Background: Hydrosalpinx is a condition in which the fallopian tube is distally blocked and filled with serous or clear fluid and is often caused by infection, scar tissue, or endometriosis. Evidence suggests that hydrosalpinx adversely affects the expression of endometrial receptivity key molecules such as Homeobox A10 (HOXA10) in the pre-implantation endometrium, and salpingectomy can restore the endometrial HOXA10 gene expression. Objective: We aimed to determine whether salpingectomy would restore endometrial HomeoboxA9 (HOXA9) and Homeobox A11 (HOXA11) expressions and HOXA10 in women with hydrosalpinx. Materials and Methods: This prospective study evaluated 10 infertile women with moderate to severe hydrosalpinges who underwent laparoscopic salpingectomy from January 2021 to January 2022. All participants had normal hormonal (follicular stimulating hormone, luteinizing stimulation hormone, thyroid stimulation hormone, anti-mullerian stimulation hormone, prolactin profile, body mass index (18-28 kg/m 2 ), and regular menstrual cycles indicated by mid- luteal progesterone levels of > 10 ng/mL. The presence of hydrosalpinx (uni-or bilateral) was confirmed by hysterosalpingography or laparoscopy, and the cases with sono-visible hydrosalpinx (diameter > 10 mm) were evaluated. Mid-luteal-phase endometrial sampling was performed at the time of surgery, and second endometrial biopsies were obtained forth-post treatment cycle during the mid-luteal phase. Endometrial sampling was obtained in the mid-luteal phase of the menstrual cycle at the time of salpingectomy and forth-post treatment by pipelle. 10 healthy fertile age-matched women with a successful pregnancy history were considered the control group and scheduled to undergo endometrial biopsy in the mid-luteal phase. All women had no history of hormonal medication during the last 3 months. After endometrial sampling, extraction of RNA and cDNA synthesis were performed. Quantitate real- time PCR was used to determine the gene expression level of HOXA9 and HOXA11. Results: Gene expression profiles of HOXA9 and HOXA11 significantly decreased in hydrosalpinx endometrial tissue compared to the control samples (p = 0.03 and p = 0.01, respectively). After salpingectomy, endometrial expression levels of HOXA9 and HOXA11 were upregulated significantly (4.2-fold and 4.7-fold, p = 0.02, p = 0.04, respectively). Compared to before surgery. Moreover, there were no significant differences in HOXA9 and HOXA10 expression profiles between surgery and control groups after salpingectomy (p = 0.97, p = 0.90). Conclusion: In conclusion, salpingectomy restores HOXA9 and HOXA11 expression. Women with hydrosalpinges can undergo endometrial receptivity evaluation by assessing a panel of molecular marker implantation genes such as HOXA9/HOXA10/HOXA11 pre and post-salpingectomy. Evaluation of molecular marker implantation genes would be helpful for the optimal management of cases and assessment of the effectiveness of treatment.
