versus 17.6% in untreated controls [16]. However, the potential spread of the hydrosalpinx fuid in the pelvis/abdomen after aspiration may increase risks of postoperative infection after oocyte retrieval. Therefore careful considerations need to exercised before this option is recommended.

Back to our patient, initial HSG (proximal tubal obstruction did not allow dye to enter and distend the tubes) and ultrasound examination did not readily demonstrate presence of hydrosalpinges. Detecting fuid in the uterine cavity during a mid-cycle ultrasound examination while she was monitored for a FET raised the suspicion of back fow of hydrosalpinx fuids. Indeed subsequent removal of the tubes appeared to improve the uterine environment and optimize implantation leading to a successful pregnancy outcome.

References

1.\Practice Committee of the American Society for Reproductive Medicine. Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertil Steril. 2021;115(5):1143–50.

2.\Thurmond AS, Machan LS, Maubon AJ, Rouanet JP, Hovsepian DM, Moore A, et al. A review of selective salpinography and fallopian tube catheterization. Radiographics. 2000;20(6):1759–68.

3.\Honore GM, Holden AE, Schenken RS. Pathophysiology and management of proximal tubal blockage. Fertil Steril. 1995;71(5):785–95.

4.\Farhi J, Ben-Haroush A, Lande Y, Fisch B. Role of treatment with ovarian stimulation and intrauterine insemination in women with unilateral tubal occlusion diagnosed with hysterosalpingography. Fertil Steril. 2007;88(2):396–400.

5.\American Fertility Society. The American Fertility Society classi cations of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fetil Steril. 1988;49(6):944–55.

6.\Practice Committee of the American Society for Reproductive Medicine. Salpingectomy for hydrosalpinx prior to in vitro fertilization. Fertil Steril. 2008;90(5 Suppl):S66–8.

7.\Camus E, Poncelet C, Gof net F, Wainer B, Meriet F, Nisand I, et al. Pregnancy rates after in-­vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies. Hum Reprod. 1999;14(5):1243–9.

8.\Strandell A. Treatment of hydrosalpinx in the patient undergoing assisted reproduction. Curr Opin Obstet Gynecol. 2007;19(4):360–5.

9.\Chan CC, Ng EH, Li CF, Ho PC. Impaired ovarian blood fow and reduced antral follicle count following laparoscopic salpingectomy for ectopic pregnancy. Hum Reprod. 2003;18(10):2175–80.

10.\Dar P, Sachs GS, Strassburger D, Bukovsky I, Arieli S. Ovarian function before and after salpingectomy in arti cial reproductive technology patients. Hum Reprod. 2000;15(1):142–4.

11.\Stadtmauer LA, Riehl RM, Toma SK, Talbert LM. Cauterization of hydrosalpinges before in vitro fertilization is an effective surgical treatment associated with improved pregnancy rates. Am J Obstet Gynecol. 2000;183(2):367–71.

12.\Nakagawa K, Ohgi S, Nakashima A, Horikawa T, Irahara M, Saito H. Laparoscopic proximal tubal division can preserve ovarian reserve for infertility patients with hydrosalpinges. J Obstet Gynaecol Res. 2008;34(6):1037–42.

13.\Goynumer G, Kayabasoglu F, Aydogdu S, Wetherilt L. The effect of tubal sterilization through electrocoagulation on the ovarian reserve. Contraception. 2009;80(1):90–4.

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Chapter 21

Endometrial Factor

Ashley Aluko and Joshua Stewart

Case

A 31-year-old G0 presents for a second opinion after 2 failed frozen embryo transfers. Her history was notable for polycystic ovary syndrome and irregular menses. Due to anovulatory infertility, she was initially treated with three cycles of letrozole ovulation induction and intrauterine insemination. None of these cycles resulted in a pregnancy, and the couple then pursued IVF. Her rst IVF cycle yielded six euploid blastocysts, and her three subsequent medicated frozen embryo transfer cycles failed to result in a positive serum HCG. In all of her cycles, the endometrial lining was greater than 7 mm and had a trilaminar appearance prior to transfer.

The patient, who grew increasingly frustrated during her course of treatment, was searching for a rationale behind her implantation failures. Her medical history was signi cant for Crohn’s disease, which was well-controlled with infiximab. She had undergone an exploratory laparotomy and ileocecal resection several years before and had no other previous surgeries. Her infertility evaluation had included a hysterosalpingogram, which demonstrated bilaterally normal, patent fallopian tubes and normal intrauterine contours. Her anti-Mullerian hormone level was 4.75 ng/ mL. Her partner’s semen analysis had normal parameters.

Before her consultation at our of ce, an endometrial receptivity analysis (ERA) performed during a mock medicated cycle revealed “receptive endometrium.” We performed a diagnostic hysteroscopy followed with endometrial sampling. Pathology from the endometrial sampling was negative for syndecan-1 (CD138) immunohistochemistry staining.

A. Aluko · J. Stewart (*)

Reproductive Medicine and Ob/Gyn, The Ronald Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Medical College of Cornell University, New York, NY, USA e-mail: jds9013@med.cornell.edu

P. H. Chung, Z. Rosenwaks (eds.), Problem-Focused Reproductive Endocrinology and Infertility, Contemporary Endocrinology, https://doi.org/10.1007/978-3-031-19443-6_21

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