Hydrosalpinx: Treatment, Causes, Diagnosis, Symptoms

Blocked Fallopian Tube and Impact on Fertility

Woman with her hands on her abdomen
Hydrosalpinx does not often cause noticeable symptoms, but some women will experience pelvic pain. Vincent Besnault/Getty Images

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 percent of tubal infertility cases. Learn about this condition including diagnosis, treatment, and whether you can get pregnant if you have a hydrosalpinx.

Causes

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.

Link to Infertility

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 both 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 draw the egg in.

Assuming sex has taken place close to ovulation, the egg will meet with sperm inside the tube. Fertilization of the egg will occur inside the tube—and not inside the uterus, which is a common misconception. The fertilized egg, or embryo, will 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, finger-like projections called fimbriae extend from the end of the fallopian tube close to the ovary. They help draw in 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.

Pregnancy Chances With One Hydrosalpinx Blocked Tube

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 the 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.

Diagnosis

Blocked tubes are usually diagnosed during a fertility workup. An 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 percent 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.

Symptoms

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.

They may also have symptoms of the root cause of hydrosalpinx. For example, pelvic inflammatory disease (PID) is a risk factor for hydrosalpinx.

Treatment

Surgery is the most common treatment for hydrosalpinx, with IVF treatment after 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.

If PID is responsible for the hydrosalpinx, you may also receive antibiotics to treat lingering infections.

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 is commenced. 

Sclerotherapy may be an alternative to removal of the fallopian tube. In this procedure, liquid is aspirated from the affected tube. Then, a sclerosing agent is injected to prevent the tube from refilling with fluid. This is all done via a vaginal ultrasound-guided needle and is less invasive than laparoscopic surgery.  However, research on this method is lacking. It's unclear what all the possible risks are and whether it is truly better than the 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. For women who go this route, natural conception after the repair is usually the goal. 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.

Sources:

Conceiving After Tubal Surgery: Fact Sheet. American Association of Reproductive Medicine.

Hydrosalpinx: Fact Sheet. American Association of Reproductive Medicine.

Kasius JC, Broekmans FJ. "Pregnancy Outcomes of Interventional Ultrasound Sclerotherapy With 98% Ethanol on Women With Hydrosalpinx." Am J Obstet Gynecol. 2015 Jan;212(1):118. doi: 10.1016/j.ajog.2014.09.018. Epub 2014 Sep 20.

Na ED1, 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 Dec;39(4):182-6. doi: 10.5653/cerm.2012.39.4.182. Epub 2012 Dec 31.