**3. Role of Hydatid of Morgagni in UI**

The recommendations of all societies define UI after a free tubal patency test. They didn't define which test. One of the great advantages of diagnostic laparoscopy is proper visualization of the genital organs and the pelvis. Some Wollfian duct vestigial remnants could be easily seen by laparoscopy like Hydatif of Morgagni and paratubal cysts and of course are not visible by HSG.

Hydatid of Morgagni is commonly underestimated finding even by expert laparoscopists. Tubal heaviness, possible fimbrial occlusion and restricted tubal mobility hindering ovum pick-up from the pouch of Douglas are possible mechanisms of infertility. Whether they are definite cause of infertility or not was studied in a randomized study [20]. They recruited a total 455 patients. The 240 of them were pregnant to whom planned cesarean section (C/S) and the other 215 were infertile one who have undergone diagnostic laparoscopy. Fertile Group (Group 1) consisted of women whom have become spontaneously pregnant without any kind of infertility management. These are planned to undergo C/S with different indications. Infertile group (Group 2) consisted of women diagnosed as unexplained infertility and planned to undergo diagnostic laparoscopy according to ASRM 2006 guidelines. The frequen‐ cy, number, and the bilaterality of the MH were evaluated during the C/S in fertile group and diagnostic laparoscopy in infertile group. SPSS was used for statistical analyses. The Morgagni hydatids (MH) frequency was higher in Group 2 than Group 1 (P < 0.05). The bilaterality of MHs was significantly higher in Group 2 than Group 1 (P < 0.05). The number of the MHs was significantly higher in Group 2 than Group 1 (P < 0.05). They concluded that these findings suggest a possible effect of MH on fertility. The theory of MH disturbing tubal motility with respect to the pick-up and transport of ovum appears logical in this aspect.

Another non-randomized study [21] was conducted on two hundred and thirteen patients with unexplained infertility and hydatid of Morgagni diagnosed at laparoscopy were includ‐ ed. The laterality (bilateral vs unilateral), location (fimbrial vs juxta-fimbrial), number (single vs multiple) and diameter of the hydatids of Morgagni were recorded. Patients were allocated to a study group (n=127) who underwent laparoscopic excision of hydatid of Morgagni and a control group (n=86) who underwent no intervention. Patients were followed for six months without any infertility or hormonal treatment to detect spontaneous pregnancy. Patients missed during the follow-up or who received infertility treatment was excluded. Statistical analysis was done using Chi-square test and Student's t-test. To find the most important character of hydatid of Morgagni which impedes pregnancy, logistic regression analysis of the dependent variable (no pregnancy) and independent variables (different characters ofhydatid of Morgagni) was carried out in the control group. Hydatid of Morgagni was detected in 52.1% of patients with unexplained infertility compared to 25.6% of those with explained infertility (p<0.001). The pregnancy rate was higher in the study group than the control group (58.7% vs 20.6%, p<0.001). The pregnancy rate was significantly higher in the study group than the control group if the hydatid cystwas bilateral (85.7% vs 5.3%, p<0.001), fimbrial (85.6% and 9.1%, p<0.001), single (57.6% and 30.3%, p<0.001) or 1-2 cm in diameter (58.1% and 25.5%, p<0.001). Logistic analysis showed that the bilaterality and fimbrial location of thehydatid of Morgagni were the most significant characteristics impeding pregnancy (odds ratio=7.27 and 3.67 respectively). They concluded that Hydatid of Morgagni is a possible underestimated cause of unexplained infertility. Laparoscopic removal of hydatid of Morgagni in patients with unexplained infertility was followed with a high spontaneous pregnancy rate. This is partic‐ ularly obvious with bilateral and fimbrial hydatid of Morgagni.
