosalpinx fluid compared with salpingectomy. TRIAL REGISTRATION Clinical trials.gov ( NCT02008240 ), registered 8 December 2013.
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Affiliation(s)
- Usama M Fouda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt,
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Romano M, Di Giuseppe J, Serri M, Noviello C, Martino A, Cobellis G, Ciavattini A. A possible association between sports and isolated fallopian tube torsion in children and adolescent females. Gynecol Endocrinol 2015; 31:688-92. [PMID: 26291807 DOI: 10.3109/09513590.2015.1056144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Isolated fallopian tube torsion (IFTT) is a rare occurrence characterized by the rotation of the fallopian tube on its own axis, without twisting the ipsilateral ovary. Pre-operative diagnosis is difficult due to the lack of specific clinical symptoms and radiological signs. The etiology is to date unknown and only some pre-disposing factors have been reported. The history, clinical presentation, laboratory findings and surgical treatment of five patients aged 12-16 with IFTT were evaluated. All patients came to be examined for worsening abdominal pain, nausea or vomiting. 75% of them practiced sports involving sudden changes in body position. They all underwent blood tests, ultrasound and Magnetic Resonance and then laparoscopy for the persistence of acute symptoms. Laparoscopic salpingectomy was performed in three patients. Another two needed a conversion to open salpingectomy due to the presence of pelvic adhesions. During the follow-up period, every girl was fine. The cause of IFTT is undetermined. In this series, a close association between IFTT and sports causing rapid body movements was found. The possibility of IFTT should be considered in the differential diagnosis of acute abdominal pain in children or adolescent females, especially if they practice sports.
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Affiliation(s)
- Mercedes Romano
- a S.O.D. di Chirurgia Pediatrica e delle Specialità Chirurgiche and
| | - Jacopo Di Giuseppe
- b Clinica Ostetrica e Ginecologica, Presidio Ospedaliero di Alta Specializzazione "G. Salesi" - Az. Ospedaliero - Universitaria Ospedali Riuniti di Ancona - Università Politecnica delle Marche , Ancona , Italy
| | - Matteo Serri
- b Clinica Ostetrica e Ginecologica, Presidio Ospedaliero di Alta Specializzazione "G. Salesi" - Az. Ospedaliero - Universitaria Ospedali Riuniti di Ancona - Università Politecnica delle Marche , Ancona , Italy
| | - Carmine Noviello
- a S.O.D. di Chirurgia Pediatrica e delle Specialità Chirurgiche and
| | - Ascanio Martino
- a S.O.D. di Chirurgia Pediatrica e delle Specialità Chirurgiche and
| | | | - Andrea Ciavattini
- b Clinica Ostetrica e Ginecologica, Presidio Ospedaliero di Alta Specializzazione "G. Salesi" - Az. Ospedaliero - Universitaria Ospedali Riuniti di Ancona - Università Politecnica delle Marche , Ancona , Italy
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Optimal time interval between laparoscopic tubal ligation for hydrosalpinges and ICSI-ET. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2014. [DOI: 10.1016/j.mefs.2013.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Arora P, Arora RS, Cahill D. Essure®for management of hydrosalpinx prior toin vitrofertilisation-a systematic review and pooled analysis. BJOG 2014; 121:527-36. [DOI: 10.1111/1471-0528.12533] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- P Arora
- Department of Reproductive Medicine; St Mary's Hospital; Manchester UK
| | - RS Arora
- Department of Medical Oncology; Max Super Speciality Hospital; New Delhi India
| | - D Cahill
- Academic Unit of Obstetrics and Gynaecology; St Michael's Hospital; Bristol UK
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22
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Reduced live organism recovery and lack of hydrosalpinx in mice infected with plasmid-free Chlamydia muridarum. Infect Immun 2013; 82:983-92. [PMID: 24343644 DOI: 10.1128/iai.01543-13] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Plasmid-free Chlamydia trachomatis and Chlamydia muridarum fail to induce severe pathology. To evaluate whether the attenuated pathogenicity is due to insufficient infection or inability of the plasmidless chlamydial organisms to trigger pathological responses, we compared plasmid-competent and plasmid-free C. muridarum infections in 5 different strains of mice. All 5 strains developed hydrosalpinx following intravaginal inoculation with plasmid-competent, but not inoculation with plasmid-free, C. muridarum. The lack of hydrosalpinx induction by plasmid-free C. muridarum correlated with significantly reduced live organism recovery from the lower genital tract and shortened infection in the upper genital tract. The plasmid-free C. muridarum organisms failed to induce hydrosalpinx even when the organisms were directly inoculated into the oviduct via an intrabursal injection, which was accompanied by significantly reduced survival of the plasmidless organisms in the genital tracts. Furthermore, plasmid-competent C. muridarum organisms after UV inactivation were no longer able to induce hydrosalpinx even when directly delivered into the oviduct at a high dose. Together, these observations suggest that decreased survival of and shortened infection with plasmid-free C. muridarum may contribute significantly to its attenuated pathogenicity. We conclude that adequate live chlamydial infection in the oviduct may be necessary to induce hydrosalpinx.
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Casey RK, Damle LF, Gomez-Lobo V. Isolated fallopian tube torsion in pediatric and adolescent females: a retrospective review of 15 cases at a single institution. J Pediatr Adolesc Gynecol 2013; 26:189-92. [PMID: 23642839 DOI: 10.1016/j.jpag.2013.02.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/13/2013] [Accepted: 02/19/2013] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To identify and review cases of isolated fallopian tube torsion (FTT) at our institution to further characterize diagnosis and management. DESIGN Retrospective review. SETTING Tertiary care medical center. PARTICIPANTS Case series of pediatric and adolescent females, <21 years old, with operatively diagnosed isolated fallopian tube torsion from our institution. INTERVENTION None. MAIN OUTCOME MEASURE Isolated fallopian tube torsion. RESULTS Fifteen cases of isolated fallopian tube torsion were identified based on intraoperative diagnosis. Patient ages ranged from 8-15 years old, mean age of 12. Fourteen patients (93%) presented with abdominal pain, 8 (53%) localized to the side of associated torsion. Ultrasonography reports described a tubular structure in 4 patients and an associated ovarian or paraovarian cyst in eleven patients. Suspicion of fallopian tube torsion was only described for those patients with a tubular structure described on ultrasonography report. Intraoperatively, 7 patients (47%) were found to have no associated pathology and 8 (53%) were found to have associated cyst or hydrosalpinx. Eight (53%) patients underwent salipingectomy and 7 (47%) underwent reversal of torsion with drainage of associated cyst or cystectomy. CONCLUSIONS Isolated fallopian tube torsion is a rare condition that seems to occur in younger adolescents. Vague clinical presentation contributes to low preoperative suspicion. Preoperative suspicion may be increased based on radiographic findings of an enlarged tubular structure or an adjacent normal ovary. Management may be considered nonemergent and salpingectomy is controversial. Long-term fertility outcomes must be further assessed for more definitive decisions regarding surgical management.
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Affiliation(s)
- Rachel K Casey
- Department of Obstetrics and Gynecology, The George Washington University Medical Center, Children's National Medical Center, Washington, DC 20037, USA.
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Kamal EM. Ovarian performance after laparoscopic salpingectomy or proximal tubal division of hydrosalpinx. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2012.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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25
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Committee opinion: role of tubal surgery in the era of assisted reproductive technology. Fertil Steril 2012; 97:539-45. [DOI: 10.1016/j.fertnstert.2011.12.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 12/19/2011] [Indexed: 11/23/2022]
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26
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Efficacy of surgical treatment for successful pregnancy in infertile patients with hydrosalpinx. ACTA ACUST UNITED AC 2012. [DOI: 10.5468/kjog.2012.55.12.929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Galen DI, Khan N, Richter KS. Essure Multicenter Off-Label Treatment for Hydrosalpinx Before In Vitro Fertilization. J Minim Invasive Gynecol 2011; 18:338-42. [DOI: 10.1016/j.jmig.2011.01.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 01/21/2011] [Accepted: 01/26/2011] [Indexed: 11/28/2022]
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Jiang H, Pei H, Zhang WX, Wang XM. A prospective clinical study of interventional ultrasound sclerotherapy on women with hydrosalpinx before in vitro fertilization and embryo transfer. Fertil Steril 2010; 94:2854-6. [PMID: 20674895 DOI: 10.1016/j.fertnstert.2010.06.065] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 06/21/2010] [Accepted: 06/22/2010] [Indexed: 11/18/2022]
Abstract
In this prospective clinical study, ultrasound-guided transvaginal aspiration and sclerotherapy with 98% ethanol was performed before the IVF cycle in 33 patients with hydrosalpinx. The results showed that ultrasound aspiration and sclerotherapy could improve the endometrial receptivity and outcomes of IVF, with no recurring sign of the hydrosalpinx and no adverse effect on ovarian reserve or responsiveness during the IVF procedure.
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Affiliation(s)
- Hong Jiang
- Reproductive Medicine Center, Huangshan Hospital, Hefei, People's Republic of China.
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Johnson N, van Voorst S, Sowter MC, Strandell A, Mol BWJ. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev 2010; 2010:CD002125. [PMID: 20091531 PMCID: PMC7154223 DOI: 10.1002/14651858.cd002125.pub3] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Tubal disease, and particularly hydrosalpinx, has a detrimental effect on the outcome of in-vitro fertilisation (IVF). Performing a surgical intervention such as salpingectomy, tubal occlusion, aspiration of the hydrosalpinx fluid, or salpingostomy, prior to the IVF procedure in women with hydrosalpinges is thought improve the likelihood of successful outcome. OBJECTIVES To assess and compare the value of surgical treatments for tubal disease prior to IVF. SEARCH STRATEGY Trials were sought in the Cochrane Menstrual Disorders and Subfertility Group trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PSYCHMED and in Conference proceedings and reference lists up until Ocober 28 2009. Researchers in the field were contacted to reveal unpublished studies. SELECTION CRITERIA All trials comparing a surgical treatment for tubal disease with a control group generated by randomisation were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data. The studied outcomes were live birth, ongoing pregnancy, viable-, clinical- and biochemical pregnancy, ectopic pregnancy, miscarriage, multiple pregnancy, ovarian function and complications. MAIN RESULTS Five randomised controlled trials involving 646 women were included in this review. Four studies assessed salpingectomy versus no treatment, two of which also included a tubal occlusion arm, and one trial assessed aspiration versus no treatment. No trials reported on the primary outcome: live birth. The odds of ongoing pregnancy (Peto OR 2.14, 95%CI 1.23 to 3.73) and of clinical pregnancy (Peto OR 2.31, 95%CI 1.48 to 3.62) however were increased with laparoscopic salpingectomy for hydrosalpinges prior to IVF. Laparoscopic occlusion of the fallopian tube versus no intervention did not increase the odds of ongoing pregnancy significantly (Peto OR 7.24, 95%CI 0.87 to 59.57) but the odds of clinical pregnancy (Peto OR 4.66, 95%CI 2.47 to 10.01) had sufficient power to show a significant increase. Comparison of tubal occlusion to salpingectomy did not show a significant advantage of either surgical procedure in terms of ongoing pregnancy (Peto OR: 1.65, 95%CI 0.74, 3.71) or clinical pregnancy (Peto OR 1.28, 95%CI 0,76 to 2.14). One RCT reported efficacy of ultrasound guided aspiration, however the odds of pregnancy did not show a significant increase in the odds of clinical pregnancy (Peto OR 1.97, 95%CI 0.62 to 6.29), and confidence intervals were wide. Throughout the different comparisons no significant differences were seen in adverse effects of surgical treatments. AUTHORS' CONCLUSIONS Surgical treatment should be considered for all women with hydrosalpinges prior to IVF treatment. Previous evidence supported only unilateral salpingectomy for a unilateral hydrosalpinx (bilateral salpingectomy for bilateral hydrosalpinges). This review now provides evidence that laparoscopic tubal occlusion is an alternative to laparoscopic salpingectomy in improving IVF pregnancy rates in women with hydrosalpinges. Further research is required to assess the value of aspiration of hydrosalpinges prior to or during IVF procedures and also the value of tubal restorative surgery as an alternative (or as a preliminary) to IVF.
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Affiliation(s)
- Neil Johnson
- University of AucklandDepartment of Obstetrics & GynaecologyPO Box 92019AucklandNew Zealand1003
| | | | | | - Annika Strandell
- University of GothenburgObstetrics and GynecologyKungälv HospitalKungälvSweden
| | - Ben Willem J Mol
- Máxima Medical CenterObstetrics and GynaecologyPostbox 7777VeldhovenNetherlands5500 MB
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Nakagawa K, Ohgi S, Nakashima A, Horikawa T, Irahara M, Saito H. Laparoscopic proximal tubal division can preserve ovarian reserve for infertility patients with hydrosalpinges. J Obstet Gynaecol Res 2009; 34:1037-42. [PMID: 19012705 DOI: 10.1111/j.1447-0756.2008.00801.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate whether laparoscopic proximal tubal division for the treatment of hydrosalpinges could preserve ovarian function. METHODS From June 2002 to October 2006, before assisted reproductive treatment (ART), a total of 17 infertile patients with bilateral hydrosalpinges were studied--11 patients underwent laparoscopic proximal tubal division (PTD group), and six underwent laparoscopic salpingectomy (salpingectomy group). In both groups, the basal follicle-stimulating hormone (FSH) values before and after surgery, the operation time and outcome of ART treatment were retrospectively evaluated. RESULTS The mean FSH value before laparoscopic PTD was similar to that after surgery. The FSH value before laparoscopic salpingectomy significantly increased after surgery (6.8 +/- 1.1 vs 14.1 +/- 9.3). The operation time in the PTD group was significantly shorter than in the salpingectomy group. The outcomes of ART were similar in both groups. The pregnancy rate per patient in the PTD and salpingectomy groups were 45.5% and 50%, respectively. CONCLUSIONS Laparoscopic proximal tubal division preserved ovarian function and was an optimal operation method for infertility patients with hydrosalpinges. The basal FSH values after laparoscopic proximal tubal division were comparable to those before surgery.
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Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine, Department of Perinatal Medicine and Maternal Care, National Center for Child Health and Development, Tokyo, Japan.
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Abstract
PURPOSE OF REVIEW Patients with hydrosalpinx are a recognized group with poor prognosis in in-vitro fertilization. This review presents evidence for the effectiveness of different treatment options. RECENT FINDINGS Theories explaining the mechanisms behind the impaired outcome of in-vitro fertilization still focus on the hydrosalpingeal fluid. Gamete and embryotoxic effects have been demonstrated, but it is not a consistent finding. Endometrial receptivity may be altered by the reduced expression of cytokines and integrins important to implantation, and reduced endometrial and subendometrial blood flows may play a role. The rationale for treatments to improve the results of in-vitro fertilization is based on interruption of the leakage of hydrosalpinx fluid into the uterine cavity. Laparoscopic salpingectomy has been evaluated in a large randomized trial and proved effective in restoring birth rates. Proximal tubal ligation may also be effective according to one smaller randomized trial. Other suggested methods such as transvaginal drainage have been poorly investigated. SUMMARY Pre-in-vitro fertilization salpingectomy is the only method that has proved effective in restoring birth rates in patients with hydrosalpinx. The underlying mechanism explaining reduced implantation and embryo development awaits further research.
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Affiliation(s)
- Annika Strandell
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Göteborg University, Goteborg, Sweden.
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Ozmen B, Diedrich K, Al-Hasani S. Hydrosalpinx and IVF: assessment of treatments implemented prior to IVF. Reprod Biomed Online 2007; 14:235-41. [PMID: 17298728 DOI: 10.1016/s1472-6483(10)60792-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
It is well known that the success of artificial reproductive techniques, especially IVF, for patients with tubal pathologies such as hydrosalpinx is reduced by half compared with patients without hydrosalpinx. Notably, there are also substantial increases in both early pregnancy loss and ectopic pregnancies. Alterations in the outcome of these patients generally reflect a detrimental effect of hydrosalpinx. However, although many theories have been published, a single explanation has not yet been found over a period of decades. Therefore, the negative effects of hydrosalpinx have generally been attributed largely to: (i) mechanical effects; (ii) embryo and gametotoxicity; (iii) alterations in endometrial receptivity markers; or dwindled cross talk between embryo-endometrium resulting in hindered implantation, and (iv) direct effect on endometrium, leading to intrauterine fluid formation. On the other hand, the most important question is selection of the preferred treatment option with either surgical or medical therapies. How should hydrosalpinx be managed? Does selection of the surgical method, either proximal obstruction or salpingectomy, depending on patients' clinical findings, differ in outcome, or is routine prophylactic salpingectomy needed? Additionally, the requirement for IVF or intracytoplasmic sperm injection is still controversial in patients with unilateral hydrosalpinx who have been treated with unilateral salpingectomy.
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Affiliation(s)
- B Ozmen
- University of Ankara, Department of Gynecology and Obstetrics, Centre of Artificial Reproduction, Campus of Cebeci, Mamak, Ankara, Turkey.
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Daftary GS, Kayisli U, Seli E, Bukulmez O, Arici A, Taylor HS. Salpingectomy increases peri-implantation endometrial HOXA10 expression in women with hydrosalpinx. Fertil Steril 2007; 87:367-72. [PMID: 17173899 DOI: 10.1016/j.fertnstert.2006.06.041] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 06/21/2006] [Accepted: 06/21/2006] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Gaurang S Daftary
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA
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Abstract
Hydrosalpinx is a common cause of female infertility. Lower implantation and pregnancy rates have been reported in women with hydrosalpinges. How hydrosalpinx exerts its negative effect on the implantation process is not clearly understood. Mechanical factors, toxicity of the hydrosalpingeal fluid, and receptivity dysfunction may explain the impaired IVF outcome in the presence of hydrosalpinx. Laparoscopic surgery has a place in the diagnosis and management of hydrosalpinx. Analysis of the results of laparoscopic management of hydrosalpinx underscores the positive role of laparoscopy in fertility outcomes in women with this pathological tubal disease. Laparoscopic salpingectomy should be offered in those women who have bilateral disease or in cases where hydrosalpinges are large enough to be visible on ultrasound. Further randomized trials are required to assess other surgical treatment options for hydrosalpinx, such as laparoscopic salpingostomy, laparoscopic or hysteroscopic tubal occlusion, and drainage of hydrosalpinx before or during oocyte retrieval.
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Affiliation(s)
- John N Bontis
- First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
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Kontoravdis A, Makrakis E, Pantos K, Botsis D, Deligeoroglou E, Creatsas G. Proximal tubal occlusion and salpingectomy result in similar improvement in in vitro fertilization outcome in patients with hydrosalpinx. Fertil Steril 2006; 86:1642-9. [PMID: 17069813 DOI: 10.1016/j.fertnstert.2006.05.032] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Revised: 05/08/2006] [Accepted: 05/08/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate and compare the clinical impact of proximal tubal occlusion and salpingectomy when performed before IVF in patients with hydrosalpinges. DESIGN Prospective randomized study. SETTING Assisted reproduction unit in an obstetrics and gynecology department in a university hospital in Greece as well as assisted reproduction unit in an urban clinic in a major city in Greece. PATIENT(S) One hundred fifteen patients with unilateral or bilateral hydrosalpinges who were candidates for IVF treatment. INTERVENTION(S) Laparoscopic proximal tubal occlusion, laparoscopic salpingectomy, controlled ovarian hyperstimulation, IVF, and embryo transfer. MAIN OUTCOME MEASURE(S) Implantation rate, clinical-pregnancy rate, ongoing-pregnancy rate, abortion rate, and ectopic-pregnancy rate. RESULT(S) Patients who underwent proximal tubal occlusion before IVF demonstrated significantly increased implantation, clinical-pregnancy, and ongoing-pregnancy rates compared with those with no surgical intervention and demonstrated implantation, clinical-pregnancy, and ongoing-pregnancy rates comparable to those who underwent salpingectomy. CONCLUSION(S) Proximal tubal occlusion, when performed in women with unilateral or bilateral hydrosalpinges before their IVF treatment, represents a potentially beneficial surgical procedure, increasing significantly the chances for successful implantation and for clinical and ongoing pregnancy. Proximal tubal occlusion may be viewed as a valid alternative when salpingectomy is technically difficult or not feasible.
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Affiliation(s)
- Antonios Kontoravdis
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece
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Ducarme G, Uzan M, Hugues JN, Cedrin-Durnerin I, Poncelet C. Management of hydrosalpinx before or during in vitro fertilization-embryo transfer: a national postal survey in France. Fertil Steril 2006; 86:1013-6. [PMID: 16962113 DOI: 10.1016/j.fertnstert.2006.02.120] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 02/17/2006] [Accepted: 02/17/2006] [Indexed: 11/19/2022]
Abstract
Using an anonymous and sealed questionnaire sent to all French IVF centers, the current management of hydrosalpinx before or during IVF was evaluated. Laparoscopic salpingectomy was recommended and undertaken in less than half of the centers, even though several other treatments were reported and despite medical evidence for this surgical option.
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Affiliation(s)
- Guillaume Ducarme
- Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, University Paris XIII, Paris, France
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Garde RV, Jovanovic VP, Couchman GM, Walmer DK, Price TM. Ectopic pregnancy in a preexisting hydrosalpinx during a spontaneous pregnancy. Fertil Steril 2006; 86:1001.e11-3. [PMID: 16949588 DOI: 10.1016/j.fertnstert.2006.02.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 02/13/2006] [Accepted: 02/13/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To discuss the possible role of abnormal embryo migration as a cause of ectopic pregnancy during IVF with hydrosalpinges. DESIGN Case report. SETTING University-based reproductive endocrinology and fertility clinic. PATIENT(S) A patient presenting with a tubal ectopic pregnancy after spontaneous conception in a preexisting hydrosalpinx. INTERVENTION(S) Laparoscopic salpingectomy. MAIN OUTCOME MEASURE(S) Ultrasound and operative findings. RESULT(S) Case demonstration of abnormal embryo migration into a surgically documented preexisting hydrosalpinx during a spontaneous conception. CONCLUSION(S) The mechanism of increased tubal ectopic pregnancy rates during IVF with hydrosalpinges remains unexplained. This case supports abnormal embryo migration due to the hydrosalpinx as a contributing factor.
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Affiliation(s)
- Rachana V Garde
- Division of Reproductive Endocrinology and Fertility, Duke University, Durham, North Carolina, USA
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Abstract
PURPOSE OF REVIEW The clinical management of hydrosalpinges in infertile patients remains a contentious issue. This review aims to provide a critical analysis on the available treatments for hydrosalpinges, which have recently created a fierce debate between the promoters of salpingectomy and in-vitro fertilization and those who endorse tubal surgery. RECENT FINDINGS Hydrosalpinges have a detrimental effect on the outcome of in-vitro fertilization yet their mechanism is still unclear. Salpingectomy prior to in-vitro fertilization restores the likelihood of a successful outcome in a well defined group of patients with ultrasound-visible hydrosalpinges. However, not every woman with large hydrosalpinges should undergo salpingectomy as some fallopian tubes may be amenable to surgical repair. Preserved tubal mucosa indicates a good prognosis for tubal surgery, therefore an appropriate mucosal assessment should be routine prior to deciding upon further management. SUMMARY As salpingectomy is a definitive procedure it should be performed when the hydrosalpinges are beyond repair or in cases of in-vitro fertilization failure. Tubal surgery should be preferred to salpingectomy in mild to moderate tubal disease. A comparative study of restorative tubal surgery versus salpingectomy and in-vitro fertilization in selected women with hydrosalpinges is needed and will significantly help this debate. Prophylactic salpingectomy prior to in-vitro fertilization and tubal surgery is not competing but complementary in the treatment of hydrosalpinges-related infertility.
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Affiliation(s)
- Luca Sabatini
- Centre for Reproductive Medicine & Surgery, Department of Obstetrics and Gynecology, St Bartholomew's Hospital, West Smithfield, London, UK.
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Bayrak A, Harp D, Saadat P, Mor E, Paulson RJ. Recurrence of hydrosalpinges after cuff neosalpingostomy in a poor prognosis population. J Assist Reprod Genet 2006; 23:285-8. [PMID: 16865531 PMCID: PMC3506369 DOI: 10.1007/s10815-006-9050-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 05/01/2006] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the recurrence rate of hydrosalpinges after cuff neosalpingostomy in poor prognosis candidates. METHODS Forty consecutive patients with hydrosalpinx treated with cuff neosalpingostomy were included. Main outcome measures were recurrence rate of hydrosalpinx after cuff neosalpingostomy, intrauterine and ectopic pregnancy rates. RESULTS Intraoperatively, the mean size of the hydrosalpinx was 1.9+/-0.7 cm, and 77% of patients had evidence of pelvic adhesions. Recurrence of hydrosalpinx, whether unilateral or bilateral was 70% (28/40) per patient. Intrauterine and ectopic pregnancy rates were 5% (2/40) and 2.5% (1/40), with a total pregnancy rate of 7.5% (3/40). CONCLUSIONS Most patients experience recurrence of hydrosalpinx after cuff neosalpingostomy, thus requiring additional surgery such as salpingectomy prior to in vitro fertilization (IVF). In a poor prognosis population, salpingectomy should be considered as the primary treatment for hydrosalpinx prior to IVF.
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Affiliation(s)
- Aykut Bayrak
- Department of Obstetrics and Gynecology, University of Southern California-Keck School of Medicine, Women's and Children's Hospital, Los Angeles, CA 90033, USA.
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Zolghadri J, Momtahan M, Alborzi S, Mohammadinejad A, Khosravi D. Pregnancy outcome in patients with early recurrent abortion following laparoscopic tubal corneal interruption of a fallopian tube with hydrosalpinx. Fertil Steril 2006; 86:149-51. [PMID: 16716315 DOI: 10.1016/j.fertnstert.2005.12.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2005] [Revised: 12/02/2005] [Accepted: 12/02/2005] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Jaleh Zolghadri
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Gelbaya TA, Nardo LG, Fitzgerald CT, Horne G, Brison DR, Lieberman BA. Ovarian response to gonadotropins after laparoscopic salpingectomy or the division of fallopian tubes for hydrosalpinges. Fertil Steril 2006; 85:1464-8. [PMID: 16580673 DOI: 10.1016/j.fertnstert.2005.10.036] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Revised: 10/03/2005] [Accepted: 10/03/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare the effect of prophylactic laparoscopic salpingectomy versus division of the fallopian tubes on ovarian response to gonadotropins in women undergoing IVF. DESIGN Retrospective study. SETTING National Health Service-based tertiary referral center for reproductive medicine. PATIENT(S) One hundred sixty-eight women with tubal factor infertility. Sixty-five women with hydrosalpinges had either salpingectomy (n = 40, group A) or proximal tubal division (n = 25, group B), while the remaining women with tubal disease but without hydrosalpinges acted as the control group (n = 103, group C). INTERVENTION(S) Prophylactic laparoscopic salpingectomy or proximal division of the fallopian tubes and ovarian stimulation with gonadotropins for IVF. MAIN OUTCOME MEASURE(S) Day 2 serum FSH levels before surgery and 3 months after surgery but before ovarian stimulation, ovarian response assessed as total dose of hMG administered, serum E2 concentrations on day 3 and day 8 of stimulation and on the day of hCG injection, number of follicles, and number of oocytes retrieved and fertilized. RESULT(S) In group A, baseline FSH levels were significantly raised after surgery compared with before surgery. Postsurgery FSH concentrations were significantly higher in group A compared with group B. The number of follicles (15-20 mm) was significantly lower in group A compared with group B and group C. The serum E2 levels on day 8 of stimulation were lower in group A compared with group B, and on the day of hCG injection it was significantly reduced in group A compared with groups B and C. The number of oocytes retrieved per cycle was significantly lower in group A compared with group B. There were no significant differences in pregnancy rates and miscarriage rates among the three groups. CONCLUSION(S) These findings suggest that prophylactic salpingectomy in women with hydrosalpinx may compromise ovarian response to stimulation without affecting pregnancy rates. A randomized control trial is recommended to determine the most appropriate laparoscopic procedure in the management of hydrosalpinx before IVF.
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Affiliation(s)
- Tarek A Gelbaya
- Department of Reproductive Medicine, Saint Mary's Hospital, Manchester, United Kingdom
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Bedaiwy MA, Falcone T, Goldberg JM, Attaran M, Sharma R, Miller K, Nelson DR, Agarwal A. Relationship between cytokines and the embryotoxicity of hydrosalpingeal fluid. J Assist Reprod Genet 2005; 22:161-5. [PMID: 16021860 PMCID: PMC3455287 DOI: 10.1007/s10815-005-4913-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The exact chemical composition of hydrosalpingeal fluid is unknown. The objective of this study was to characterize cytokines in hydrosalpingeal fluid (HSF) and examine their possible role in the embryo development. STUDY DESIGN HSF was aspirated at laparoscopic salpingectomy in eight infertile women. Levels of IL-1beta, IL-13, IL-8, IL-6 and TNF-alpha in the HSF were determined by quantitative immunoassay kits. Two-cell mouse embryos were incubated with 0, 25, 50 and 75% concentrations of HSF. The blastocyst development rate (BDR) of mouse embryos was measured at each HSF concentration. RESULT(S) The embryotoxicity of HSF was concentration dependent. An increase in the HSF concentration resulted in significant decrease in % BDR (p < 0.01). IL-1beta was present in six of the eight HSF samples with a mean (+/-SD) concentration of 0.9 +/- 0.8 pg/mL. IL-13 was not detected in any of the HSF samples. IL-8, IL-6 and TNF-alpha were detected in all samples with a mean (+/-SD) concentration of 4741.2 +/- 6554.4 pg/mL, 204.8+/-132.8 pg/ml and 12 +/- 12.8 pg/mL respectively. IL-6 was positively correlated with BDR (r = 0.53; p < 0.04). CONCLUSION(S) We demonstrated for the first time the presence of IL-1beta, IL-8, IL-6 and TNF-alpha and the absence of IL-13 in human hydrosalpingeal fluid. IL-6 was positively related to the BDR.
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Affiliation(s)
- Mohamed A Bedaiwy
- Center for Advanced Research in Human Reproduction, Infertility and Sexual Function, Department of Obstetrics & Gynecology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Abstract
PURPOSE OF REVIEW Laparoscopy is widely used during infertility work-up, although it is sometimes unnecessary. This review highlights when laparoscopic intervention should be used in women undergoing assisted reproductive technology cycles. RECENT FINDINGS There is no evidence for an increase in pregnancy rates in assisted reproductive technology cycles following surgical treatment of pelvic adhesions or endometriosis with laparoscopy. If the patient has bilateral visible hydrosalpinges, laparoscopy may be an option for evaluation of the tubes and treatment with salpingectomy in order to enhance the chance of pregnancy before commencing an assisted reproductive technology cycle. Laparoscopic ovarian drilling before assisted reproductive technology may be considered a therapeutic option in polycystic ovary disease patients who previously had severe ovarian hyperstimulation syndrome. Finally, laparoscopy may be useful in replacing the transposed ovaries to their original sites in the pelvic cavity in previously treated cancer patients so that monitoring of the controlled ovarian hyperstimulation and the oocyte aspiration would be much easier during the assisted reproductive technology cycles. SUMMARY Laparoscopy should be considered before assisted reproductive technology cycles if the procedure diagnoses and treats a pelvic pathology at the same time and if laparoscopic intervention increases the chance of pregnancy following these cycles.
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Affiliation(s)
- C Tamer Erel
- Division of Reproductive Endocrinology, IVF Unit, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey.
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Rosenfield RB, Stones RE, Coates A, Matteri RK, Hesla JS. Proximal occlusion of hydrosalpinx by hysteroscopic placement of microinsert before in vitro fertilization–embryo transfer. Fertil Steril 2005; 83:1547-50. [PMID: 15866598 DOI: 10.1016/j.fertnstert.2004.10.056] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Revised: 10/01/2004] [Accepted: 10/01/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe proximal occlusion of a hydrosalpinx by hysteroscopic placement of a microinsert before IVF-ET. DESIGN Case report. SETTING Health maintenance organization and tertiary-care assisted reproductive technology unit. PATIENT(S) Obese, infertile woman with pelvic adhesive disease and unilateral hydrosalpinx. INTERVENTION(S) Hysteroscopic placement of a microinsert into the proximal segment of a fallopian tube that was distally obstructed by hydrosalpinx. No intraoperative or postoperative complications occurred with hysteroscopic placement of microinsert. MAIN OUTCOME MEASURE(S) Nonincisional proximal tubal occlusion under local anesthesia and intravenous sedation. Pregnancy by IVF-ET. RESULT(S) No intraoperative or postoperative complications with hysteroscopic placement of microinsert were seen. After uterine transfer of three embryos, dichorionic-diamniotic twins were delivered by cesarean section at 34 weeks of gestation. CONCLUSIONS(S) Hysteroscopic placement of a microinsert to proximally occlude a hydrosalpinx might be an alternative to laparoscopic proximal tubal occlusion or salpingectomy in patients with tubal disease planning IVF-ET.
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Affiliation(s)
- Gavin Sacks
- Department of Reproductive Medicine, Hammersmith Hospital, London, UK
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Kodaman PH, Arici A, Seli E. Evidence-based diagnosis and management of tubal factor infertility. Curr Opin Obstet Gynecol 2004; 16:221-9. [PMID: 15129051 DOI: 10.1097/00001703-200406000-00004] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW The investigation for potential tubal disease is an essential step in the work-up of infertility. This review article provides an evidence-based overview of the diagnosis and management of tubal factor infertility. RECENT FINDINGS While laparoscopic chromopertubation remains the gold standard in the diagnosis of tubal disease and hysterosalpingography is still widely used, newer modalities offer some advantages. Sonohysterography with the use of contrast medium is superior to hysterosalpingography and comparable to laparoscopic chromotubation in diagnosing tubal blockage. Chlamydia serology is the most cost-effective and least invasive diagnostic test for tubal disease, and it is comparable to, if not better than, hysterosalpingography. Depending on the nature and degree of tubal dysfunction as well as the age and ovarian reserve of the patient, various treatments for tubal infertility are available. For proximal tubal obstruction, transcervical tubal cannulation with tubal flushing is a reasonable first approach. Surgical techniques for tubal repair, such as salpingostomy or fimbrioplasty for distal tubal obstruction, can provide good results. Still, tubal factor remains a major indication for in-vitro fertilization and embryo transfer, which bypasses the tubal problem altogether. In certain situations, such as the presence of hydrosalpinx, prophylactic surgery can be used in conjunction with in-vitro fertilization and embryo transfer. SUMMARY As with infertility in general, the diagnosis and management of tubal infertility should be tailored to the individual patient. Future studies should help to further clarify the role of the various diagnostic tests and therapeutic approaches for tubal infertility.
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Affiliation(s)
- Pinar H Kodaman
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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Kihaile P, Misumi J, Utsunomiya T. Peritonitis after a ruptured left pyosalpinx in a patient undergoing in vitro fertilization. Fertil Steril 2003; 79:1034-6. [PMID: 12749451 DOI: 10.1016/s0015-0282(02)04926-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report acute abdomen in a young woman with infertility due to small asymptomatic bilateral hydrosalpinges who was on the 12th day of an IVF cycle. DESIGN Case report. SETTING Private IVF clinic. PATIENT(S) A 35-year-old woman with asymptomatic bilateral hydrosalpinges. INTERVENTION(S) Abdominal laparoscopy. MAIN OUTCOME MEASURE(S) Pus and a ruptured left pyosalpinx. RESULTS The patient suddenly developed acute abdomen while lifting a disabled person at a nursing home where she worked as a nurse. About 200 mL of pus was aspirated, and the patient had a ruptured left pyosalpinx. Bilateral salpingectomy was done by laparoscopy; the patient's postoperative recovery was uneventful. CONCLUSION We report a rare case of acute abdomen due to peritonitis after a ruptured pyosalpinx in an IVF patient who lifted a disabled person.
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Affiliation(s)
- Paul Kihaile
- St. Luke Hospital and Oita Medical University, Oita, Japan.
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LaCombe J, Ginsburg F. Adnexal torsion in a patient with hydrosalpinx who underwent tubal occlusion before in vitro fertilization. Fertil Steril 2003; 79:437-8. [PMID: 12568862 DOI: 10.1016/s0015-0282(02)04672-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To report a rare case of adnexal torsion in an infertile patient with bilateral hydrosalpinges who had proximal tubal occlusion performed before IVF-ET 5 years earlier. DESIGN A case report and literature review. SETTING Reproductive endocrine division in a community teaching hospital. PATIENT(S) A 43-year-old infertile woman with acute left-side pelvic pain. INTERVENTION(S) Laparoscopic bilateral salpingectomies. MAIN OUTCOME MEASURE(S) Diagnosis and etiology of pelvic pain with subsequent therapy to alleviate symptoms. RESULT(S) The patient experienced resolution of her pain and prophylactic prevention of further torsion status after bilateral salpingectomies. CONCLUSION(S) Although laparoscopic proximal tubal occlusion is an effective treatment of hydrosalpinges in patients undergoing IVF-ET, it carries the risk of torsion of the hydrosalpinx and the associated morbidities.
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Affiliation(s)
- Julie LaCombe
- Department of Obstetrics and Gynecology, Stamford Hospital, Connecticut 06904, USA
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Abstract
OBJECTIVE To determine the effect of hydrosalpinx fluid on the expression of HOXA10, an essential regulator of endometrial receptivity. DESIGN In vitro study. SETTING Academic medical center. PATIENT(S) Patients with unilateral or bilateral hydrosalpinx. INTERVENTION(S) Hydrosalpinx fluid was aspirated from 10 patients at laparoscopy. The fluid was serially diluted in minimum essential medium. Ishikawa cells (an endometrial adenocarcinoma cell line, representative of endometrial epithelium) were incubated with this fluid at concentrations of 10% and 50% for 48 hours. Cells were also incubated in undiluted minimum essential medium (MEM) and in 10% serum as controls. After incubation, the cells were lysed in Trizol, and total RNA was extracted and analyzed by Northern blot using a 32P-labeled HOXA10 riboprobe. A 32P-labeled G3PDH probe was used as a control for loading. MAIN OUTCOME MEASURE(S) HOXA10 mRNA expression. RESULT(S) HOXA10 mRNA expression in endometrial cells decreased with increasing concentrations of hydrosalpinx fluid. Densitometric analysis of the northern blot revealed that HOXA10 mRNA expression was different from control at both concentrations (P<.007). CONCLUSION(S) HOXA10 is necessary for implantation in the murine model. HOXA10 expression is diminished by hydrosalpinx fluid. This effect on HOXA10 is a potential molecular mechanism by which implantation rates are diminished in women with hydrosalpinges.
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Affiliation(s)
- Gaurang S Daftary
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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Shulman A, Marom H, Oelsner G, Horowitz A, Ben-Nun I, Mashiach S, Dor J. The effect of adnexal surgery on the ovarian response to stimulation in in vitro fertilization. Eur J Obstet Gynecol Reprod Biol 2002; 103:158-62. [PMID: 12069740 DOI: 10.1016/s0301-2115(02)00047-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The effect of adnexal surgery on ovarian function is a controversial issue of high clinical significance. The purpose of this study was to assess the effect of adnexal surgery on ovarian function. STUDY DESIGN All patients who underwent adnexal surgery in our department during an 8-year period (all records were obtained from the hospital database between January 1991 and December 1998) were cross-matched with our in vitro fertilization (IVF) database. We compared the baseline hormonal levels and the patients' response to IVF stimulation (assessed by the total amount of gonadotropins, maximal estradiol (E2) levels, number of retrieved and fertilized oocytes). RESULTS Sixty-four consecutive patients who underwent adnexal surgery were compared with 68 matched controls. Neither of the analyzed parameters were affected by the tubal surgery. CONCLUSIONS We conclude from our study adnexal surgery is not detrimental to ovarian function.
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Affiliation(s)
- Adrian Shulman
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Aviv University, 52621, Tel Hashomer, Israel.
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