What Is a Hydrosalpinx?

This fallopian tube blockage can affect fertility

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What Is Hydrosalpinx?

A hydrosalpinx is a specific type of fallopian tube blockage. Studies have found that hydrosalpinx blockages are present in 10% to 30% of tubal infertility cases. When a hydrosalpinx blockage occurs, it is typically on the far end of the fallopian tube, near the ovaries. But it is possible for blockage to exist at both ends. If the fallopian tubes become blocked or infected, infertility may result.

In a healthy reproductive system, the fallopian tubes serve as pathways for an ovulated egg to reach the uterus. After an egg is released from the ovary, finger-like projections from the fallopian tube, called fimbriae, draw the egg into the tube. With a hydrosalpinx, the fimbriae are often damaged and stuck together.

A hydrosalpinx can also interfere with implantation. Assuming an egg does travel into the tube, and sex takes place close to ovulation, the egg will meet with sperm inside the tube.

Fertilization occurs inside the tube—not in the uterus, which is a common misconception. The fertilized egg, or embryo, must make its way down the tube, into the uterus, and implant itself into the uterine wall. If this pathway is blocked, as it is with a hydrosalpinx, infertility may result.

Depending on the cause for the hydrosalpinx, additional adhesions around the fallopian tube and ovary may occur. This can also interfere with ovulation and fertility.

The fallopian tubes

Symptoms

Most people with a hydrosalpinx don’t have any symptoms, infertility is often the first and only symptom that something is wrong. However, some people will experience pelvic pain. Rarely, there may be some unusual vaginal discharge.

The underlying cause of hydrosalpinx may result in symptoms. For example, one common risk factor for hydrosalpinx is pelvic inflammatory disease (PID). PID is an infection of the reproductive organs. It's frequently caused by untreated sexually transmitted infections, such as gonorrhea and chlamydia. Less commonly, it's caused by other bacteria that finds its way into the reproductive tract.

While some people with PID don't have symptoms, the infection can cause unusual discharge, pelvic pain, and flu-like symptoms. Symptoms of PID can be acute or chronic.

How Hydrosalpinx Affects Fertility

Technically speaking, it is possible to conceive with just one open tube, as may be the case if you have one hydrosalpinx tube and the other is healthy. However, the delicate environment of the uterus may be affected with a hydrosalpinx and this reduces pregnancy rates.

The irritation and/or adhesions associated with the hydrosalpinx seem to reduce the possibility of conception occurring via the healthy tube. It's also possible that fluid buildup inside the affected tube may leak into the uterus, impacting embryo implantation.

Diagnosis

Blocked tubes are usually diagnosed during a fertility workup. A hysterosalpingogram, or HSG—a special kind of x-ray—can show tubal blockages. The tube usually appears distended, which means it is swollen with fluid.

To determine if the blockage is a hydrosalpinx, a sonohysterosalpingography may be needed. This procedure involves passing saline fluid and sterile air through the cervix and into the uterus. Then, transvaginal ultrasound is used to visualize the reproductive organs.

Ultrasound can also be used to diagnose hydrosalpinx, but it’s not always possible to see the fluid-filled tube this way. One study found that only 34% of hydrosalpinx were visible via ultrasound.

Laparoscopy also may be used to diagnose hydrosalpinx. Diagnostic laparoscopy can also determine if additional factors, like endometriosis, are causing fertility problems.

Causes of Hydrosalpinx

Most often, hydrosalpinx is caused by a long-term infection of the fallopian tubes. This infection may occur due to a sexually transmitted disease, ruptured appendix, or any other cause of infection that impacts the reproductive system or nearby organs.

Hydrosalpinx may also be caused if adhesions (scar tissue) or endometrial deposits (from endometriosis). These conditions can irritate the fallopian tubes.

Hydrosalpinx Treatment

Surgery is the most common treatment for hydrosalpinx, followed by IVF treatment to aid in conception. Most often, the fallopian tube is removed completely.

Depending on the root cause of the hydrosalpinx, surgery may also involve removal of other adhesions, scar tissue, or endometrial growths. Another option is artificial blockage of the affected tube at the uterine end, so it is less likely to affect the uterine environment. If the hydrosalpinx is caused by PID, that will be treated with antibiotics as well.

When patients go straight to IVF treatment, without surgically removing the infected fallopian tube, pregnancy and live birth rates are much lower than would be expected. This is why many fertility specialists suggest surgical removal of the hydrosalpinx before beginning IVF treatment.

Sclerotherapy is an alternative to surgical removal of the tube. In this procedure, the liquid is aspirated from the affected tube. Then, a sclerosing agent is injected to prevent the tube from refilling with fluid. This is done via a vaginal ultrasound-guided needle and is less invasive than laparoscopic surgery. However, it is unclear what all the possible risks are and whether this procedure is truly better than removal of the tube.

Surgical repair of a blocked fallopian tube—where the blockage is opened but the tube is left intact—may be done for other kinds of fallopian tube blockages. Unfortunately, this is not recommended with hydrosalpinx. The blockage and swelling often return. Repair of a hydrosalpinx followed by an attempt at natural conception is not recommended.

A Word From Verywell

If you have been experiencing challenges getting pregnant, your healthcare provider may perform tests to see if hydrosalpinx could be affecting your efforts. If you are diagnosed with the condition, they may explore several options. However, surgery is often recommended for hydrosalpinx treatment.

Talk to your provider about your options, your recovery time, and how long after the procedure IVF will start. Having as much information as possible often helps you process what is going on and know what to expect.

2 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Zhang WX, Jiang H, Wang XM, Wang L. Pregnancy and perinatal outcomes of interventional ultrasound sclerotherapy with 98% ethanol on women with hydrosalpinx before in vitro fertilization and embryo transfer. Am J Obstet Gynecol. 2014;210(3):250.e1-5. doi:10.1016/j.ajog.2013.11.024

  2. Na ED, Cha DH, Cho JH, Kim MK. Comparison of IVF-ET outcomes in patients with hydrosalpinx pretreated with either sclerotherapy or laparoscopic salpingectomy. Clin Exp Reprod Med. 2012;39(4):182-6. doi:10.5653/cerm.2012.39.4.182.

By Rachel Gurevich, RN
Rachel Gurevich is a fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. She is a professional member of the Association of Health Care Journalists and has been writing about women’s health since 2001. Rachel uses her own experiences with infertility to write compassionate, practical, and supportive articles.