Tubal Infertility and Chlamydia Trachomatis in a Congolese Infertile Population

Infertility of tubal origin is the most frequent in sub-Saharan area. It is due to tuboperitoneal lesions mainly because of infection;especially sexually transmitted infection. Worldwide, Chlamydia trachomatis is the main pathogen. In our setting, some studies failed to establish the link between tubal infertility and chlamydia trachomatis. The current study aimed to determine the local data related to chlamydia trachomatis role in tubal infertility and the usefulness of Chlamydia trachomatis antibody titer test (CAT) in discrimination of the patients with and without tuboperitoneal lesions. Patients’ average age was 33.9 ± 4.8 years, average coitarche 19.4 ± 4.4 years and average number of partners: 3.1 ± 1.6. The level of CAT is correlated to the tuboperitoneal severity. CAT was more specific (93.3%;CI 95%: 81.7 - 98.6) than sensitive (72.7% CI 95%: 49.8 - 89.3) and discriminated correctly 89% (AUC = 0.89) of the patients with or without tuboperitoneal lesions. In conclusion, as it is stated worldwide, Chlamydia trachomatis is the most frequent sexually transmitted pathogen associated with tubal infertility. CAT has to be used as a tool to select patients to be submitted to invasive investigation, like laparoscopy.

Induced Abortion and the Risk of Tubal Infertility

Objective To explore the association between induced abortion and tubal infertility in Chengdu, China.Methods A 1 ： 2 case-control study was designed. Infertile women with bilateral tubal occlusion in the case group compared with two control groups： infertile control group with bilateral tubal patency and pregnant control group with currently pregnancy. Data were collected using questionnaires through face-to-face interviews, covering the subjects＇ demographic details and histories of gynecology and obstetrics. Adjusted odds ratio was calculated as a measure of the association using stepwise multiple logistic regression analysis.Results Induced abortion was not found to be associated with tubal infertility in the analysis including either the infertile controls or the pregnant controls, but other risk factors were found, such as history of acute pelvic inflammatory disease （PID）, lower abdominal surgeries, dysmenorrhea and pregnancy.Conclusion It is contended that facing an increasing trend of infertile cases with tubal occlusion in China, it is emphasized that special attention should paid to the long term impact of reproductive tract infection, especially, asymptomatic ones, rather than induced abortion.

Treatment of Infertile Women with Unilateral Tubal Occlusion Diagnosed by Hysterosalpingography:The Role of Intrauterine Insemination

Summary:The optimal assisted reproductive treatment strategy for infertile women with unilateral tubal obstruction remains uncertain.To investigate the role of intrauterine insemination(IUI)in the treatment of infertile women with unilateral tubal occlusion,the data of 148 couples were retrospectively collected and analyzed.Seventy-eight infertile women with unilateral occlusion diagnosed by hysterosalpingography(HSG)were categorized as the study group and 70 others with unexplained infertility as the control group.The study group was divided into a proximal occlusion subgroup and a mid-distal occlusion subgroup for further analysis.The main outcomes,namely the clinical pregnancy rate(CPR),ongoing pregnancy rate(OPR),and live birth rate(LBR)per cycle,were analyzed.Our results showed a tendency of lower CPR,OPR,and LBR in the study group than in the control group,without statistical significance.Further investigations revealed that the unilateral proximal occlusion subgroup had similar CPR,OPR,and LBR as the control group,while the unilateral mid-distal occlusion subgroup had significantly lower CPR(5.1%vs.20.0%,P=0.035),OPR(5.1%vs.20.0%,P=0.035),and LBR(5.1%vs.20.0%,P=0.035)than the control group.In conclusion,the clinical outcomes of IUI were worse in patients with unilateral tubal occlusion than in those with unexplained infertility.This might be primarily caused by the worse outcome of patients with unilateral mid-distal tubal occlusion instead of proximal occlusion.

Different traditional Chinese medicine treatments on Tubal obstructive infertility

Objective To observe the clinical efficacy of prescription of Chinese medical retention enema, Chinese herbal decoction and acupncture at acupoints of thoroughfare vessel and conception vessel in treating tubal obstructive infertility. Methods One hundred and five patients with tubal obstructive infertility were randomly divided into 3 groups according to random number table （A, B and C） with 35 cases in each group）. The patients in group A were treated by retention enema with concentrated decoction of Taoren （核仁 Semen Persicae）, HGnghua （红花 Flos Carthami）, Lizhi He （荔枝核 Semen Litchi）, Juhe （橘核 Semen Citri Reticulatae） and other Chinese medicine; the patients in group B were given Chinese herbal decoction of Hongteng （红藤 Caulis Sargentodoxae）, BbijiGngcao （败酱草 Herba Patriniae）, Chishao （赤芍 Radix Paeoniae Rubra）, Xibkucao （夏枯草 Spica Prunellae） 20 g, Zbojiaoci （皂角刺 Spina Gleditsiae） and so on orally; the patients in group C were given acupuncture treatment by needling in ZhGngji （中极 CV 3）, Guanyuan （关元 CV 4）, O.ihai （气海 CV 6） and other acupoints with uniform reinforcing- reducing method and then combined with moxibustion for 15 min. The therapeutic effect of three groups was recorded after treatment of three menstrual cycles. Results The total effective rate of group A was 45.71%; the total effective rate of group B was 77.14%; the total effective rate of group B was 85.71%. The difference in statistics of group A and group B, Group A and group C had obvious statistical significance （both P〈0.05） but statistics of group B and group C had no statistical significance （P〉0.05）. Conclusion Different kinds of traditional Chinese medicine treatments all have an effect in treating tubal obstructive infertility, Chinese herbal decoction and acupncture in thoroughfare vessel and conception vessel have better effects than retention enema.

Bilateral hydrosalpinges,what to do:Salpingectomy or salpingoplasty?Result of a 480 cases continuous series

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.

In vitro fertilization-embryo transfer in patients with unexplained recurrent pregnancy loss

Background:Empiric therapy for patients with unexplained recurrent pregnancy loss(URPL)is not precise.Some patients will ask for assisted reproductive technology due to secondary infertility or advanced maternal age.The clinical outcomes of URPL patients who have undergonein vitro fertilization-embryo transfer(IVF-ET)require elucidation.The IVF outcome and influencing factors of URPL patients need further study.Methods:A retrospective cohort study was designed,and 312 infertile patients with URPL who had been treated during January 2012 to December 2015 in the Reproduction Center of Peking University Third Hospital were included.By comparing clinical outcomes between these patients and those with tubal factor infertility(TFI),the factors affecting the clinical outcomes of URPL patients were analyzed.Results:The clinical pregnancy rate(35.18%vs.34.52%in fresh ET cycles,P=0.877;34.48%vs.40.27%in frozen-thawed ET cycles,P=0.283)and live birth rate(LBR)in fresh ET cycles(27.67%vs.26.59%,P=0.785)were not significantly different between URPL group and TFI group.URPL group had lower LBR in frozen-thawed ET cycles than that of TFI group(23.56%vs.33.56%,P=0.047),but the cumulative LBRs(34.69%vs.38.26%,P=0.368)were not significantly different between the two groups.The increased endometrial thickness(EMT)on the human chorionic gonadotropin day(odds ratio[OR]:0.848,95%confidence interval[CI]:0.748-0.962,P=0.010)and the increased number of eggs retrieved(OR:0.928,95%CI:0.887-0.970,P=0.001)were protective factors for clinical pregnancy in stimulated cycles.The increased number of eggs retrieved(OR:0.875,95%CI:0.846-0.906,P<0.001),the increased two-pronucleus rate(OR:0.151,95%CI:0.052-0.437,P<0.001),and increased EMT(OR:0.876,95%CI:0.770-0.997,P=0.045)in ET day were protective factors for the cumulative live birth outcome.Conclusion:After matching ages,no significant differences in clinical outcomes were found between the patients with URPL and the patients with TFI.A thicker endometrium and more retrieved oocytes increase the probability of pregnancy in fresh transfer cycles,but a better normal fertilization potential will increase the possibility of a live birth.