Tubal Pathology on Hysterosalpingography in Women with Unoperated Endometriomas: a Comparative Analysis

This 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. Similar content being viewed by others Data Availability The data underlying the findings of this study will be shared on reasonable request to the corresponding author.

Giudice LC. Clinical practice. Endometriosis. N Engl J Med 2010;362:2389–2398. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98:511–9. Chapron 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. García-Velasco JA, Somigliana E. Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod. 2009;24:496–501. Dun E, Nezhat C. Tubal factor infertility: diagnosis and management in the era of assisted reproductive technology. Obstet Gynecol Clin North Am. 2012;39:551–66. Qi H, Zhang H, Zhang D, Li J, Huang Z, Zhao X, et al. Reassessment of prevalence of tubal endometriosis, and its associated clinicopathologic features and risk factors in premenopausal women received salpingectomy. Eur J Obstet Gynecol Reprod Biol X. 2019;4:100074. Abuzeid MI, Mitwally MF, Ahmed AI, Formentini E, Ashraf M, Abuzeid OM, et al. The prevalence of fimbrial pathology in patients with early stages of endometriosis. J Minim Invasive Gynecol. 2007;14:49–53. American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67:817–21. Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Paladini D, Lissoni AA, et al. Endometriomas: their ultrasound characteristics. Ultrasound Obstet Gynecol. 2010;35:730–40. Grimbizis GF, Gordts S, Di Spiezio SA, Brucker S, De Angelis C, Gergolet M, et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 2013;28:2032–44. Cohen J. Statistical power analysis for the behavioral sciences. 2nd edn. Hillsdale: Lawrence Erlbaum Associates; 1988. Carson SA, Kallen AN. Diagnosis and management of infertility: a review. JAMA. 2021;326:65–76. Pérez-Milán F, Caballero-Campo M, Carrera-Roig M, Moratalla-Bartolomé E, Domínguez-Arroyo JA, Alcázar-Zambrano JL, et al. Hydrosalpinx treatment before in-vitro fertilization: systematic review and network meta-analysis. Ultrasound Obstet Gynecol. 2025;65:414–26. Ng KYB, Cheong Y. Hydrosalpinx - salpingostomy, salpingectomy or tubal occlusion. Best Pract Res Clin Obstet Gynaecol. 2019;59:41–7. https://doi.org/10.1016/j.bpobgyn.2019.01.011. As-Sanie S, Mackenzie SC, Morrison L, Schrepf A, Zondervan KT, Horne AW, Missmer SA. Endometriosis: a review. JAMA. 2025. https://doi.org/10.1001/jama.2025.2975. Yazicioglu C, Yuceturk A, Karaosmanoglu O, Aslan IO, Peker N, Cakiroglu Y, et al. Why should we check the tubes in IVF patients with ovarian endometriosis before embryo transfer? a retrospective study. BMC Pregnancy Childbirth. 2025;25(1):403. https://doi.org/10.1186/s12884-025-07492-5. Demirel E, Ali A, Seraji S, Khullar P, Nezhat FR. Incidence of fallopian tube endometriosis and its association with endometriomas, hydrosalpinx, and peritubal adhesions: a prospective cohort study. Fertil Steril. 2024;122(Suppl):E158–9. https://doi.org/10.1016/j.fertnstert.2024.07.561. Somigliana E, Vigano' P, Invernici D, Fornelli G, Merli CEM, Vercellini P. Risk of endometriosis progression in infertile women trying to conceive naturally or using IVF. Hum Reprod. 2025;deaf090. https://doi.org/10.1093/humrep/deaf090. McGuinness B, Nezhat F, Ursillo L, Akerman M, Vintzileos W, White M. Fallopian tube endometriosis in women undergoing operative video laparoscopy and its clinical implications. Fertil Steril. 2020;114:1040–8. Wang Y, Nicholes K, Shih IM. The origin and pathogenesis of endometriosis. Annu Rev Pathol. 2020;15:71–95. Ghonge NP, Ghonge SD. Hystero-salphingography in current clinical practice-old flames, die hard! Abdom Radiol (NY). 2025;50(1):213–23. https://doi.org/10.1007/s00261-024-04456-9. Infertility Workup for the Women’s Health Specialist. ACOG Committee Opinion Summary, Number 781. Obstet Gynecol. 2019;133:1294–5. National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment. Clinical guideline CG156. 2017. https://www.nice.org.uk/guidance/cg156/chapter/Recommendations-investigationof-fertility-problemsand-management-strategies. Accessed Jan 31 2021. Kilcoyne A, O’Shea A, Gervais DA, Lee SI. Hysterosalpingography in endometriosis: performance and interpretation. Abdom Radiol (NY). 2020;45:1680–93. Funding Not applicable. Author information Authors and Affiliations Contributions E.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. Corresponding author Ethics declarations Ethical Approval Institutional review board (IRB) approval was obtained from Lokman Hekim University, Ankara (No.2024081). Consent to Participate Informed consent was obtained from all individual participants included in the study. Consent to Publish Not applicable. Use of AI Tools During 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. Conflict of interest All authors declare no conflict of interest regarding the study. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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