Background: In the work there are presented the aspects of pathogenesis, diagnosis and treatment of tubal infertility by assisted reproductive technologies (ART) methods. Material and methods: The study was carried out in the National Centre for Reproductive Health and Medical Genetics on 286 patients with tubal infertility. In the patients groups we investigate anticardiolipin antibodies, autoantibodies to ”heat shock” proteins cHSP60, levels of IL-1β, IL-2, IL-4, IL-6 and IFN-γ and TNF-α, pH and chemical composition of the tubal fluid, the effects of hydrosalpinx fluid on sperm motility and survival. Results: It was determined that the patients with hydrosalpinx run the growing risk for development of reproductive autoimmunity with frequent detection of anticardiolipin antibodies and antibodies to heat shock protein (anti-cHSP60). The studies carried out have shown the considerable change of biochemical composition of tubal secretion in case of hydrosalpinx: increase of pH and bicarbonates level, decrease of osmolarity, concentration of calcium, glucose and lactate. The estimation of the concentration of cytokines in the hydrosalpinx fluid has shown the extremely high secretion of proinflammatory cytokines (IL1β, IL6, THF-α), cytokines TH1 (IFNγ, IL-2), and antibodies to cHSP60 in the tubal secretion. Immunological and biochemical imbalance of the tubal secretion has determined the sharp spermatotoxic effect on the migration of spermatozoa in the biological cultures. The clinical results of the application of assisted reproduction to the patients with tubal infertility have shown the considerably lower level of implantation and pregnancy rate and higher level of the preclinical pregnancy loss by the patients with hydrosalpinx. Proximal tubal clamping before the IVF procedure in the patients with hydrosalpinx improves the IVF implantation rate. Conclusions: IVF patients with untreated hydrosalpinx have lower conception rates than control. Tubal fluid that enters the endometrial cavity has the modified biochemical and immunological characteristics that affect embryo’s implantation. We advocate that prior to an IVF attempt the hydrosalpinx should be removed or clamming.

В работе представлены аспекты патогенеза, диагностики и лечения трубного бесплодия с помощью методов вспомогательной репродукции. Исследование проводилось в рамках Национального Центра Репродуктивного Здоровья и Медицинской Генетики среди 286 пациенток с трубным бесплодием. Было установлено, что пациентки с гидросальпинксом подвержены высокому развития репродуктивного аутоиммунитета, с изменением биохимического и иммунологического состава секрета маточных труб. Клинические результаты применения вспомогательной репродукции у пациенток с гидросальпинксом показали значительно более низкиe показатели имплантации и частоты наступления беременности. Лигирование маточных труб в проксимальном отделе или сальпингэктомия перед процедурой ЭКО улучшает прогноз для наступления и успешного развития беременности.