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Objective: To evaluate the risk of monozygotic splitting with embryo biopsy during in vitro fertilisation (IVF).Design: A cohort study.Setting: Anonymised assisted reproductive technology national data from the Human Fertilisation and Embryology Authority, UK.Population: Women undergoing single-embryo transfer (SET) following either pre-implantation genetic testing (PGT) involving embryo biopsy or IVF without PGT.Methods: Data on women undergoing SET either following PGT and non-PGT IVF treatment in 2000-2016 were analysed to compare the risk of zygotic splitting and monozygotic twining. Logistic regression analysis was performed adjusting for potential confounders.Main Outcomes: Monozygotic spitting, monozygotic twin birth.Results: Data comprising a total of 207 697 SET cycles (4544 following PGT and 203 153 following non-PGT IVF) were analysed. The live birth rate per embryo transfer was 31.9% (95% confidence interval [CI] 30.5-33.2%) following PGT and 26.9% (95% CI 26.7-27.1%) following non-PGT IVF. The incidence of zygotic splitting following PGT was 2.4% (95% CI 1.7-3.3%) versus 1.5% (95% CI 1.4-1.6%) following non-PGT IVF. There was a significantly higher risk of zygotic splitting with PGT versus non-PGT IVF cycles (odds ratio [OR] 1.64, 95% CI 1.19-2.27). The higher risk of zygotic splitting with PGT cycles remained significant after adjusting for potential confounders (adjusted OR 1.51, 95% CI 1.06-2.15).Conclusions: The present study demonstrated an increased risk of monozygotic splitting with embryo biopsy. Given the current sparse literature, it is important to accumulate further evidence to validate the findings.Tweetable Abstract: A likely increased risk of monozygotic splitting following embryo biopsy. [ABSTRACT FROM AUTHOR]

Objectives: To explore whether non-tuberculous mycobacteria (NTM) are associated with tubal disease leading to infertility.Design: Prospective observational study.Setting: Teaching hospital.Population: Women with tubal factor infertility.Methods: In all, 173 infertile women with tubal disease were investigated for genital tuberculosis, Chlamydia trachomatis and Neisseria gonorrhoeae using polymerase chain reaction, culture and histopathological examination. On culture, NTM were grown in 23.7% of endometrial samples. The mycolic characteristics of these organisms were analysed.Main Outcome Measure: Whether NTM are associated with tubal disease leading to infertility.Results: The organisms identified in association with tubal disease were Mycobacterium tuberculosis in 30%, gonococci in 1.7%, Chlamydia in 7.5% and NTM in 23.7% of cases. Mycobacterium chelonae was the predominant organism identified by high-performance liquid chromatography. In ten women, for whom there was laparoscopic evidence of tubal disease, the only organism that was grown was NTM, and the tests for other organisms were negative. Tests for possible environment (theatre, instruments) contamination was reported negative.Conclusion: While evaluating infertile women for tubal disease, culture studies revealed a high prevalence of NTM in the endometrium. In the absence of M. tuberculosis, gonococci and Chlamydia infection, the presence of NTM suggests the possibility that these organisms may be responsible for tubal damage leading to infertility.Tweetable Abstract: On evaluating the causes of tubal disease, NTM were associated with tubal disease. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence and pattern of tuboperitoneal pathologies among infertile women in Nigeria, using laparoscopy.Methods: A prospective study was undertaken of infertile women who underwent diagnostic laparoscopy in two fertility clinics in Nigeria between November 2015 and April 2017. The rates of identified tuboperitoneal diseases were examined.Results: The age of the 230 women ranged from 21 to 46 years, and most women had a parity group of 0-1 (87.8%; n=202). Secondary infertility accounted for 124 (53.9%) cases, and the mean duration of infertility was 4.6 ± 2.7 years. Tuboperitoneal pathologies were seen in 171 (74.4%) women and mainly comprised tubal occlusion (56.5%; n=130), hydrosalpinx (41.7%; n=96), pelvic adhesions (39.6%, n=91), and endometriosis (8.8%; n=19). Bilateral tubal occlusion was seen in 46 (20.0%) women, whereas proximal tubal occlusion accounted for 73 (56.2%) of all cases of tubal occlusion.Conclusion: There was a high rate of tuboperitoneal abnormalities in the studied population, which mainly comprised tubal occlusion, hydrosalpinx, pelvic adhesions, and endometriosis. The introduction of laparoscopy is recommended in the initial evaluation of all women with infertility in Nigeria. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of Chlamydia trachomatis infection among Nigerian women undergoing hysterosalpingography (HSG) and to identify any correlation between chlamydial antibody levels and a diagnosis of tubal disease.Methods: A prospective cross-sectional study was conducted from January 1 to June 30, 2013, among women scheduled to undergo HSG in the radiology department of Lagos University Teaching Hospital, Nigeria. Endocervical swabs and serum samples were collected to assess the levels of chlamydial antigen and antibody, respectively.Results: Among 150 participants, 83 (55.3%) had bilateral tubal patency and 67 (44.7%) had tubal disease. Overall, 53 (35.3%) women had positive test results for chlamydial antibodies; however, none of the participants tested positive for chlamydial antigen. Women with tubal disease were more likely to test positive for chlamydial antibodies (n=44 [65.7%]) than were those whose test results were negative (n=9 [10.8%]; P<0.001). The sensitivity and specificity of chlamydial antibody testing to predict tubal disease diagnosed by HSG were 66% and 89%, respectively.Conclusion: The presence of chlamydial antibodies was quantitatively related to the likelihood of HSG-diagnosed tubal disease. [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]

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]

Objective: To compare the therapeutic effects of cannulation guided by ultrasound or tactile sensation in women with proximal tubal obstruction.Method: This prospective randomized study reports on outcomes for 50 women treated as outpatients, 25 by the ultrasound-guided method and 25 by the tactile sensation method.Results: Of the 50 fallopian tubes in each group, 42 tubes (84%) were successfully cannulated by the ultrasound-guided method and 32 (64%) by the tactile sensation method; and of the 50 patients, 8 (16%) conceived in the 6 months following cannulation. The difference in pregnancy rates between the 2 groups was not statistically significant.Conclusion: Whether guided by ultrasound or tactile sensation, cannulation can be offered as a first-line outpatient procedure to women with proximal tubal obstruction. [ABSTRACT FROM AUTHOR]