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Background Hydrosalpinx is the most common lesion of the distal part of the tube. Hydrosalpinx is well known to have deleterious effect on fertility. Methods Two options are doable in case of hydrosalpinx: radical treatment(salpingectomy) or conservative treatment (salpingoneostomy). Results This work demonstrates that in experienced hands and with an acute selection, salpingoneostomy gives results comparable to those obtained after IVF. The cuff salpingoneostomy technique is much better than racket form salpingoneostomy and should be preferred whenever it is possible. Conclusions Conservative treatment should be discussed in infertile patients having hydrosalpinx after a careful selection.

Objective This systematic review and meta-analysis were aimed to summarize the body of evidence on the prognosis after laparoscopic surgeries for pathological conditions on distal oviducts, then, furthermore, to evaluate prognostic factors for pregnancy outcomes. Methods We conducted a systematic review and meta-analysis to summarize the body of evidence on this topic, with the review question formulated as “what is the prognosis after the laparoscopic fimbrioplasty, salpingostomy, or salpingoneostomy for patients with pathologic conditions on the distal oviducts.” We searched Medline and EMBASE on June 1st, 2020. Two investigators (HH and ZY) independently screened the references of all retrieved records for potentially eligible studies by firstly, through titles and abstract, and then full-text. A study would be included if it was a primary study reporting pregnancy outcomes of patients after laparascopic surgery. A meta-analysis of the rates of pregnancy, ectopic pregnancy, live birth, and miscarriage was performed using a random effect model. Results We identified 3861 records and included 21 reports with 2473 participants. The pooled estimate for the pregnancy rate was 35.1% (95% CI: 30.7%–39.7%, I2 ​= ​78%, low certainty). The pooled estimates for the live birth rate, ectopic pregnancy rate, and miscarriage were 24.4% (95% CI: 20.2%–28.8%, I2 ​= ​58%; 1154 participants; low certainty), 6.2% (95% CI: 4.4%–8.2%, I2 ​= ​61%; 2363 participants; low certainty), and 4.6% (95% CI: 2.8%–6.9%, I2 ​= ​10%; 544 participants; low certainty). Our analyses suggested that the more damaged tubal was associated with a decreased pregnancy rate, and patients with moderate or severe adhesion had lower pregnancy rates compared with patients with mild pelvic adhesion. Conclusion We estimated the pregnancy rate, ectopic pregnancy rate, and miscarriage rate of patients with distal tubal pathology after the laparoscopic fimbrioplasty or salpingostomy. Low certainty evidence suggested that laparoscopic surgery can restore the tubal function and cure infertility and should be considered as an alternative to in vitro fertilization. Tubal damage stage and adhesion are associated with worse pregnancy outcomes.

To investigate the impact of a history of previous naturally conceived tubal ectopic pregnancy (TEP) on subsequent IVF/intracytoplasmic sperm injection (ICSI) pregnancy and perinatal outcomes.Retrospective cohort study.Reproductive medicine center in a tertiary hospital.A total of 2,892 women with tubal infertility undergoing the first fresh IVF/ICSI cycle.Women were stratified into three groups according to the type of previous naturally conceived pregnancy: TEP, intrauterine pregnancy (IUP), and no pregnancy.Pregnancy and neonatal outcomes were analyzed for each cohort and stratified into the following categories based on female age:30 years, 30-35 years, and ≥35 years.Of the 2,892 patients with tubal factor infertility, 511 (17.7%) women had a history of TEP, 1,044 (36.1%) had prior IUP, and 1,337 (46.2%) had never been pregnant. Couples with an initial TEP tended to be younger and had experienced a shorter duration of infertility. Across the whole cohort, the optimal live birth rate decreased in older age groups. Live birth rates stratified by maternal age (30, 30-35, ≥35 years) did not differ between the TEP group (59.9%, 53.7%, 45.5%) and the IUP (62.0%, 53.8%, 40.6%) and no pregnancy group (56.7%, 54.4%, 45.6%). This did not change after adjusting for confounders such as age and years of infertility. Previous treatment of TEP with salpingectomy, salpingostomy, or medical treatment did not significantly affect subsequent fertility outcomes. The rates of preterm and low birth weight after TEP were also not significantly higher than in women with a previous IUP.Fertility history, including previous TEP, does not influence the probability of live birth after IVF/ICSI in women with tubal factor infertility.

BackgroundIn men, involuntary or voluntary ischiocavernosus muscle contractions after erection lead to intracavernous blood pressures far higher than the systolic pressure, which builds and maintains penile rigidity. Thus, erectile dysfunction may be partly due to ischiocavernosus muscle atrophy and may be treated by rehabilitation interventions.ObjectiveThe purpose of this study was to determine whether pelvic-floor muscle strengthening interventions could be associated with increases in intracavernous pressure that would increase penile rigidity.DesignAn observational study was conducted.MethodsOne hundred twenty-two men with isolated erectile dysfunction and 108 men with isolated premature ejaculation participated (no neuromuscular diseases or previous perineal rehabilitation). Thirty-minute sessions of voluntary contractions coupled with electrical stimulation were designed to increase ischiocavernosus muscle strength (monitored through intracavernous pressure increase). A linear mixed-effects model per group analyzed separately, then jointly, the maximum change in pressure (ΔP) and the maximum baseline (ie, respectively, the average contraction-generated difference in intracavernous pressure and the intracavernous pressure plateau at full erection, both measured during the highest moving average of the best 2 minutes of each session).ResultsOver 20 sessions, the maximum ΔP increased in erectile dysfunction as well as in premature ejaculation (87% and 88%, respectively, in men with positive trends). The maximum baseline also increased (99% and 72%, respectively, in men with positive trends). The joint modeling indicated that the mean expected progressions of the intracavernous pressure after 5 sessions in erectile dysfunction and premature ejaculation were 62.85 and 64.15 cm H2O, respectively.LimitationsIndirect measurements were obtained of intracavernous pressure and ischiocavernosus muscle force.ConclusionsPelvic-floor muscle rehabilitation was found to be beneficial in erectile dysfunction. However, its effects on symptoms of premature ejaculation, despite intracavernous pressure gains, were much more difficult to assess. The definitive proof of its benefits requires rather difficult-to-design clinical trials.