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Persistent müllerian duct syndrome (PMDS) is usually a surprise finding either during orchidopexy or during routine inguinal hernia repair in male patients. Often, the surgeon would face a dilemma about what is to be done with the remnants of müllerian duct, i.e. the fallopian tubes, uterus and proximal vagina. Till recently, it was advised to retain these structures whenever it was felt that the complete excision of these structures may jeopardise the blood supply and integrity of the vas deferens. Recent reports of malignancy in these retained structures would justify more aggressive approach. In our patients with PMDS, we have removed the mucosa of the retained müllerian structures, without compromising the integrity and vascularity of the vas deferens, thus reducing the chances of malignancy. [ABSTRACT FROM AUTHOR]

The lack of proven screening tools for early detection and the high mortality of ovarian serous carcinoma (OSC), particularly high grade, have focused attention on identifying putative precursor lesions with distinct morphological and molecular characteristics. The finding of occult invasive and intraepithelial fallopian tube carcinomas in prophylactically removed specimens from asymptomatic high-risk BRCA 1/2-mutation carriers supports the notion of an origin for OSC in the fallopian tube. The intraepithelial carcinomas have been referred to as serous intraepithelial carcinomas (STICs) but our own findings (unpublished data) and recent reports have drawn attention to a spectrum of changes that fall short of STICs that we have designated serous tubal intraepithelial lesions (STILs). [ABSTRACT FROM AUTHOR]

Introduction: Endosalpingiosis describes the ectopic growth of Fallopian tube epithelium. Pathology confirms the presence of a tube-like epithelium containing three types of cells: ciliated, columnar cells; non-ciliated, columnar secretory mucous cells; and intercalary cells.We report the case of a woman with umbilical endosalpingiosis and examine the nature and characteristics of cutaneous endosalpingiosis by reviewing and combining the other four cases existing in the international literature.Case Presentation: A 50-year-old Caucasian, Greek woman presented with a pale brown nodule in her umbilicus. The nodule was asymptomatic, with no cyclical discomfort or variation in size. Her personal medical, surgical and gynecologic history was uneventful. An excision within healthy margins was performed under local anesthesia. A cystic formation measuring 2.7×1.7×1 cm was removed. Histological examination confirmed umbilical endosalpingiosis.Conclusions: Umbilical endosalpingiosis is a very rare manifestation of the non-neoplasmatic disorders of the Müllerian system. It appears with cyclic symptoms of pain and swelling of the umbilicus, but not always. The disease is diagnosed using pathologic findings and surgical excision is the definitive treatment. [ABSTRACT FROM AUTHOR]

Female genital tuberculosis (FGTB) is an important cause of infertility in developing countries. Various type of TB salpingitis can be endosalpingitis, exosalpingitis, interstitial TB salpingiti and salpingitis isthmica nodosa. The fallopian tubes are thickened enlarged and tortuous. Unilateral or bilateral hydrosalpinx or pyosalpinx may be formed. A new sign python sign is presented in which fallopian tube looks like a blue python on dye testing in FGTB. [ABSTRACT FROM AUTHOR]

In the present investigation a total number of 390 samples of female genital tract were examined from cattle of different age and breeds. One hundred and fifty six specimens suspected for abnormalities were further processed for histopathological examination. Out of these 10 samples showing gross lesions were collected and tissue sections from these were subjected to histopathological examination. Fallopian tube revealed pathological conditions in 6.41% cases as: acute salpingitis 0.64%, chronic salpingitis 2.56%, hydrosalpinx 1.28% and epithelial hyperplasia in 1.92% cases. [ABSTRACT FROM AUTHOR]

Objective: To explore the probability of hysteroscopy, replacing salpingoscopy, in tubal reconstructive surgery with infertility of hydrosalpinx. Methods: Data from 43 patients with infertility of hydrosalpinx who accepted operation in our hospital from January 2012 to August 2012 were retrospectively analyzed. All the patients received the conjunction of hysteroscopy with laparoscopy. Under hysteroscopy, we observed the tubal lumen, including adhesions, loss of mucosal folds, rounded edges of mucosal folds, debris, foreign bodies and abnormal vessels. The F score expressed the sum of the above abnormal results, each abnormal result was given one score. After linear salpingectomy or salpingostomy following the F score, a follow-up within 24 months was done, and the pregnancy rate and the live birth rate were recorded. Results: In 43 patients, 66 tubes were diagnosed as hydrosalpinx by laparoscopy, 8 tubes (F score≥2) were removed. The pregnancy rate was 45% (18/40), and the live birth rate was 35% (14/40). Conclusions: Hysteroscopy can be used to replace salpingoscopy to observe the tubal lumen, which can afford beneficial suggestion of hydrosalpinx therapy. [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]

Purpose: To evaluate the effectiveness of hysteroscopy as a method for the diagnosis of tubal patency using saline distention media. Methods: In this prospective study, 62 women between 21 and 38 years with a history of at least 1 year of infertility who underwent hysteroscopy and hysterosalpingography (HSG) on two consecutive cycles were studied. Transvaginal ultrasonography carried out before and after hysteroscopy in order to measure the abdominal fluid (in ml) in the peritoneal cavity of the cul-de-sac. The difference between the two results was calculated. A next cycle HSG was performed and patients were divided into three groups according to whether there was no tubal occlusion (group 1), a unilateral occlusion (group 2) or a bilateral occlusion (group 3): Peritoneal fluid measurements were compared among the three groups. Finally, pain and discomfort were recorded at the end of the process. Results: According to the HSG, 34 women were in group 1, 13 in group 2 and 9 in group 3. Peritoneal fluid measurements were 6.88 +/- 2.7 ml in group 1, 4.21 +/- 0.9 ml in group 2 and 1.08 +/- 0.7 ml in group 3. Statistical differences were found between groups 1 and 3 and between groups 2 and 3 (P < 0.05). All of the patients reported significantly less pain during hysteroscopy in response to HSG. Conclusions: Using saline distension media during hysteroscopic evaluation was effective to allow measurement of the accumulating fluid in the peritoneal cavity and to confirm at least one patent tube with minimal pain. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the tolerability, side effects and complications of hysterosalpingocontrast sonography (HyCoSy).Design: Prospective study.Setting: University hospital.Patient(s): 669 infertile women.Intervention(s): All patients were examined with HyCoSy and monitored for 30 minutes after the procedure. A telephone interview was subsequently carried out to record possible late side effects and postprocedural complications.Main Outcome Measure(s): Tolerability to the procedure was evaluated by means of an 11-point (0 to 10) numeric rating scale of the pain experienced. Postprocedural fever, pelvic infections, peritonitis, hemorrhage were recorded.Result(s): Of 660 patients who completed the examination, 483 (73.2%) completed the telephone follow-up after a period of 14.7 +/- 9.9 months from the procedure. The mean patient age was 34.5 +/- 4.3 years, and mean infertility duration was 28.1 +/- 23.2 months. The mean numeric rating scale was 2.7 +/- 2.5, and 10 patients (2.0%) required postprocedural drug treatment for pain relief. Mild vasovagal reactions were experienced in 20 cases (4.1%), and four patients (0.8%) had a severe vasovagal reaction. No late complications were reported. No patients required hospital admission after the procedure.Conclusion(s): In our series, HyCoSy was a well-tolerated examination with a very low rate of side effects and no late complications that required no atropine or anti-inflammatory drugs. These data support the safety of HyCoSy when performed as described, but further work is needed to estimate the rate of late complications and side effects in other settings. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficiency of hysterosalpingo-contrast-sonography performed with air and saline (Hydro-HyCoSy) with HyCoSy performed with contrast media (SonoVue) and contrast-tuned imaging technology (CnTI-SonoVue-HyCoSy) considering hysterosalpingography (HSG) and laparoscopy (LPS) as reference tests and to evaluate the learning curve of this procedure.Design: Retrospective study.Setting: Reproductive unit of a university hospital.Patient(s): Forty-two infertile female patients.Intervention(s): HyCoSy were performed with a 2.4-mm intrauterine catheter. Patients underwent HSG or LPS as controls.Main Outcome Measure(s): Mean age, sensitivity, specificity, positive and negative predictive value, kappa value, and diagnostic accuracy were evaluated for statistical analysis.Result(s): Sensitivity, specificity, and positive and negative predictive values of Hydro-HyCoSy were 91%, 71%, 55%, and 95%, respectively, while for CnTI-SonoVue-HyCoSy they were 87%, 84%, 69%, and 94%. The diagnostic accuracy of Hydro-HyCoSy and of CnTI-SonoVue-HyCoSy were 77% and 85%, with a Cohen's kappa of 0.52 and 0.66, respectively. CnTI-SonoVue-HyCoSy does not require a learning curve period.Conclusion(s): CnTI-SonoVue-HyCoSy is more accurate than Hydro-HyCoSy for the assessment of fallopian tubes. The very high normal predictive value of Hydro-HyCoSy suggests that this procedure could be performed as a screening examination, whereas CnTI-SonoVue-HyCoSy could be used as a second-step technique. [ABSTRACT FROM AUTHOR]

Fallopian tube disease, both acute and chronic, is a common cause of a sonographically indeterminate adnexal mass and may mimic ovarian cancer. Magnetic resonance imaging (MRI) is now widely used as a problem-solving tool in these circumstances. The purpose of this review is to provide the discriminative MRI features of Fallopian tube masses and illustrate the key signs that establish their origin and nature. Familiarity with these characteristics enables distinction of tubal disease from malignant adnexal disease with major impact on management. On MRI, Fallopian tube disease exhibits features that parallel the classical sonographic findings, but which can be more reliably recognized due to improved contrast and spatial resolution, multiplanar capacity, effective field of view, and tissue characterization. Recognition of these characteristic morphological features and specific MRI signal patterns are key to a specific diagnosis. The anatomical and histopathological basis of these MRI signs is emphasized, covering also the differential diagnosis and pitfalls. Two new signs, “synechiae” and “amorphous shading”, are also described that have not been well described previously in MRI of tubal disease. [Copyright &y& Elsevier]

Objective: To investigate the association between the expressions of leukemia inhibitory factor and the occurrence of tubal pregnancy. Design: Prospective observational study. Setting: University-based obstetrics and gynecology hospital. Patient(s): Thirty women undergoing salpingectomy for tubal pregnancy and 30 nonpregnant patients with benign uterine or appendix disease. Intervention(s): Oviduct tissues with ectopic gestation were separated into implantation sites and nonimplantation sites. Samples of ampullary fallopian tubes during midsecretory phase were collected as control groups. Immunohistochemical and Western blot analysis were performed. Main Outcome Measure(s): The differences of leukemia inhibitory factor expression between the implantation and nonimplantation sites of oviduct tissues and the normal and chronically inflamed fallopian tubes. Result(s): The expression of leukemia inhibitory factor in the implantation group is significantly higher than that in the nonimplantation group or in the normal group. A statistically significant difference was also found for leukemia inhibitory factor between the chronic inflammation group and the normal group by Western blot analysis but no difference between the chronic inflammation group and the implantation group or the nonimplantation group. Conclusion(s): Leukemia inhibitory factor might be one of the reasons that cause patients with salpingitis to be more susceptible to tubal pregnancy and might be involved in the implantation process of tubal pregnancy. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the efficacy and toxicity of carboplatin, granulocyte-macrophage colony-stimulating factor (GM-CSF) and recombinant interferon gamma 1b (rIFN-γ1b) in women with recurrent, platinum-sensitive ovarian, fallopian tube and primary peritoneal cancer. Methods: In this phase II study, patients with recurrent, platinum-sensitive ovarian, fallopian tube or primary peritoneal cancer were treated with subcutaneous GM-CSF and rIFN-γ1b before and after intravenous carboplatin until disease progression or unacceptable toxicity. All patients had measurable disease and a chemotherapy-free interval >6 months. Response was determined using RECIST criteria and CA 125 levels. Results: Between 2003 and 2007, 59 patients received a median of 6 cycles of therapy (range, 1 to 13 cycles). Median age at enrollment was 61 years (range, 35 to 79 years). Median time to progression prior to enrollment was 11 months (range, 6 to 58 months). Of 54 patients evaluable for response, 9 (17%) had a complete response, 21 (39%) had a partial response, and 24 (44%) had progressive disease. The overall response rate was 56% (95% CI: 41% to 69%). With a median follow-up of 6.4 months, median time to progression was 6 months. Myeloid derived cells and platelets increased on day 9 of each chemotherapy cycle. The most common adverse effects were bone marrow suppression, carboplatin hypersensitivity, and fatigue. Responders reported improved quality of life. Conclusion: This pre and post-carboplatin cytokine regimen resulted in a reasonable response and a hematologic profile that could invite further evaluation of its components in the treatment of patients with ovarian cancer. [Copyright &y& Elsevier]

Limited information is available regarding the usefulness of third-line chemotherapy for recurrent ovarian, fallopian tube, and primary peritoneal cancer treated with platinum-taxane regimens as first-line therapy. We retrospectively reviewed the medical records of women with ovarian, fallopian tube, and primary peritoneal cancer who were treated at the National Cancer Center Hospital between 1999 and 2005 to investigate the relations of clinicopathological factors to important clinical endpoints such as the response rate (RR), time to progression (TTP) and overall survival (OS) after third-line chemotherapy. A total of 172 patients received first-line platinum/taxane regimens during the study period, among whom 111 had disease progression after first-line chemotherapy. Eighty-one of these 111 patients received second-line chemotherapy, and 73 had disease progression. Fifty-four of the 73 patients with disease progression received third-line chemotherapy. The RR to third-line chemotherapy was 40.7% (95% CI, 27.6–53.8%). The median TTP was 4.4 months (range 0–19.5 months), and the median OS was 10.4 months (range 1.5–44.3 months). Performance status (PS) and primary drug-free interval (DFI) were independent predictive factors for the RR to third-line chemotherapy ( P = 0.04 and P = 0.009). PS and primary DFI were also independent predictive factors for TTP and OS on multivariate analysis ( P = 0.006, P = 0.005 and P = 0.01, P = 0.004, respectively). PS and primary DFI are useful predictors of the response to third-line chemotherapy in women with recurrent ovarian, fallopian tube, and primary peritoneal cancer. In this setting, however, both of these variables are subject to several well-established potential biases and limitations; further prospective studies are thus needed. [ABSTRACT FROM AUTHOR]

Introduction: Hysterosalpingography is defined as the sequent introduction in the uterus, fallopian tubes and abdominal cavity, of an opaque substance (non ionic iodized compound) with a probe, while external cervical orifice is obstructed and under supervised pressure, it is prescribed for uterine cavity and surroundings evaluation, being relevant the permeability demonstration of the uterine tubes in patients diagnosed with infertility and in some cases anexial pathology. Objective: Report incidence of ultra and linkages pathology reported by hysterosalpingography, stressing advantages and disadvantages of this method and making a description of observed findings. Material and methods: Longitudinal, retrospective study was made to 288 female patients, ages between 19 and 40 years old, with diagnosis of infertility and uterine anomalies and/or anexial, in the period comprised between January 2006 to January 2009. Test was performed to all patients between days 7 and 12 of menstrual cycle, in digital X-Rays room with fluoroscopy and G.E. Prestige II control. Taking AP projections, oblique, right side and emptying. Results: Endometrial cavities with normal aspect in 185 patients were found. Endometrial cavities with intraluminal filling defects in 103 patients, with respect to Fallopian tubes were found normal or permeable 142 patients and with tubaric bilateral obstruction 86 patients, unilateral obstruction 52 patients. Anatomic variants represented only 8.33%, being bi-horn unicoles, arcuate and septated uterus the most common, with anexial masses observed only in 2.7 % of the cases. Conclusions: Hysterosalpingography is considered still as one of imaging methods, allowing to identify tubarian pathologies, as well as of the endometrial, anexial cavity and alterations of uterine morphology, with a great impact in the diagnosis of tubarian obstruction, being this main indication in patients with of primary or secondary infertility diagnosis. Represent a simple, efficient and low-cost method of diagnostic imaging, with the only disadvantage of the ionizing radiation use. It is important that every Radiologist or specialist in fertility be familiar with imaging interpretation and findings described in each of the pathologies that can be observed by this imaging method. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine the effects of hysterectomy and bilaterally salpingo-oophorectomy (BSO) on Female Sexual Function Index (FSFI) in the post-menopausal women. Method: This study included 92 women who underwent vaginal hysterectomy (VH) and BSO (n:37) and who underwent abdominal hysterectomy (AH) and BSO (n:55). Estrogen replacement therapy (ERT) was given 21 women who underwent VH and BSO and 28 women who underwent AH and BSO in pre- and postoperative periods. All patients were evaluated preoperatively and postoperative 6th month in terms of FSFI scores. Results: It was found that hysterectomies by abdominal or vaginal routes reduced FSFI scores significantly (P <0.05). The use of ERT were no effect on total score of FSFI in AH and BSO (P >0.05). ERT prevented deterioration of FSFI in women who underwent VH relative to preoperative values but AH. Conclusion: Hysterectomy causes unfavourable effects on sexual functions at least in the first 6 postoperative months and this negative effect can not be repaired by estrogen replacement therapy in AH and BSO. [Copyright &y& Elsevier]

Noninflammatory tubal abnormalities are rare in children and usually not well covered by traditional educational material. The presenting symptoms are nonspecific and are common to many other conditions, so its preoperative diagnosis is rarely made. The purpose of this study was to review the hospital charts and imaging findings in children and sexually inactive adolescents who showed fallopian tube pathology. Understanding of the pertinent findings of previous imaging examinations might assist radiologists in making the correct preoperative diagnosis and increase the likelihood of preserving the fallopian tubes. The clinical entities described in this article include isolated tubal torsion, paratubal cysts, hydrosalpinx, undescended/ectopic fallopian tube, and tubal inguinal hernia. [ABSTRACT FROM AUTHOR]

The prognosis of patients with platinum refractory disease is dismal. We present data from heavily pretreated patients to whom the folinic acid, 5-fluorouracil and oxaliplatin (Folfox) regimen was administered. The objectives were to assess response rate and to evaluate the safety profile. Patients with recurrent, resistant or refractory pretreated ovarian carcinoma were eligible for oxaliplatin (85 mg/m2) and leucovorin (200 mg/m2), both given as a 2-h infusion on day 1, followed by a 48-h infusion of 5FU 2,600 mg/m2 every 2 weeks. Fourteen patients were treated. Median age: 56 years (49–70). Median number of previous chemotherapy regimens: 5 (3–10) and previous platinum-based regimens: 2 (1–3). Median chemotherapy-free interval (interval since the completion of the last-line chemotherapy before the administration of the Folfox regimen): 9.5 weeks (1–39). Median number of administered cycles of Folfox/patient: 8 (2–11 cycles). Two (14.5%) patients had a disease complete response, 2 (14.5%)—partial response, 4 (29%)—stable disease and 6 (43%)—progressive disease. Four (29%) patients had a CA-125 complete response, 2 (14.5%)—CA-125 partial response, 5 (35.5%)—stable CA-125 levels and 3 (21%)—progressive CA-125 levels. There were no grade 4 adverse events or deaths due to the treatment. No dose modifications were required due to toxicity. Folfox seems to be a valuable option for heavily pre-treated patients with ovarian cancer, with an overall response rate, according to RECIST criteria, of 29% and disease stabilization in an additional 29% of patients, with a manageable toxicity profile. These results support further assessment of Folfox as salvage treatment for patients with carcinoma of the ovary or fallopian tube. [ABSTRACT FROM AUTHOR]

The article discusses diseases of the fallopian tube. Details related to the review, are the assessment of the most commonly used diagnostic tests and discuss the advantages and disadvantages of the various treatment methods available. Diagnostic tests and treatments are also discussed in the article. Information on laparoscopy and dye test for fallopian tube testing is presented. T

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]

Endometriosis is an estrogen-dependent disorder defined as the presence of endometrial tissue outside of the uterine cavity. A leading cause of infertility, endometriosis has a prevalence of 0.5–5% in fertile and 25–40% in infertile women. The optimal choice of management for endometriosis-associated infertility remains obscure. Removal or suppression of endometrial deposits by medical or surgical means constitutes the basis of endometriosis management. Current evidence indicates that suppressive medical treatment of endometriosis does not benefit fertility and should not be used for this indication alone. Surgery is probably efficacious for all stages of the disease. Controlled ovarian hyperstimulation with intrauterine insemination is recommended in early-stage and surgically corrected endometriosis when pelvic anatomy is normal. In advanced cases, in vitro fertilization is a treatment of choice, and its success may be augmented with prolonged gonadotropin-releasing hormone analog treatment. Further randomized clinical trials focusing on diverse etiopathogenic mechanisms and therapeutic innovation are necessary to find more conclusive, evidence-based answers regarding this enigmatic disease. [ABSTRACT FROM AUTHOR]

Chronic tubal torsion is a rare clinical entity. A 15-year-old adolescent presented with an 18-month history of intermittent lower abdominal pain at our outpatient department after various preceding consultations with different physicians. She was asymptomatic and showed no abnormality on physical examination. Ultrasound findings revealed a cystic structure adjacent to the left ovary. Diagnostic laparoscopy showed a twisted and dilated left fallopian tube with thickened wall and adherence to the pelvic sidewall. Following detorsion, there was no evidence of reperfusion. Consequently, a left salpingectomy was performed. Chronic tubal torsion is a rare but possible differential diagnosis of current lower abdominal pain. Physicians should have a high index of suspicion. [ABSTRACT FROM AUTHOR]

Abstract: Two groups of women were used to compare effects of P2 receptor agonists on the contractile activity of isolated human fallopian tubes with and without acute purulent inflammation. A control group included women with uterine tubes without inflammation (n =15). A study group included women, operated for unsuccessful conservative anti-inflammatory treatment of acute purulent tuboovarial formations (group with acute purulent salpingitis, n =16). Division into two groups was done according to pathohistological diagnosis. Spontaneous contractions of the isolated tubes were registered isometrically with electromechanical transducer before and after incubation of the tissues with agonists of P2 receptors—ATP, UTP, 2-methylthio-ATP and α,β-methylene-ATP. In the control group neither of the agonists produced any significant effect on fallopian tube contractility. In the study group, ATP, 2-methylthio-ATP and α,β-methylene-ATP significantly increased the spontaneous contractility of isolated tubes. It is suggested that higher activity of P2 receptor agonists in the uterine tubes with acute purulent inflammation is due to expression of several subtypes of P2 receptors during inflammation. [Copyright &y& Elsevier]

Objective: To determine the efficacy of a non-invasive, manual soft-tissue physical therapy in opening completely blocked fallopian tubes in infertile women with confirmed bilateral occlusion and a history indicative of abdominopelvic adhesions. Design: Retrospective analysis. Setting: Clear Passage Therapies, Inc, clinic, Gainesville, Florida. Patients: 28 infertile women (mean age=35.2) with diagnosed complete tubal occlusion (proximal, midtubal, distal, or combination). The patients were being treated for various types of abdominopelvic pain and dysfunction (eg, intercourse and/or pelvic pain, menstrual cramps, endometriosis pain). Intervention: A 20-hour series of manual physical therapy treatments (mean duration=1 week) designed to address pain and restricted soft tissue mobility due to adhesions and micro-adhesions. The therapists accessed some of the deeper structures (such as the fallopian tubes) indirectly by manipulating the peritoneum, uterine and ovarian ligaments, and neighboring structures. Main outcome measures: (1) Unilateral or bilateral tubal patency confirmed by diagnostic test or natural intrauterine pregnancy; (2) natural intrauterine pregnancy rate achieved by patent patients within the 2-year follow-up period. Results: Of the 28 patients, 17 (61%, 95% exact Cl 41%-78%) demonstrated post-treatment unilateral or bilateral patency, as measured by hysterosalpingography or natural intrauterine pregnancy. The median interval between the last treatment date and patency confirmation was 1 month. Nine of the 17 (53%) patent patients reported a subsequent natural intrauterine pregnancy. Conclusion: Since truly occluded tubes are not known to reopen spontaneously, the results suggest this non-invasive therapy might be considered as an adjuvant to standard gynecological procedures in treating tubal occlusion. [ABSTRACT FROM AUTHOR]

To prospectively investigate the prevalence of Chlamydia trachomatis (CT), Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU) in the cervical canal and pouch of Douglas in unexplained infertile women and compare it to healthy controls in the Turkish population. A total of 31 women presenting with a history of infertility [ n = 24 (77%) primary infertility, n = 7 (23%) secondary infertility] between 20 and 38 years of age and 31 women willing to have tubal ligation between 30 and 41 years of age were consecutively included into this study. Specimens were taken from intra-abdominal washings and from the cervical canal. CT, MH and UU were detected with polymerase chain reaction (PCR). Results of 62 women were analyzed. None of the participants met the criteria for salpingitis during laparoscopy. The most common infection in the cervical canal in both groups was UU, which was detected in 13 cases of infertile patients and 11 controls ( P = 0.602). Cervical chlamydial and mycoplasmic infection was detected in one case each in infertile and control patients. Neither MH nor UU were obtained from the pouch of Douglas in both groups. Only CT was present in peritoneal fluid of an infertile woman who had also a concomitant chlamydial infection in the cervical canal. Demonstration of cervical colonization of CT by PCR may be a promising method for the detection of asymptomatic pelvic infection in patients with unexplained infertility. However, screening for MH and UU is not cost-effective due to similar low rates of detection. [ABSTRACT FROM AUTHOR]

In the case of tubal disease, selection of patients is critical to decide whether tubal surgery or IVF should be proposed as the therapeutic option. Selection is based on tubal lesions, including the aspect of tubal mucosa and tuboperitoneal environment. Therefore, non-invasive diagnostic methods have proved to be insufficient, and endoscopy is mandatory. Fertiloscopy represents an attractive alternative. Fertiloscopy is minimally invasive, reproducible, and at least as precise as lap and dye. Moreover, fertiloscopy and not laparoscopy allows the routine practice of salpingoscopy and microsalpingoscopy. On this basis, fertiloscopy should be adopted as the standard procedure for tubal evaluation in the management of tubal disease. [ABSTRACT FROM AUTHOR]

Tubal disease is the cause of subfertility in approximately 30% of women, and 10-25% of these are due to proximal tubal obstruction. False-positive diagnosis of proximal tubal obstruction can be as high as 50%. A decrease in expertise in tubal microsurgery has resulted largely from the use of IVF as the treatment option for most causes of infertility and more specifically for tubal factor infertility. Selective salpingography and tubal cannulation have a unique role in the management of tubal infertility and should be offered to selected candidates prior to IVF. Tubal cannulation can be used effectively to restore patency in a proportion of cases of proximal tubal obstruction thus avoiding the need for expensive assisted reproductive techniques. This review examines the evidence supporting the effectiveness of tubal cannulation and aims to enhance awareness of the procedure as an option for the management of female subfertility secondary to isolated proximal tubal obstruction. [ABSTRACT FROM AUTHOR]

Tubal disease is a major cause of infertility. The amount of damage can vary greatly in extent, anatomical location and nature. For women with infertility due to tubal disease, prognostication for pregnancy often remains unclear and there is no universally accepted classification. A classification system that reliably distinguishes infertile patients with tubal disease into favourable and unfavourable groups would be useful if subsequent management could depend on this assessment, especially if the classification is able to define which group of patients would benefit most from interventions such as surgery. The progress of IVF questions the contribution of the Fallopian tube to the successful achievement of pregnancy in infertile women. Nonetheless, several studies reveal that severity is the key factor in the determining outcome, and the classifications reviewed in this paper imply that women with tubal disease could be categorized into prognostic groups using a simple classification system based on severity. However, prospective trials are needed to validate and assert the usefulness of any particular classification. [ABSTRACT FROM AUTHOR]

Prospective studies of reproductive outcomes frequently record data at multiple cycles. For example, studies of in vitro fertilization and embryo transfer (IVF-ET) follow women or couples for possibly several IVF cycles and record outcomes such as pregnancy status and embryo implantation. Several time-varying covariates, such as age and diagnostic markers, typically are available as well. When attention is focused on measurement of exposure effects, the use of multiple cycle data poses several complications. If the study is observational, the exposure probability may depend on subject characteristics. Moreover, attrition rates in IVF-ET can be substantial, and the attrition process can be expected to depend heavily on prior outcome. In fact, both success (pregnancy) and failure (lack of embryo implantations) can be prognostic of dropout. In this paper, we illustrate the use of causal modeling for multiple cycle data. Key assumptions are reviewed, and inference based on weighted estimating equations is described in detail. The methods are applied to a study of the effects of hydrosalpinx among women with tubal disease undergoing IVF-ET. [ABSTRACT FROM AUTHOR]

Objective: To compare endometrial and subendometrial blood flows among patients with and without hydrosalpinx (HSP) during in vitro fertilization treatment as measured by a three-dimensional power Doppler ultrasound. Design: A prospective observational study. Setting: A tertiary assisted-reproduction unit. Patient(s): Twenty-one patients with HSP were compared with 42 matched controls without HSP. Intervention(s): None. Main Outcome Measure(s): Endometrial thickness, endometrial pattern, endometrial volume, pulsatility index (PI) and resistance index (RI) of uterine vessels, and the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of endometrial and subendometrial regions were measured on the day of oocyte retrieval. Result(s): The proportion of the non-multilayered endometrial pattern was significantly higher in the HSP group than in the non-HSP group. Patients in the HSP group had significantly lower endometrial and subendometrial VI and VFI. Endometrial thickness, endometrial volume, uterine PI, uterine RI, and endometrial and subendometrial FI were similar between the two groups. No significant differences were observed in endometrial and subendometrial VI, FI, and VFI among patients with unilateral and bilateral HSP. Conclusion(s): A change in endometrial pattern and a decrease in endometrial and subendometrial blood flows may be the reasons for impaired implantation in patients with HSP. [ABSTRACT FROM AUTHOR]

Tube torsion refers to a gynecological acute abdominal disease, in which the fallopian tube rotates on its own axis, without ipsilateral ovarian torsion. The incidence is very low, only 1/1 500 000. Clinical symptoms are not typical, easy to cause misdiagnosis. Tube torsion during pregnancy is even rarer, accounting for 12% of all cases of tubal torsion. Due to the lack of specific examination methods, the diagnoses are often delayed, even resulting in peritonitis and thereby endangering the life of the mother and baby. A case of pregnancy complicated with tubal torsion in our hospital was reported as follows, with a review of literatures, in order to explore the clinical characteristics and treatment methods of this rare and complex disease, so as to improve our ability of diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Worldwide, 5%-10% of infertility patients have FGTB. 24 infertile women with a pathological diagnosis of FGTB between April 2013 and Feb 2019 were identified and the clinical features and findings on transvaginal sonography (TVS) were investigated. Endometrial TB was pathological diagnosed in 15 women, the sonographic features were as follows: intrauterine adhesions 46.67% (7/15), endometrial polyps 13.33% (2/15), heterogeneous endometrium with subendometrial calcification 13.33% (2/15), and normal 26.67% (4/15). [Extracted from the article]

Throughout the fallopian tube, there are longitudinal folds and mucosal rugae, that in concert with cilia, help transport an egg to the uterus and also help clear fluid from the fallopian tube into the peritoneal cavity [[2]]. If the fallopian tube becomes blocked, usually in the ampullary segment which constitutes half the length of the tube [[2]], fluid is not cleared and the fallopian tube becomes dilated and fluid-filled producing a hydrosalpinx [[1]]. The fallopian tube is fluid-filled with thickened folds along the periphery producing the "cogs" on the wheel (white arrows). [Extracted from the article]

OBJECTIVE: To compare clinical and histologic features between fallopian tube cancers in women with germline BRCA mutations and sporadic cases. METHODS: Twenty-eight patients with fallopian tube cancer had BRCA mutation testing using multiplex polymerase chain reaction and protein truncation testing. Histologic slides were reviewed by 2 pathologists, and immunohistochemical staining for p53, ki67, estrogen receptor, and progesterone receptor was performed on carcinomas and dysplastic and benign tubal epithelia. RESULTS: Twelve of 28 (43%) women had BRCA mutations: 11 BRCA1, 1 BRCA2. Excluding 4 cases found at prophylactic surgery, the median age of diagnosis of BRCA mutation carriers was 57 years compared with 65 years among sporadic cases (P = .09). Patients with BRCA-associated fallopian tube cancer had a median survival time of 68 months compared with 37 months when compared with sporadic cases (P = .14). Both groups had predominantly advanced stage, high grade, serous fallopian tube cancers. No patient had exclusively proximal disease. Occult fallopian tube cancer diagnosed at prophylactic surgery in BRCA mutation carriers was exclusively distal. ‘Skip’ areas of high-grade dysplasia were only seen in 2 patients, both of whom were BRCA mutation carriers. There were no differences in the immunohistochemical staining for p53, ki67, estrogen receptor or progesterone receptor in carcinomas and dysplastic or benign epithelia of patients with or without BRCA mutations. Overexpression of p53 was commonly seen in fallopian tube cancers and dysplastic epithelium, but rarely noted in benign epithelium. CONCLUSION: Fallopian tube cancer is part of the BRCA mutation phenotype and seems to share many clinical features with sporadic fallopian tube cancers, including no exclusively proximal disease. The presentation of BRCA-associated fallopian tube cancers may, however, occur at a younger age and have an improved survival. [ABSTRACT FROM AUTHOR]

Objectives: Mycoplasma genitalium has been associated with cervicitis, endometritis, and tubal factor infertility. Because the ability of this bacterium to ascend and infect the fallopian tube remains undefined, we performed an investigation to determine the prevalence of M genitalium in fallopian tube, endometrial, and cervical specimens from women laparoscopically diagnosed with acute salpingitis in Nairobi, Kenya.Methods: Women presenting with pelvic inflammatory disease were laparoscopically diagnosed with salpingitis. Infection with M genitalium in genital specimens was determined by polymerase chain reaction (PCR).Results: Of 123 subjects with acute salpingitis, M genitalium was detected by PCR in the cervix and/or endometrium in nine (7%) participants, and in a single fallopian tube specimen. In addition, those infected with M genitalium were more often HIV infected than women not infected by M genitalium (seven of nine (78%) v 42 of 114 (37%), p<0.03).Conclusions: M genitalium is able to ascend into the fallopian tube, but its association with tubal pathology requires further investigation. [ABSTRACT FROM AUTHOR]

Background In theory, infections that arise after female genital mutilation (FGM) in childhood might ascend to the internal genitalia, causing inflammation and scarring and subsequent tubal-factor infertility. Our aim was to investigate this possible association between FGM and primary infertility. Methods We did a hospital-based case-control study in Khartoum, Sudan, to which we enrolled women (n=99) with primary infertility not caused by hormonal or iatrogenic factors (previous abdominal surgery), or the result of male-factor infertility. These women underwent diagnostic laparoscopy. Our controls were primigravidae women (n=180) recruited from antenatal care. We used exact conditional logistic regression, stratifying for age and controlling for socioeconomic status, level of education, gonorrhoea, and chlamydia, to compare these groups with respect to FGM. Findings Of the 99 infertile women examined, 48 had adnexal pathology indicative of previous inflammation. After controlling for covariates, these women had a significantly higher risk than controls of having undergone the most extensive form of FGM, involving the labia majora (odds ratio 4·69, 95% CI 1·49-19·7). Among women with primary infertility, both those with tubal pathology and those with normal laparoscopy findings were at a higher risk than controls of extensive FGM, both with borderline significance (p=0·054 and p=0·055, respectively). The anatomical extent of FGM, rather than whether or not the vulva had been sutured or closed, was associated with primary infertility. Interpretation Our findings indicate a positive association between the anatomical extent of FGM and primary infertility. Laparoscopic postinflammatory adnexal changes are not the only explanation for this association, since cases without such pathology were also affected. The association between FGM and primary infertility is highly relevant for preventive work against this ancient practice. [ABSTRACT FROM AUTHOR]

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

Background: Compared with their ovarian counterparts, serous borderline tumors of the fallopian tube are uncommon, with limited experience about their clinical behaviour. We present a case of serous borderline tumor of the fallopian tube with unusual presentation and summarise all the published cases to date. Case presentation: A case of serous borderline tumor of the fallopian tube in a 34-year old patient is presented, incidentally found during routine gynecologic examination. At laparoscopy the tumor was unusualy presented as hematosalpinx and was treated by salpingectomy. Cell-cycle analysis of the tumor tissue revealed a diploid DNA content and a low S-phase fraction. There was no evidence of the disease during the follow-up period of 4.6 years. Conclusion: The current case and review of the literature suggest salpingectomy as the optimal treatment for patients with serous borderline tumor of the fallopian tube. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although observational studies suggest that IVF is more effective than no treatment for women with Fallopian tube patency, this has not been tested rigorously in a randomized controlled trial (RCT). METHODS: Eligible consenting couples planning their first treatment cycle in five Canadian fertility clinics received either IVF, within 90 days of randomization, or a period of 90 days with no treatment. Random allocation was stratified by female age and sperm quality, and administered using numbered, opaque, sealed envelopes. Follow‐up assessed live birth and associated morbidity. RESULTS: Sixty‐eight couples were randomized to a first cycle of IVF and 71 couples had 3 months without treatment. The live birth rates were 20/68 (29%) and 1/71 (1%), respectively. The single delivery in the untreated group was of twins, as were six of the 20 IVF deliveries (30%). An average of 2.0 embryos were transferred and no triplet pregnancies resulted. The relative likelihood of delivery after allocation to IVF was 20.9‐fold higher than after allocation to no treatment [95% confidence interval (CI) 2.8–155]. The presence of abnormal sperm did not reduce this likelihood. Treating four women (95% CI 3–6) with one cycle of IVF is required to achieve a single additional birth. CONCLUSIONS: This study provides a valid and up‐to‐date comparison for policy makers and patients as they make choices around IVF, accurately measuring and confirming a major benefit from treatment. [ABSTRACT FROM AUTHOR]

Background: Studies carried out over the past 10 years have suggested that hydrosalpinges reduce the pregnancy rate in IVF. Here we report our observations of spontaneous pregnancies in patients who underwent salpingectomy (n = 18) or proximal tubal occlusion (n = 7) following diagnoses of unilateral hydrosalpinges and patent contralateral tubes.Methods: This multi-centre, retrospective study included 25 infertility patients with known unilateral hydrosalpinges with a patent contralateral Fallopian tube. Laparoscopic treatment of unilateral hydrosalpinges by either salpingectomy or tubal occlusion was performed in each patient. Rates of subsequently observed spontaneous pregnancy, and time to pregnancy, are reported.Results: The average duration of infertility in these patients was 3 years with a range of 1-10 years. Following laparoscopic surgical treatment, a total of 22 patients (88%) achieved intrauterine pregnancies, all without IVF treatment. Pregnancies occurred in an average of 5.6 months with a range of 1-21 months. There were no ectopic pregnancies in the study population.Conclusions: Selected patients with unilateral hydrosalpinges and a patent contralateral Fallopian tube may exhibit increased cycle fecundity after salpingectomy or proximal tubal occlusion of the affected tube and conceive without the need for IVF. [ABSTRACT FROM AUTHOR]

Background: Chlamydia trachomatis infections have been associated with tubal pathology. However, not all C.trachomatis-infected women actually develop tubal pathology. Recently, host genetic factors such as the interleukin-1 gene cluster have been linked to inflammatory and infectious diseases.Methods: Dutch Caucasian women were investigated for (i) the role of interleukin-1B (IL-1B) and interleukin-1 receptor antagonist (IL-1RN) gene polymorphisms in tubal pathology (group 1); and (ii) the presence of these gene polymorphisms in C.trachomatis IgG-positive women with and without tubal pathology (group 2). Group 1 consisted of women with (n = 40) or without (n = 95) tubal pathology, respectively, and group 2 of C.trachomatis IgG-positive women of whom 28 had tubal pathology at laparoscopy and 47 did not. IL-1B-511 and IL-1B+3954 gene polymorphisms were assessed by PCR-restriction fragment length polymorphism (RFLP), and the variable number of tandem repeats (VNTR) of the IL-1RN gene were assessed by a PCR-based assay.Results: Neither IL-1B-511, IL-1B+3954 nor IL-1RN genotypes, allele or carrier frequencies showed significant association with tubal pathology or C.trachomatis post-infection-based tubal pathology.Conclusions: The data obtained suggest that specific IL-1 gene polymorphisms are not associated with the tubal pathology risk or to the development of C.trachomatis-based post-infectious severe sequelae. [ABSTRACT FROM AUTHOR]

Background: The adverse effects of hydrosalpinx on the outcomes of IVF have been well documented, but the mechanisms of hydrosalpinx fluid formation remain unclear. This study compares the mRNA expression of vascular endothelial growth factor (VEGF) and its receptors (KDR and flt-1) in the hydrosalpinx with that in the healthy oviduct.Methods: Oviduct tissue was collected from 10 infertile women with hydrosalpinx and 10 parous women with healthy oviduct. The mRNA expression of VEGF and its receptors in isolated oviduct epithelial cells were analysed using semi-quantitative reverse-transcriptase PCR.Results: mRNA expression of VEGF and its receptor flt-1 in the hydrosalpinx was significantly higher than that in the healthy oviduct, but no significant difference was demonstrated for the KDR receptor.Conclusions: This study supports the notion that VEGF may play an important role in the hydrosalpinx fluid formation, possibly by promoting vascular and epithelial permeability and therefore serum transudation. [ABSTRACT FROM AUTHOR]

Reports on tubal subfertility. Causes of tubal damage which include Chlamydia trachomatis, gonorrhoea, gential tuberculosis, post pregnancy sepsis and intrauterine contraceptive devices, endometriosis, complications after surgery and sterilisation; Safe sex on the top of the list of preventions; Diagnosis through infection screening, sonography, x ray and laparoscopy; Management options including transcervical tubal cannulation, surgery and in vitro fertilisation.

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 assess retrospectively if there is a trend of change in the epidemiology of tubo-ovarian abscess (TOA) and to define the epidemiologic, clinical and laboratory risk factors associated with failed response to conservative antibiotic therapy.Study Design: The charts of 60 patients, admitted with clinically and sonographically diagnosed TOA between January 1995 and December 2000, were reviewed. On admission, all patients were treated with broad-spectrum antibiotics, and were divided into two groups according to the response to medical treatment. Forty-three patients, responding to antibiotic therapy, constituted group A, whereas 17 patients who did not respond and were further treated by sonographically guided drainage or surgery, were included in group B. The groups were compared with respect to patient characteristics, clinical and sonographic presentation, laboratory findings, duration of hospital stay and recovery rate of different pathogens from the endocervix.Results: The mean age of patients responding to medical therapy (group A) was significantly lower (39.6 +/- 8.3) than the age of patients who did not respond (group B) (45.3 +/- 6.6) (p = 0.02). The gravidity as well as the percentage of menopausal women were significantly increased in group B (p = 0.03 and p = 0.02, respectively). There was a significantly lower incidence of previous pelvic surgery and past history of PID in group B versus group A (p = 0.02 and p = 0.03, respectively), yet the duration of IUD use was significantly prolonged in group B (p = 0.02). The size of TOA, evaluated clinically and sonographically, was significantly increased in group B compared with group A (p = 0.04 and p = 0.009, respectively). Pelvic peritonitis was observed in 40% of group B patients and in none of group A patients (p = 0.0001). The only laboratory finding differentiating between the two groups was the mean sedimentation rate, being significantly higher in group B than in group A (p = 0.0005). The time interval from admission to afebrile condition as well as the duration of hospitalization were significantly shorter in group A (6.1 +/- 2.3 days) than in group B (10.7 +/- 4.7 days) (p = 0.00003). The incidence of positive culture from the endocervix was significantly higher in group B than in group A (p = 0.007). One hundred percent of patients in group B versus 65.2% of patients in group A were treated with triple agent therapy (p = 0.007).Conclusion: The results of the current study strengthen our previous assumption that there is probably a new trend in the epidemiology of TOA, occurring in older women, who do not present the traditional risk factors for pelvic inflammatory disease and TOA. [ABSTRACT FROM AUTHOR]

: ObjectiveTo understand immunogenetic mechanisms of Chlamydia trachomatis infection and tubal scarring.: MethodsWe measured and compared previously significant human leukocyte antigen (HLA) class II DQ alleles, their linked DRB genes, and polymorphisms in selected cytokine genes (tumor necrosis factor α-308 promoter; transforming growth factor β1-10 and -25 codons; interleukin 10-1082, -819, and -592 promoters; interleukin 6-174 promoter; and interferon γ+874 codon 1) among Kenyan women with confirmed tubal infertility with and without C trachomatis microimmunofluorescence antibody.: ResultsTwo class II alleles, HLA-DR1*1503 and DRB5*0101, were detected less commonly in C trachomatis microimmunofluorescence seropositive women than in C trachomatis microimmunofluorescence seronegative women with infertility (0% versus 20%; odds ratio [OR] 0.05; 95% confidence interval [CI] 0, 0.7, and 6% versus 26%; OR 0.2; 95% CI 0.02, 1.0, respectively). These alleles are commonly linked as a haplotype at the DRB locus. This finding could not be explained through linkage disequilibrium with the other studied HLA or cytokine genes.: ConclusionThese alleles may lead to an immunologically mediated mechanism of protection against C trachomatis infection and associated tubal damage, or alternatively increase risk for tubal scarring due to another cause. [Copyright &y& Elsevier]

Background: Heterotopic pregnancy is a potentially fatal condition, rarely occurring in natural conception cycles.Case: We report such a case in a 28-year old para 0, gravida 1 woman with no known risk factors. The ectopic pregnancy was diagnosed after rupturing at 11 weeks, 4 weeks after diagnosis of the intrauterine pregnancy, and resected via laparotomy. A healthy baby was delivered without complications at 40 weeks gestation.Conclusion: Heterotopic pregnancy is possible with natural conception and the survival of the intrauterine fetus is feasible. [ABSTRACT FROM AUTHOR]

: ObjectiveTo evaluate the usefulness and prognostic value of transvaginal hydrolaparoscopy (THL) in infertile women.: DesignRetrospective study.: SettingJichi Medical School Hospital, Tochigi, Japan.: Patient(s)Thirty-six patients who were followed up for 6 months or longer after THL was performed.: Intervention(s)Transvaginal hydrolaparoscopy findings in comparison with hysterosalpingography (HSG).: Main outcome measure(s)Transvaginal hydrolaparoscopy findings, HSG findings, treatment strategy, and prognosis.: Result(s)Twenty of 36 patients (55.5%) became pregnant, including 7 by coitus, 7 by artificial insemination with the husband’s semen, and 6 by assisted reproductive technology (ART). In 11 of these pregnant patients, information obtained during THL differed from findings on HSG.: Conclusion(s)Transvaginal hydrolaparoscopy is useful in selecting a future treatment strategy. [Copyright &y& Elsevier]