Hydrosalpinx: Treatment, Diagnosis, and Causes

In This Article

A hydrosalpinx is a specific type of fallopian tube blockage. The fallopian tubes extend from the uterus, one on the right and one on the left. If they become blocked or infected, infertility may result. Studies have found that hydrosalpinx blockages are present in 10% to 30% of tubal infertility cases.

The fallopian tubes.

Overview

A hydrosalpinx blockage is typically on the far end of the fallopian tube, near the ovaries, but it is possible for blockage to exist at both ends. In a healthy reproductive system, the fallopian tube serves as the pathway 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.

Assuming sex has taken 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, will then 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.

Normally, fimbriae extend from the end of the fallopian tube close to the ovary. They help draw the ovulated egg from the ovary into the fallopian tube. With a hydrosalpinx, the fimbriae are often damaged and stuck together.

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.

Fertility Impact

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.

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. Another option is artificial blockage of the affected tube at the uterine end, so it is less likely to affect the uterine environment.

Causes of Hydrosalpinx

A hydrosalpinx is when a blocked fallopian tube fills with fluid. If both tubes are affected, this is called hydrosalpinges. The tube usually appears distended, which means it is swollen with fluid.

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) irritate the fallopian tubes.

Symptoms of Hydrosalpinx

With hydrosalpinx, infertility is often the first and only symptom that something is wrong. Most women don’t have any symptoms and are diagnosed only after they try to unsuccessfully have children. However, some women will experience pelvic pain. Rarely, there may be some unusual vaginal discharge.

A person may also have symptoms of the root cause of hydrosalpinx. 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.

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. Untreated PID can have serious consequences for health and fertility (especially if the infection spreads). The infection is treated with antibiotics.

How Hydrosalpinx Is Diagnosed

Blocked tubes are usually diagnosed during a fertility workup. A hysterosalpingogram, or HSG—a special kind of x-ray—can show tubal blockages.

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 visualize the fluid-filled tube this way. One study found that only 34% of hydrosalpinx were visible via ultrasound.

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

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. For example, if PID is responsible for the hydrosalpinx, you may also receive antibiotics.

IVF success odds are lower when a hydrosalpinx is present. For this reason, the frequently recommended treatment is to have the affected tube surgically removed first. Then, IVF treatment begins.

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's 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.

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  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.