The ultrastructural effects of surgical treatment of hydrosalpinx on the human endometrium

Hydrosalpinx is a disease commonly observed in women and characterized by the obstruction which is in the shape of a fluid filled sac at the distal part of tuba uterina closed to the ovary. Hydrosalpinx is a sexually transmitted disease and it is thought that the disease could be occured as a result of Gonorrhea and Chlamydia infections, pelvic inflamatory disease and inflamatory reactions of tuba uterina. It has been reported that surgical complications, endometriosis, tubal or ovarian cancers and tubal tuberculosis can lead to this disease. Nowadays, it has been reported in the researches that hydrosalpinx markedly reduce pregnancy and implantation rate and increase the risk of abortion in women. In recent studies it has been reported that hdyrosalpinx reduce the pregnancy rate about % 50 and increase the abortion risk in the patients underwent IVF treatment. Although the cause of the reducement in implantation rate is not exactly known, peristaltic contractions of uterine muscles, intrauterin fluid flow due to reflux, toxic effects of the fluid in the hdyrosalpinx on the embryo and alterations in endometrial receptivity are considered to be effective in this condition. There is a decrease in implantation rate of embryo to the uterus and an increase in abortion risk in the patient with hydrosalpinx so the effects of this disease on the uterin endometrium is very obvious. Although there have been lots of study which investigate integrins, transcription factors, cell surface markers on the endometrium of the infertile women with and without hydrosalpinx and pelvic inflammatory disease, there have been no study in the literature on the ultrastructure of endometrium in patients with hydrosalpinx before and after surgical treatment. So, in this study we aimed to obtain endometrial tissue samples from the patients with hydrosalpinx, before and after the surgical treatment and compare these endometrial tissue samples by using light and electron microscope. Endometrial tissue samples were obtained from the 24 women with bilateral hydrosalpinx range 19-46 years before and after the surgical treatment and normal endometrial tissues were collected from 5 women without hydrosalpinx and evaluated as control group. The endometrial tissue samples were prepared according to the routine tissue preparation methods. In endometrial samples of patients with hydrosalpinx; it was observed that large and unregulated interstitial spaces representing the organellar destruction, membranous whorl structures associated with organelle destruction, thinning in the surface epithelium, decreasing in numbers of microvillus and pinopodes in microvilli cells, increasing in heterochromatin and picnotic changes in the nucleus, expansion and vacuolization in the endoplasmic reticulum cisternae in the apical cytoplasm and intraepithelial macrophages and lymphocytes were rised in number. Also, in endometrial gland epithelium, enlargement in intercellular intervals and organelle destruction in glandular epithelial cells were encountered. In addition, structural changes in stromal cells were identified with wide intercellular spaces representing endometrial stromal edema areas. Although mild structural changes were observed in endometrial tissues obtained after surgical treatment of hydrosalpinx, surface epithelium and glandular and stromal cell structures were more similar with control endometrial specimens. In conclusion; serious structural changes have occured in endometrial tissues of patients with hydrosalpinx. These structural abnormalities have removed after surgical treatment so it is considered that surgical treatment is effective in patients with hydrosalpinx.