P-737 Congenital tubal anomalies: exploring its relationship with tubal factor infertility: observational-descriptive study
Authors: Pabuccu E , Israfilova G , Deniz D  H , Valadova A , Pabuccu R 
Published: July 2024

Abstract

Study question
Is there any relation between congenital Fallopian tube anomalies and tubal factor infertility in subset of infertile women?

Summary answer
Nearly 15% of women who underwent diagnostic laparoscopy revealed congential tubal anomaly (15%), including total or partial agenesis of tubes.

What is known already
The fallopian tubes play a crucial role in the reproductive process. These structures are 10-12 cm in length, consists of four parts from proximal to distal side: intramural, isthmic, ampullary and fimbrial [1]. Any abnormalities in their development or structure can severely affect fertility. Fallopian tube agenesis, whether partial or complete, constitutes one such anomaly. While there have been numerous advances in the understanding and management of fallopian tube disorders, partial or complete fallopian tube agenesis remains an enigmatic entity with unknown prevalance in the general population.

Study design, size, duration
Observational study was conducted between 2020 and 2023. All couples with primary infertility were evaluated in an outpatient clinic using basic hormone analysis, semen analysis, sonography and hysterosalpingogram as a standard of care. All women with suspected tubal pathology were offered to have diagnostic laparoscopy (LS) in order to confirm the anomaly. When tubal and/or Mullerian anomalies were detected, urinary system was examined by intravenous pyelography. Other suspected pathologies were examined by abdominopelvic CT x-ray.

Participants/materials, setting, methods
All women with suspected tubal pathology were offered to have diagnostic laparoscopy in order to confirm the anomaly. Surgeries was performed by two experienced surgeons, after having informed consent. When tubal and/or Mullerian anomalies were detected, urinary system was examined by intravenous pyelography. Other suspected pathologies were examined by abdominopelvic CT x-ray imaging. All anomalies have been reported in an electronic database.

Main results and the role of chance
A total of 4230 infertile couples were admitted to clinics. Mean age of women in the study population is 30±2.3 years. Overall duration of infertility is 1.2±0.6 years. Among them, 895 women were diagnosed to have suspected tubal pathology after HSG examination (21%). Diagnostic LS was performed to 220 women. Flowchart of the patients is given in figure-1.
Among them, 113 (51,3%) women revealed tubal pathologies/anomalies and 107 (49,7%) revealed normal findings. Total of 34 women revealed congenital proximal and/or distal tubal anomaly. Half of these cases (17/34) were complete agenesis and remaning were either with proximal or mid-distal portion agenesis.
Majority of women 32/34 (94 %) with tubal pathology revealed at least 1 uterine anomaly as well. Among them, 19 (55.9 %) of these patients was confirmed to have unicornuate uterus, 6 (17.6 %) had uterus didelphys, 4 (11.8 %) had bicornuate uterus, and 3 (8.8%) had uterine septum. No uterine anomaly was observed in 2 (5.9 %) patients. Total of 16 women (14%) were diagnosed to have other system anomalies.

Limitations, reasons for caution
Lack of a control group in normal population in order to compare incidences. Secondly, our sample size is not enough to precisely conclude on exact prevalances. Third, we did not report fertility data following LS.

Wider implications of the findings
Tubal factor infertility is one of the major etiologic factor among primary infertility cases and congenital tubal anomalies were reported to be relatively higher (15%) in these younger women contrary to general expectations. Second important finding is high congenital uterine anomaly incidence in women with congenital tubal anomalies.

Trial registration number
not applicable