TUBAL OSTIUM MEMBRANES AND THEIR RELATION TO INFERTILITY

Objective: To define the clinical significance of tubal ostium membran es. Design: Retrospective multivariate stepwise logistic regression an alysis. Setting: Algemene Kliniek Sint-Jan, Brussels, Belgium. Patient s: Three thousand forty-six hysteroscopies on 2979 patients, including 172 with infertility, over a 9-year period. Main Outcome Measures: Pr esence of tubal ostium membranes, age, infertility, endometrial thickn ess, and hormonal environment. Results: Tubal ostial membranes were pr esent in 74 (2.5%) patients: they were unilateral in 30 (42.1%) and bi lateral in 44 (57.9%). Their presence was independent from hormonal st ate and from endometrial thickness. The incidence of ostial membranes was significantly higher (9.9%) in patients referred for infertility f or unilateral (3.5%) as well as for bilateral presence (6.4%). Only th e bilateral form was age dependent. Conclusions: Tubal ostium membrane s may be one of the unknown limiting factors affecting female fertilit y and thus reducing the monthly fecundity rate. The present data sugge st that bilateral and unilateral tubal ostium membranes may have a dif ferent 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 les s related to infertility, is found in women of older age, and can be a cquired. Further prospective analysis is needed to clarify the pathoge nesis and pathophysiology of tubal ostium membranes. Tubal ostium memb ranes should routinely be looked for when performing a hysteroscopic e xamination in infertile women.