Are the Stage and the Incidental Finding of Endometriosis Associated with Fallopian Tube Occlusion? A Retrospective Cohort Study on Laparoscopic Chromopertubation in Infertile Women

Abstract

Endometriosis seems to have a strong negative effect on female fertility. The aim of this study was to assess the rate of tubal occlusion diagnosed via laparoscopic chromopertubation in infertile women with endometriosis and compare the results to infertile women without endometriosis. In this retrospective cohort study, 275 infertile women with endometriosis and 49 infertile women without endometriosis undergoing diagnostic laparoscopy for primary or secondary infertility with chromopertubation at the Medical University of Vienna between January 2012 and December 2020 have been investigated. During the laparoscopic assessment of tubal patency, significantly more fallopian tubes were occluded in the endometriosis group compared to the control group (25.8 versus 15.3%; p = 0.029). Unilateral and bilateral occlusion was found significantly more often in patients with endometriosis (p = 0.021). In the multivariate analysis, only the rASRM stage (the revised classification of endometriosis by the American Society for Reproductive Medicine) showed a significant association with bilateral occlusion (OR 1.400, 95%CI: 1.018–1.926; p = 0.038). Both a higher rASRM stage (OR 2.181, 95%CI: 1.191–3.995; p = 0.012) and secondary infertility (OR 1.514, 95%CI: 1.156–1.983; p = 0.003) were associated with an increased risk for any kind of fallopian tube occlusion. Endometriosis seems to be associated with an increased risk for fallopian tube occlusion. The rate of tubal occlusion increased significantly with the rASRM stage.

Proposal for individual treatment by tubal occlusion factor based on the results of salpingoscopic salpingoplasty

“…In endometriosis patients a higher rASRM stage has been reported to be associated with an increased risk of tubal obstruction 7 . In our cases, however, when evaluated by rASRM stage, there was no significant difference among each stage when natural pregnancy rate after FT was compared.…”

“…Endometriosis not only causes tubal obstruction, but also reduces the quality of eggs, disturbs fertilization and other infertility factors. 7 When the infertility couples with endometriosis consider the transition to ART, we suggest after our results that they may wait for 14 months and decide without considering the rASRM stage.…”

Evaluation of tubal patency based on peak injection pressure in four-dimensional hysterosalpingo-contrast sonography among infertile females: a preliminary study

“…The patent status of the fallopian tubes was determined by the exit of methylene blue from the fallopian fimbria. An obstructed fallopian tube generally exhibits significant resistance during injection, with reflux to the cervix or vagina, and an absence of methylene blue overflow from the fallopian fimbria ( 25 , 26 ). To ensure the independence between 4D-HyCoSy and LC procedures, the examiners of both examinations were blinded to the results of the other examination.…”

Higher miscarriage rate in subfertile women with endometriosis receiving unbiopsied frozen-warmed single blastocyst transfers

“…Women with a surgically confirmed diagnosis of endometriosis and subfertility were included in the case group. We chose women with idiopathic infertility to avoid any known pathology associated with local inflammation as eventually present in tubal factor infertility (Karande et al, 1995;Qi et al, 2019;Hill et al, 2020;Mayrhofer et al, 2022) or any endocrinological disease such as PCOS (polycystic ovary syndrome), which might have an impact on oocyte quality. As fertilization rates, which are also related to sperm quality and fertilization method (Opøien et al, 2012) were equal in women with endometriosis and controls we left these women in our analysis (Table 2).…”