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Tubal ostium membranes and their relation to infertility
D Coeman1, Y Van Belle, G Vanderick
1Department of Obstetrics and Gynecology, Algemene Kliniek Sint--Jan, Brussels, Belgium.
Objective:
To define the clinical significance of tubal ostium membranes.
Design:
Retrospective multivariate stepwise logistic regression analysis.
Setting:
Algemene Kliniek Sint--Jan, Brussels, Belgium.
Patients:
Three thousand forty-six hysteroscopies on 2979 patients, including 172 with infertility, over a 9-year period.
Main Outcome Measures:
Presence of tubal ostium membranes, age, infertility, endometrial thickness, and hormonal environment.
Results:
Tubal ostial membranes were present in 74 (2.5%) patients: they were unilateral in 30 (42.1%) and bilateral in 44 (57.9%). Their presence was independent from hormonal state and from endometrial thickness. The incidence of ostial membranes was significantly higher (9.9%) in patients referred for infertility for unilateral (3.5%) as well as for bilateral presence (6.4%). Only the bilateral form was age dependent.
Conclusions:
Tubal ostium membranes may be one of the unknown limiting factors affecting female fertility and thus reducing the monthly fecundity rate. The present data suggest that bilateral and unilateral tubal ostium membranes may have a different clinical significance. The unilateral form is unrelated to age, hormonal state, or endometrial thickness and can be congenital. This form is most clearly related to infertility. The bilateral form is less related to infertility, is found in women of older age, and can be acquired. Further prospective analysis is needed to clarify the pathogenesis and pathophysiology of tubal ostium membranes. Tubal ostium membranes should routinely be looked for when performing a hysteroscopic examination in infertile women.