Background: Hydrosalpinx, characterized by fallopian tube obstruction and fluid accumulation, is associated with impaired endometrial receptivity and reduced IVF success. Salpingec- tomy, the surgical removal of affected tubes, is often performed to enhance implantation outcomes, though the underlying ul- trastructural mechanisms remain poorly defined. This study examines the ultrastructural effects of salpingectomy on the peri-implantation endometrium in patients with hydrosalpinx. Materials and Methods: Endometrial biopsies were obtained during the mid-luteal phase from 10 reproductive age patients with unilateral hydrosalpinx, both before and after salpingec- tomy, and these samples were compared to those from 20 healthy controls. Apical cell-specific characteristics of surface and glandular, polarity, shape, and integrity of cells, organelle destruction, and glycogen accumulation were evaluated using transmission electron microscopy. Results: Transmission electron microscopy (TEM) analyses revealed significant ultrastructural abnormalities in the pre-sur- gical samples when compared to the control group. These ab- normalities included loss of cell polarity, irregular cell shapes, disrupted microvilli, reduced development of pinopodes, and absence of cilia. Additionally, there was evidence of organelle destruction, disrupted tight junctions, and anisokaryosis, which refers to variations in nuclear size and shape. Post-salpingec- tomy specimens showed significant restoration of endometrial architecture, with normalized cell polarity and height, pinopo- de development, endometrial integrity, and apical cell-specific characteristics. The findings suggest that the cytotoxic and in- flammatory stressors linked to hydrosalpinx negatively impact the endometrial ultrastructure, ultimately decreasing receptivity. Conclusion: Salpingectomy minimizes adverse effects, en- hances cellular recovery, and supports embryo implantation. This study reveals how salpingectomy improves endometrial function and boosts IVF success in patients with hydrosalpinx.
