Tubal factor

3. El Deeb.W , Hazem. A , Bayoumi.D ,
Darwish.Y , Abushaeer. M , Amin. A

5.  Tubal disease is the most common
causes of infertility and is the
primary diagnosis in
approximately 25% of female
infertility cases .

6.  The fallopian tubes are very
delicate structures that are
responsible for picking up the
egg and providing the site for
fertilization of the egg as well as
early embryo development and
transport to the uterine cavity.

8.  Peristalsis
 Ciliary dysfunction
 Narrowing
 Blockage

9.  The cells lining the tube produce
secretions that nourish the egg and
embryo.
 The tubes may be damaged by
infections or other pelvic
conditions.
 A prior history of pelvic
inflammatory disease (PID), tubal
surgery, ectopic pregnancy,
ruptured appendix, ovarian surgery
or septic abortion strongly suggests
the possibility of tubal disease.

10.  PID is clearly the major cause of
tubal factor infertility,
 Infections are most often caused by
Chlamydia.
 Tubal factor infertility is due to any
anatomic abnormality that
prevents the union of sperm and
egg.

11.  In addition to PID, causes of proximal tubal disease
include intratubal debris, congenital malformations,
endometriosis, and salpingitis is thmica nodosa (SIN).
 With SIN, diverticulae of the intramural or proximal
isthmic endosalpinx enlarge and eventually obliterate the
tubal lumen . SIN is bilateral in most affected patients and
is associated with both infertility and ectopic pregnancy.
 Tubal polyps, found in approximately 11% of
hysterectomy specimens , also can cause transient
proximal tubal blockage.
 Similarly, endometriosis may affect the intramural
portion of the tube, and is present at this site in 7–14% of
patients with tubal factor infertility.

12.  Distal tubal disease is also caused by a
multitude of factors, including
salpingitis adhesions from previous
surgery, and endometriosis.
 Distal tubal disease can range from mild
(fimbrial adhesions) to severe
(complete occlusion).
 It represents approximately 85% of all
cases of tubal infertility.

13.  If blockage occurs only at the distal
end, then the secretions of the
fallopian tube will not be able to
drain out of the end of the tube.
 The resulting accumulation of fluid
in the tube (hydrosalpinx) has a
very negative affect on fertility,
even when couples utilize in vitro
fertilization ( IVF) for treatment.

14.  Spontaneous intrauterine pregnancy
following salpingectomy for a
unilateral hydrosalpinx: Case report
 M.A. Aboulghar1, R.T. Mansour and
G.I. Serour
 The Egyptian IVF–Embryo Transfer
Center, Maadi, Cairo, Egypt
 Received July 24, 2001.
 Accepted November 12, 2001.

15.  Shelton et al. observed the
effects of salpingectomy in
patients with hydrosalpinx who
had failed IVF and
demonstrated a significant
improvement in pregnancy rate
after unilateral or bilateral
salpingectomy for hydrosalpinx
(Shelton et al., 1996).

16.  In a case report, Kiefer and Check
reported that a patient failed to
conceive in 12 cycles of IVF,
including seven with donor oocytes
or embryos (Kiefer and Check,
2001). Following unilateral
salpingectomy for hydrosalpinx,
their patient conceived in three of
four trials after unilateral
salpingectomy.

17.  The main focus is on embryotoxic
properties of the hydrosalpinx fluid,
which include micro-organisms,
endotoxins, cytokines, oxidative stress
and lack of nutrients. The endometrial
receptivity may be reduced as an effect of
disturbed expression of the cytokine
cascade, which is essential for
implantation. The presence of excessive
fluid in the uterine cavity may also be a
mechanical hindrance to implantation.
We believe that the hydrosalpinx fluid is
of crucial importance, but the actual
mechanism of action needs to be
clarified.

18.  Hydrosalpinx and infertility: what
about conservative surgical
management?
Chanelles O, Ducarme G, Sifer C, Hugues
JN, Touboul C, Poncelet C.
Reference :
Department of Obstetrics and
Gynecology, Jean Verdier Hospital, AP-HP,
avenue du 14 Juillet, 2011, Bondy 93143,
University Paris XIII, Bobigny, France.

20.  Conclusion :
Hydrosalpinx management can
be conservative with a tubal
conservative of 43.5% and fair
chances for spontaneous
conception

21. * The existence of a hydrosalpinx
can decrease the success of IVF
treatments by 50%.
* A study at Yale University
compared the results of thousands
of IVF cycles, and found that
implantation decreased by 50% in
women with a hydrosalpinx, and
miscarriages were doubled.

22. 1. The overall pregnancy rate was shown to decrease in
the women with the hydrosalpinx. The women with no
blockage had a pregnancy rate of 31.2% compared to
the women with the hydrosalpinx at 19.67%.
2. The implantation rate, which looks at how many
transferred embryos were able to implant in the uterine
wall, also decreased in the women with a hydrosalpinx.
It went from 13.68% in women with out a hydrosalpinx
to 8.53% in women with one.
3. The delivery rate decreased drastically as well.
Almost twice as many women delivered without a
hydrosalpinx (23.4%) than with a hydrosalpinx
(13.4%).
4. The delivery rate was lower in part because less
women became pregnant but also because more of the
women miscarried. Early loss in pregnancy was seen
more often in the women affected than not. The rate for
affected women was 43.65% loss compared to 31.11%
of non affected women.

23.  The diagnostic evaluation of tubal
patency in infertile women can be
accomplished by performing
laparoscopy, a hysterosalpingogram
(HSG), or a saline sonohystogram.
 Each procedure has advantages and
disadvantages.

24.  HSG utilizes iodinated contrast media and
fluoroscopy in order to image the uterine cavity
and assess the internal architecture of the
fallopian tubes.
 It is much less costly than laparoscopy, but may
be quite uncomfortable for many women.
 Injection of the contrast media may cause tubal
spasm in the corneal region that may be
misinterpreted as proximal tubal occlusion.
 In fact when an HSG reveals proximal
obstruction there is a good probability (greater
than 50%) that the tube is in fact open & based
on laparoscopic follow-up..

26.  SIS is similar to a HSG, but uses
ultrasound and sterile saline.
 It is simple to perform in the office and
is associated with only mild cramping.
 Mixing a small amount of air with the
saline improves the visualization of the
fallopian tubes.
 SIS is more sensitive than HSG for
detection of intrauterine pathology,
such as polyps or submucous fibroids.

27. We did this study in 1997
Medicated transvaginal hysterosonography
an easy procedure for precious demand.
Eldeeb M.W. Elsahwy S, IFC, Lauran
,Alexandria.

28.  Retrospective randomized study of
88 infertile females.
Patients were classified according to
the degree of uterine cavity
evacuation(UCE) into three main
groups ; Group A (GA) :Smooth
irrigation and no delay of UCE. Group
B (GB) : Smooth irrigation with
partial delay and slow evacuation.
Group C (GC): Painful irrigation and
delayed UCE

29.  Out of 88 patients we had 23
pregnancies (26.1%),4 cases
GA(17.4%), 19 pregnant in GB
(82.6%) and no pregnant cases
in GC

38.  Depending on the type and degree of tubal
dysfunction, various approaches are available.
 The treatment of choice is also determined by
other factors such as the age and the ovarian
reserve of the patient, presence or absence of a
male factor, and socioeconomic considerations.
 In addition to less invasive techniques such as
transcervical tubal cannulation and selective
salpingography, and various surgical approaches,
in-vitro fertilization and embryo transfer (IVF-
ET) is a viable alternative for all types of tubal
dysfunction.

39. It can be treated hysteroscopically,
radiographically, or by
microsurgical reanastomosis. A
meta-analysis documented an
intrauterine pregnancy rate of 50%
in women undergoing surgery for
proximal tubal blockages, with the
highest success rates achieved with
selective salpingography and
transcervical cannulation.

40. Laparoscopy
It is the most comprehensive
evaluation of tubal factors such as
tubal patency as well as peri tubal
adhesions and endometriosis.

47. A/Prof R Gyaneshwar 47

48. A/Prof R Gyaneshwar

49. Advanced Fertility Center of Chicago
Gurnee, IL Crystal Lake, IL

50. A/Prof R Gyaneshwar 50

53. 28 yr prevI cs 2ndr infertility left hydatid cyst,right tubo ovarian adhesions-final.avi