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

Sarcoidosis is a systemic granulomatous disease that is most commonly manifested in the pulmonary system. Though the entire etiology of sarcoidosis remains unknown, it has been reported that Propionibacterium acnes (P. acnes) has been isolated from sarcoid lesions. Herein, we report a case of salpingitis arising from sarcoidosis. A female patient aged 37 years, gravida 2 para 0, who had been diagnosed with sarcoidosis at the age of 36 years, underwent laparoscopic right salpingectomy due to obvious right hydrosalpinx with recurrent refractory right lower abdominal pain. The pathological diagnosis was granulomatous salpingitis of the right fallopian tube suspecting sarcoidosis. Immunocytochemistry using a specific monoclonal antibody against P. acnes lipoteichoic acid (PAB antibody) revealed PAB‐positive reaction in sarcoid granuloma. This is the first case of sarcoidosis that the presence of P. acnes was shown in sarcoid lesions in the fallopian tube. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of bacterial vaginosis among women with tubal factor infertility.Methods: A cross-sectional prospective study of women with tubal factor infertility was conducted at a Nigerian teaching hospital between March and September 2014. An equal number of fertile women attending the family planning clinic were recruited as controls. Interviews were conducted to collect data on sociodemographic characteristics, history and characteristics of vaginal discharge, knowledge, and practices. Bacterial vaginosis was diagnosed using the Amsel criteria. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to determine predisposing factors.Results: Overall, 178 women with tubal factor infertility were recruited. Bacterial vaginosis was noted in 50 (28.1%) of these women, compared with 14 (7.9%) of 178 fertile women (P < 0.001). Patients with tubal factor infertility had an increased risk of bacterial vaginosis when they were of low socioeconomic class (OR 11.89; 95% CI 5.20-27.69), practiced vaginal douching (OR 19.15; 95% CI 7.26-47.75), used vaginal drying agents (OR 17.04; 95% CI 6.91-43.24), had an early sexual debut (OR 32.08; 95% CI 12.02-88.89), and had a history of sexually transmitted infections (OR 12.42; 95% CI 5.36-29.35).Conclusion: The prevalence of bacterial vaginosis was high among patients with tubal factor infertility. Socioeconomic and cultural factors contribute to the risk of the condition. [ABSTRACT FROM AUTHOR]

Aim Inflammation of the upper genital tract causes pelvic inflammatory disease ( PID), which may be complicated by pelvic abscesses, such as pyosalpinx and tubo-ovarian abscess ( TOA). This study aimed to determine the clinical differences between pyosalpinx and TOA in patients with PID. Material and Methods We retrospectively evaluated 458 female patients who were admitted to Hallym University Kang Dong Sacred Heart Hospital for a clinical diagnosis of PID from 1 January 2007 to 30 April 2012. Sociodemographic, clinical and laboratory data were compared among the non-abscess, pyosalpinx, and TOA groups. Results We identified 110 patients (24%) diagnosed with pelvic abscess associated with PID, including 34 with pyosalpinx and 76 with TOA. The pyosalpinx group had shorter hospital stays ( P = 0.007), lower C-reactive protein levels ( P = 0.015), smaller mass sizes ( P < 0.001), and fewer surgical interventions ( P < 0.001) than the TOA group. Conclusions Pyosalpinx is a less severe form of PID that leads to shorter hospital stays and more favorable outcomes than TOA. [ABSTRACT FROM AUTHOR]

Key content The pathogenesis of infertility is multi-factorial; investigative and treatment approaches should therefore be individualised., There are many tests for tubal patency with their relative usefulness, but none address all aspects of tubal function., There is often a clear need for in vitro fertilisation (IVF) in the management of infertility., This article reviews the current best available evidence and provides an expert insight on the role of tubal patency tests in the era of assisted reproductive techniques (ART)., Learning objectives To understand the relative advantages and limitations of laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, selective salpingography and tubal catheterisation, trans-vaginal hydrolaparoscopy, salpingoscopy and fertiloscopy as tests for tubal patency., To understand the role of Chlamydia trachomatis serology in tubal patency testing., To evaluate the role of tubal patency test in the hierarchy of investigations for infertility., To understand the role of tubal surgery in modern management of infertility., To understand the importance of medical history taking in infertility., Ethical issues Counselling patients about benefits and risks of tests, surgery and need for assisted conception., Should primary care trusts fund tubal surgery in patients who are not otherwise eligible for IVF?, There may be psychosocial issues or anxiety so a multidisciplinary approach is important. [ABSTRACT FROM AUTHOR]

Cerebral recurrence from Müllerian cancer is a rare event and prognosis of patients with such a condition is poor. We report a case of cerebral recurrence from International Federation of Gynecology and Obstetrics classification stage IV tubal cancer presenting with inguinal lymphadenopathy. The patient achieved more than 7 years' disease-free survival after irradiation to the brain despite the inauspicious event. The present case had a rare clinical course in terms of primary site, primary symptom, failure site, and clinical outcome. Patients with brain metastasis from Müllerian cancer have a chance for long-term survival under specified circumstances, such as solitary metastasis, no extracranial metastasis, no recurrence preceding brain metastasis and small tumor size. [ABSTRACT FROM AUTHOR]

Objective: To assess the usefulness of magnetic resonance imaging (MRI) in women with tubercular tubo-ovarian masses.Methods: Twenty-four women with a confirmed diagnosis of tubercular tubo-ovarian masses underwent MRI. The findings were compared with laparotomy/laparoscopy results wherever possible.Results: The mean age was 30.7 years and the mean parity was 1.5. The main symptom in 37.5% of patients was infertility. The MRI findings included unilateral definitive tubo-ovarian masses (n=4 [16.7%]); bilateral definitive tubo-ovarian masses (n=4 [16.7%]); unilateral hydrosalpinx (n=8 [33.3%]); bilateral hydrosalpinx (n=4 [16.7%]); unilateral adnexal cyst (n=4 [16.7%]), tuberculous deposits on the liver (n=1 [4.2%]); and cervical growth (n=1 [4.2%]). Other associated findings were endometriosis (n=2 [8.3%]), inclusion cyst (n=1 [4.2%]), subserous fibroid (n=1 [4.2%]), sacroiliac joint arthritis (n=1 [4.2%]), and enteritis (n=1 [4.2%]).Conclusion: MRI seems to be a useful modality for the diagnosis of tubercular tubo-ovarian masses. [ABSTRACT FROM AUTHOR]

Objective: To compare the expression profiles of transforming growth factor-beta 1 (TGF-β1) and its receptors in occluded tubes of infertile women with those of control patients and to evaluate the potential correlation with postsurgical pregnancy outcome.Methods: The expression profiles of TGF-β1, TGF-β1R1, and TGF-β1R2 in occluded fallopian tubes were compared using immunohistochemistry between 60 infertile patients with adhered tubes and 60 control patients with normal tubes; potential correlations with postsurgical fertility were evaluated at 2-year follow up.Results: Immunostainings of TGF-β1, TGF-β1R1, and TGF-β1R2 were all significantly elevated in patients with adhered tubes compared with normal specimens (P<0.001). In adhered specimens, correlation analyses showed positive correlations between TGF-β1 and TGF-β1R1 (P=0.008), and TGF-β1 and TGF-β1R2 (P=0.035). At 2-year follow up, 32 of the 60 infertile women had achieved normal pregnancies, 5 had had ectopic pregnancies, and 23 remained infertile. Correlation analysis showed that TGF-β1 expression level was negatively correlated with pregnancy outcome (r=-0.445, P<0.001), independent of adhesion severity or patient age.Conclusion: TGF-β1 expression was independently correlated with the postsurgical pregnancy outcome among infertile women. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical characteristics that indicate the presence of tubo-ovarian abscess (TOA) among patients with severe pelvic inflammatory disease (PID).Methods: An observational cohort study was performed from October 2011 to March 2013. The study included all patients with a diagnosis of TOA and PID admitted to a university hospital in Mexico. A complete medical history and physical examination were performed, and laboratory studies were reviewed. A logistic regression analysis was performed on variables with statistical significance.Results: Overall, 26 patients with PID and TOA (TOA group) and 26 with PID without TOA (PID group) were included in the study. Significant differences between patients with TOA and PID were found with regard to the patients' age (39.3years vs 33.1years; P=0.04), educational level (only elementary, 13 [50%] vs 5 [19%]; P=0.14), presentation with fever (23 [88%] vs 16 [62%]; P=0.025), white blood cell count (21.8×10(9)/L vs 14.9×10(9)/L; P<0.001), number of deliveries (2.2 vs 1.1; P=0.01), and presence of diarrhea (16 [62%] vs 5 [19%]; P<0.001). The triad of fever, leukocytosis, and diarrhea was positively related to the presence of TOA.Conclusion: The triad of fever, leukocytosis, and diarrhea should alert clinicians to the possibility of TOA formation in patients with PID. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the hysterosalpingographic findings from infertile women who were subsequently diagnosed with genital tuberculosis. Methods: A retrospective study of 70 infertile women who underwent hysterosalpingography to investigate infertility and were subsequently diagnosed with genital tuberculosis. Results: The mean age of the women was 27.3 years and the mean duration of infertility was 6.1 years. A total of 57 (81.4%) women had primary infertility while 13 had secondary infertility. Diagnosis of genital tuberculosis was made by polymerase chain reaction (54.3%), tuberculous granuloma on biopsy (22.8%), acid-fast bacilli culture (2.8%), and at laparoscopy or hysteroscopy (20%). Hysterosalpingographic findings were a normal uterine cavity observed in 57.1% of women, an irregular cavity in 18.5%, a shrunken cavity in 2.8%, and an irregular filling defect in 18.5%. Synechiae were observed in 17.1% of women. Conclusion: Genital tuberculosis is a common cause of infertility in India, causing significant uterine and tubal pathologies. [ABSTRACT FROM AUTHOR]

Objectives: To compare the diagnostic accuracy of hysterosalpingography and sonohysterosalpingography in detecting tubal and uterine abnormalities.Methods: In a prospective study for the evaluation of uterine and tubal pathologies, 186 patients with primary and secondary infertility rates (51.6% and 44%, respectively), as well as recurrent abortion rates (3.8%), underwent sonohysterosalpingography. The tubal pathologies, as well as intracavitary and/or structural uterine abnormalities, detected with this procedure were compared with preoperative hysterosalpingography and operative procedures.Results: With surgical findings as the gold standard, sonohysterosalpingography had a sensitivity of 78.2%, a specificity of 93.1%, a positive predictive value of 82.7%, and a negative predictive value of 91%. For total tubal and uterine pathologies, the findings for the same parameters using HSG were 76.3%, 81.8%, 90.9%, and 59.2%, respectively. Sonohysterosalpingography was more accurate than hysterosalpingography for detecting intrauterine adhesions and various forms of uterine anomalies.Conclusions: Sonohysterosalpingography is a safe, easy, accurate, and promising procedure for the detection of female upper genital tract pathologies, especially because it can differentiate specific uterine anomalies. [ABSTRACT FROM AUTHOR]

Enterosalpingeal fistula is a rare complication of Crohn's disease. And it is rarely diagnosed pre-operatively. We describe two cases of enterosalpingeal fistula. Both cases were diagnosed during exploration and required en bloc resection of the small bowel and fallopian tube. Literature review yielded only one specific case report of ileosalpingeal fistula and two other cases described in a larger series. Management of ileosalpingeal fistula should include resection of the diseased bowel as well as removal of the affected fallopian tube. Crohn's disease has an extremely wide spectrum of clinical manifestations. The hallmark of Crohn's disease is bowel inflammation with fistula or stricture formation. Organs commonly involved in fistula formation include the skin, small bowel, colon, and bladder. Rare fistula sites include the duodenum, stomach and gynecological structures such as the ovaries, fallopian tubes and vagina. We present two cases of Crohn's disease of the terminal ileum fistulizing to the fallopian tube. There is only one specific report of an ileosalpingeal fistula, although another author has described two additional cases in a large series of Crohn's fistulas. [ABSTRACT FROM AUTHOR]