الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Hydrosalpinx is an adnexal pathology which can be easily recognized and confidently confirmed using transvaginal ultrasound and HSG. The most consistent sonographic feature is a tubular structure with a well-defined echogenic wall and fold configurations protruding into the watery content. The hydrosalpinx fluid has embryotoxic components and growth inhibiting factors. Another theory is the possibility of wash-out of embryos through leakage of fluid into the endometrial cavity. The hydrosalpinx fluid may also cause endometrial alterations hostile to embryo implantation and development. The hydrosapinx treatment aim is eliminating the hydrosalpingeal fluid before commencing IVF. Laparoscopic salpingectomy will be done to patients with ultrasound-visible hydrosalpinges but salpingectomy carries a potential risk of damaging the vascular and nervous supply to the ovary resulting in fewer oocytes being retrieved from the side of operation during IVF cycle in comparison with the side with intact adnexa. The present prospective clinical trial has investigated the success rate of hysteroscopic tubal electrocoagulation for the treatment of hydrosalpinx related infertility among patients with laparoscopic contraindications undergoing IVF. A total of 80 infertile women with documented hydrosalpinx and who will be subjected to IVF procedure were divided into 2 groups; 1st group included (40) patients whom were submitted to hysteroscopic electrocoagulation of the uterine ostium of the tube. 2nd group included (40) patients whom were submitted to laparoscopic disconnection of the tube. The presence of proximal tubal occlusion on post-procedure HSG after 2 menstrual cycles was used as the main outcome measure; IVF outcome was not considered because it can be affected by many other prognostic factors. In hysteroscopic procedure , we use 5F hysteroscopy introduce through the cervix without any dilatation just use 2 tablet misoprostol 200mg before operation by 3 hours to soften the cervix . We use hysteroscopy with bipolar electrode in its channel in first entrance to shorten the time of operation and decrease time of anesthesia. The distended media was saline 0, 9% not glycine as good conducted media for bipolar electrode and also less complication as glycine. Hysteroscopic fulguration of internal orifice of fallopian tubes at a hysteroscopic bipolar coagulation power of 40w within duration of 20s was used, which leads to degeneration of internal orifice tissue of diseased tube by electric heat energy to form tissue scar so as to prevent hydrosalpinx fluid reflux to uterine cavity, helping embryo’s development and implantation. Hysteroscopic tubal electrocoagulation was found to be a successful treatment for hydrosalpinx before IVF when laparoscopy is contraindicated, e.g., in women who are obese, have severe cardiopulmonary dysfunctions or diaphragmatic hernia, or have previously undergone abdominal/pelvic surgery. Hysteroscopic tubal occlusion is an option when severe adhesions make salpingectomy technically difficult and there is a risk of damaging the ovary. The dilated tube can be left in place after occlusion of the proximal part. Hysteroscopic approach to tubal occlusion offers a non-incisional alternative to laparoscopic surgery that eliminates the need for general anesthesia and that can be readily adapted to an outpatient or office setting. Benefits of this less invasive approach include reduced post procedure pain, allowing a patient to resume normal activities more quickly. Conclusion. The evaluation of two procedures, laparoscopic tubal occlusion versus bipolar hysteroscopic tubal occlusion in-patient with hydrosalpinx found that both laparoscopy and hysteroscopy are effective methods for tubal occlusion in case of hydrosalpinx; however the hysteroscopy has the advantages of being less invasive approach , non-incisional alternative to laparoscopy when laparoscopic surgery contraindicated, also eliminates the need for general anesthesia , less operative time , less post procedure pain and more quickly resume normal activities.