{"paper_id":"55134fb5-f1d1-4ace-b027-e1e252fd0b79","body_text":"Abstract\nThis matched comparative study investigates whether unoperated ovarian endometriomas (OMAs) influence the prevalence of tubal pathology as detected by hysterosalpingography (HSG) in infertile women. A total of 266 infertile women with unilateral or bilateral OMAs ≥ 2 cm and 539 matched controls without endometriomas were included between January 2021 and October 2024. Diagnosis of OMAs was confirmed by transvaginal ultrasonography and, if necessary, MRI, and all participants underwent standardized HSG assessment. Tubal pathologies were classified into nine distinct categories. The OMA group showed significantly higher rates of tubal abnormalities (31.6% vs. 10.8%, p < 0.001), with unilateral hydrosalpinx and phimosis being notably more common. Logistic regression identified age and OMA presence as independent predictors, and ROC analysis suggested a cutoff of 4.5 cm for increased risk. These findings indicate that unoperated OMAs, especially when ≥ 4.5 cm, are associated with a markedly increased risk of tubal pathology. Early tubal assessment may be beneficial for individualized fertility planning in this population.\nSimilar content being viewed by others\nData Availability\nThe data underlying the findings of this study will be shared on reasonable request to the corresponding author.\nReferences\nGiudice LC. Clinical practice. Endometriosis. N Engl J Med 2010;362:2389–2398.\nBurney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98:511–9.\nChapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis, and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666–82. https://doi.org/10.1038/s41574-019-0245-z.\nGarcía-Velasco JA, Somigliana E. Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod. 2009;24:496–501.\nDun E, Nezhat C. 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Abdom Radiol (NY). 2020;45:1680–93.\nFunding\nNot applicable.\nAuthor information\nAuthors and Affiliations\nContributions\nE.P. and E.O. conceived the study and designed the methodology. B.P.K. and F.B.T. were responsible for data collection and patient recruitment. B.M.S. and D.H.D. contributed to the statistical analysis and data interpretation. R.P. oversaw the HSG protocol and contributed to manuscript development. All authors reviewed the manuscript critically for intellectual content and approved the final version for submission.\nCorresponding author\nEthics declarations\nEthical Approval\nInstitutional review board (IRB) approval was obtained from Lokman Hekim University, Ankara (No.2024081).\nConsent to Participate\nInformed consent was obtained from all individual participants included in the study.\nConsent to Publish\nNot applicable.\nUse of AI Tools\nDuring the preparation of this work, the author(s) used ChatGPT-4o to revise the language. After using this tool/service, the author(s) reviewed and edited the content as needed and take full responsibility for the content of the publication.\nConflict of interest\nAll authors declare no conflict of interest regarding the study.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary Information\nBelow is the link to the electronic supplementary material.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nPabuccu, E., Keskinsoy, B.P., Deniz, D.H. et al. Tubal Pathology on Hysterosalpingography in Women with Unoperated Endometriomas: a Comparative Analysis. Reprod. Sci. (2026). https://doi.org/10.1007/s43032-026-02149-w\nReceived:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s43032-026-02149-w","source_license":"public-domain-us","license_restricted":false}