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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.

What are conception rates and pregnancy outcomes after laparoscopic treatment of subtle distal tubal abnormalities among infertile women, and which factors relate to natural conception?Prospective cohort study (n = 234) conducted in a single fertility referral centre between January 2017 and December 2018. Subtle abnormalities included fimbrial agglutination, tubal diverticula, accessory ostium, fimbrial phimosis and accessory fallopian tube. Pregnancy outcomes were followed-up annually until 36 months.One hundred and nine patients conceived naturally (natural conception rate 46.6%), and 59 patients conceived after IVF. Term live birth rate of the natural conception group was significantly higher than the IVF conception group (86.2% versus 71.2%, chi-squared = 5.625, P = 0.018). Preterm birth (11.9% versus 0%, P = 0.001) and multiple pregnancy rates (27.1% versus 0%, P0.001) of the IVF conception group were significantly higher than the natural conception group. Patient age (hazard ratio = 0.917, 95% CI 0.870 to 0.967, P = 0.001), duration of infertility (hazard ratio = 0.846, 95% CI 0.740 to 0.966, P = 0.014) and concurrent types of subtle abnormalities (hazard ratio = 0.636, 95% CI 0.416 to 0.970, P = 0.036) were factors associated with natural conception.Laparoscopy is an effective treatment for infertile patients with subtle abnormalities, especially for young patients with a short infertile period and at most two types of subtle abnormalities. For older women, a long infertile period and more than two types of subtle abnormalities, IVF may be more suitable after laparoscopic diagnosis.

Bowel endometriosis is typically associated with deep endometriotic lesions in the pelvis and endometriomas, making it difficult to establish the precise impact of intestinal endometriotic lesions on fertility. Very limited data are available on rates of spontaneous conception in women with bowel endometriosis. Infertile patients with bowel endometriosis may either undergo surgery to enhance fertility or artificial reproductive techniques (ART) such as in vitro fertilization (IVF). Interpretation of the available data on fertility outcomes after colorectal surgery for deep endometriosis is difficult as the overall quality of the studies is poor. Furthermore, several studies do not distinguish patients with real infertility from those wishing to conceive without proven infertility. Patients with bowel endometriosis undergoing ART must be informed of the potential risks (e.g., bowel complications such as perforation and severe infection) during oocyte retrieval and pregnancy. Persistence of pelvic pain, intestinal symptoms due to delaying surgery as well as the progression of the degree of intestinal wall infiltration are well recorded. However, ART has some advantages in women with bowel endometriosis because it shortens the interval to conception and avoids the negative impact of postoperative complications (such as anastomotic leakage or deep pelvic abscess) on fertility. It is well established that bowel surgery leads to relief of pain and intestinal symptoms caused by endometriotic lesions. In contrast, the usefulness of bowel surgery to increase the likelihood of spontaneous conception is yet to be established.

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.

The aim of the present review is to give a comprehensive overview of fallopian subtle lesions and suggest the impacts of these abnormalities on fertility. Tubal subtle variations, including tubal diverticula, Morgagni hydatids, accessory fallopian tube, accessory ostium of the fallopian tube, tubal phimosis, agglutination, and sacculation, have been described and cited as making significant contributions to infertility. This review summarizes characteristics of these subtle abnormalities and provides an update of recent knowledge of the diagnosis and management of these variations. We hope that the present contribution may help to bring more attention to the clinical field to recognize these abnormalities and consequently aid in improving fertility.

National and international guidelines recommend referring patients with severe forms of endometriosis to expert centers. However, there is a lack of clear criteria to define an expert center. We examined the roles of surgeon and hospital procedure volumes as determinants of morbidity in deep infiltrating endometriosis of the rectum and sigmoid colon (DIERS). We conducted a French retrospective multicenter study of hospital facilities performing colorectal surgery for DIERS in 2015. The primary end point was to analyze the relation between case volume and the incidence of complications. We estimated the optimal cut-off (OCO) determined by a minimal p-value approach. The study included 56 hospital facilities and collected data of 1135 cases of surgical management of colorectal endometriosis. The mean and median number of procedures per year and per surgeon were 9.17 and 5.58, respectively. The overall rate of grade III–V complication was 7.6% (82/1135). One grade V complication occurred. The rates of rectovaginal fistula, anastomotic leakage, pelvic abscess, and ureteral fistula were: 2.7% (31/1135), 0.79% (9/1135), 3.4% (39/1135), and 0.70% (8/1135), respectively. An OCO of 20 procedures per center and per year (p

Objectives To study the feasibility and results (live-birth and complication rates) of placement of Essure ® microinserts before assisted reproductive technology (ART) treatment of women with hydrosalpinx when laparoscopy should be avoided. Study design National survey of 45 French hospital centres providing ART reporting a retrospective analysis of 43 women with unilateral or bilateral hydrosalpinges and Essure ® placement. The results of the following ART cycle were studied for 54 embryo transfers. Results The placement success rate reached 92.8% (65/70 tubes), and the mean number of visible intrauterine coils was 1.61 (range: 0–6). Pyosalpinx occurred in one case, and expulsion of the device into the uterus in two others. Of 43 women, 29 (67.4%) had a total of 54 fresh or frozen embryos transferred. The clinical pregnancy rate was 40.7% (22/54) and the live-birth rate 25.9% (14/54). The implantation rate was 29.3% (27/92). Conclusion Essure ® placement is an effective method for occlusion of hydrosalpinges before IVF. Monitoring the live-birth rate confirms that this option is the strongest in cases when laparoscopy is impossible or contraindicated.

Summary Methods A questionnaire (146 questions) devised by ASSPRO Scientifique (Association de prevention du risque operatoire – Association for the prevention of surgical risk) and covering the professional and personal indicators likely to be involved in stress was used to assess the level of satisfaction or dissatisfaction of physicians and the level of stress. The collected data were analysed using frequency distribution tables and cross tabulations. Results Of the completed questionnaires returned by 1272 physicians (21.9% of the sampled physicians), 1204 questionnaires could be used. Of the total sample, 85.5% was male, between 35 and 64 years old (92.8%); they were anaesthetists (29.6%), orthopaedists (29.4%) or obstetrician gynaecologists (12.8%) attending a single workplace (67.9%) in sector 2 (64%). More than one quarter of these physicians reported feelings of exhaustion after work and one quarter of them had a fear of the workload ahead. Overall, the mean level of happiness (on a scale from 0 to 10) was quite high (6.7) and the mean stress level (graded from 0 to 10) was 5.9 (above or equal to 8 in 29.8%). The links between the stress level and the behaviour or the frame of mind at work were especially clear and significant for the following factors (stress level on a scale from 0 to 10): fear of the workload ahead (8.3), feeling of exhaustion (7.6), inability to ‘switch off’ (7.5) or to distance oneself from the difficult times of the day (7.3), sleeping disturbances (7.3), back pain (6.9) and headaches (6.9), which factors seem to be strong indicators of an advanced state of stress.

Hysterosalpingo-contrast-sonography (HyCoSy) using saline and Echovist is a well tolerated outpatient technique that provides a significant amount of information of relevance to the infertile woman that is not obtainable at hysterosalpingogram (HSG) whilst avoiding exposure to X-ray irradiation. When performed by experienced operators, it serves as a valuable, first-line screening test for the more invasive procedures of laparoscopy and dye chromopertubation and hysteroscopy. If detailed diagnostic information is required in women in whom there is no clinical or ultrasound evidence of pelvic pathology, the surgical technique of fertiloscopy can be considered to be appropriate. This technique permits confirmation that the ovum pick-up mechanism is normal, the tubes are patent and the uterine cavity is normal, while salpingoscopy and microsalpingoscopy permit the assessment of the tubal lumen.

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.

The vascular responses of clitoral arteries to vaginal pressure stimulation in 10 volunteer women were evaluated by Doppler ultrasonography. Pressure stimulations (20-160 mm Hg) along the lower third of the vagina increased blood velocity and flow into clitoral arteries in 9 of the 10 women. The latency and duration of the Doppler responses ranged from 0.1 to 1.6 sec and from 3.2 to 9.5 sec, respectively, and the response was associated with a blood flow increase of 4 to 11 times the baseline prestimulation level. This response parallels that recorded in the cavernous arteries in men when a similar range of pressure stimulations are applied to the glans penis. Similar responses evoked in the male and female suggest a sexual synergy that may occur during intercourse in that such physiological responses and reflexes may be reciprocally reinforced.

A questionnaire (146 questions) devised by ASSPRO Scientifique (Association de prévention du risque opératoire - Association for the prevention of surgical risk) and covering the professional and personal indicators likely to be involved in stress was used to assess the level of satisfaction or dissatisfaction of physicians and the level of stress. The collected data were analysed using frequency distribution tables and cross tabulations.Of the completed questionnaires returned by 1272 physicians (21.9% of the sampled physicians), 1204 questionnaires could be used. Of the total sample, 85.5% was male, between 35 and 64 years old (92.8%); they were anaesthetists (29.6%), orthopaedists (29.4%) or obstetrician gynaecologists (12.8%) attending a single workplace (67.9%) in sector 2 (64%). More than one quarter of these physicians reported feelings of exhaustion after work and one quarter of them had a fear of the workload ahead. Overall, the mean level of happiness (on a scale from 0 to 10) was quite high (6.7) and the mean stress level (graded from 0 to 10) was 5.9 (above or equal to 8 in 29.8%). The links between the stress level and the behaviour or the frame of mind at work were especially clear and significant for the following factors (stress level on a scale from 0 to 10): fear of the workload ahead (8.3), feeling of exhaustion (7.6), inability to 'switch off' (7.5) or to distance oneself from the difficult times of the day (7.3), sleeping disturbances (7.3), back pain (6.9) and headaches (6.9), which factors seem to be strong indicators of an advanced state of stress.

Although main obstacles for entry routes (transgastric, transvesical, and transrectal) in natural orifices transluminal endoscopic surgery are closure of the incision and infection issues, the transvaginal route seems to be the most used. There is no doubt that classic colpotomy is a valid option. Nevertheless, this approach can be difficult and time consuming. From our experience with fertiloscopy via vaginal access and using an existing disposable trocar, we describe a new safe and simple technique for transvaginal natural orifices transluminal endoscopic surgery.

Study Objective To evaluate fertiloscopy ovarian drilling with bipolar energy in women with clomiphene citrate-resistant polycystic ovary syndrome (PCOS). Design Prospective study (Canadian Task Force classification II). Setting University teaching hospital and private clinic. Patients Eighty women with clomiphene citrate-resistant PCOS. Intervention Operative transvaginal fertiloscopy with a coaxial bipolar electrode. Measurements and Main Results During a mean follow-up of 18.1 months (± 6.4), 73 women (91%) recovered regular and ovulatory cycles. The cumulative pregnancy rate was 60% (44/73) for spontaneous and stimulated cycles, with 39.7% (29/73) imputed to drilling alone. The mean time to conceive was 3.9 months (range 1–11.8). There were eight miscarriages (18%), and no ectopic pregnancies or multiple pregnancy. No complications occurred. Conclusion Ovarian drilling by transvaginal fertiloscopy with bipolar electrosurgery appears to be an effective minimally invasive procedure in patients with PCOS resistant to clomiphene citrate.