What is Hydrosalpinx?
Hydrosalpinx is a form of tubal factor infertility. A hydrosalpinx is a fallopian tube that becomes filled with fluid. It can cause infertility and ectopic pregnancy. Most often it occurs at the fimbrial end of the tube next to the ovary, but it can also occur at the other end of the tube that attaches to the uterus. If you are diagnosed with a hydrosalpinx and are trying to get pregnant, you may want to seek the help of a fertility specialist.
A hydrosalpinx occurs when the fallopian tube has been damaged or if there is a blockage at the end of the fallopian tube. The blockage can cause fluid to build up, and the fallopian tube to swell. The condition may occur in one or both fallopian tubes.
A hydrosalpinx can result from scarring caused by previous tubal surgery or an infection, such as a sexually transmitted disease. Another common cause of a hydrosalpinx is the presence of adhesions, which are areas of scar tissue on your pelvic organs that can get stuck together. Adhesions are often a symptom of endometriosis and other gynecological diseases. Previous surgery in the pelvic area, particularly of the fallopian tubes themselves, can also be the cause. Other causes of blocked fallopian tubes include endometriosis, adhesions in the pelvic region, some tumors, and other infections, such as from appendicitis, pelvic infection or pelvic inflammatory disease.
Hydrosalpinx and Infertility?
It may be very difficult to get pregnant naturally with a hydrosalpinx. The blockage prevents the fallopian tube from acting as a conduit for the egg. The egg and sperm may not be able to meet, or the fertilized egg may not be able to reach the uterus. If a fertilized egg begins to divide in the fallopian tube, it is called an ectopic pregnancy. An ectopic pregnancy is not a viable pregnancy, and it is a potentially life-threatening condition.
Furthermore, the fluid building up in the fallopian tube may overflow into the uterus, making it more difficult for a fertilized egg to achieve implantation.
Symptoms of Hydrosalpinx
In many cases, hydrosalpinx produces no symptoms. However, when symptoms are present, the chief complaint is pelvic pain. Some women are unaware of their condition until they seek help for fertility problems. Common symptoms include:
- Aching, constant pain in the lower abdomen
- Increasing pain during and after a period
- Vaginal discharge
Diagnosis of Hydrosalpinx
If you’re having trouble getting pregnant, or experiencing any unusual symptoms, make an appointment with your gynecologist. If your doctor suspects you may have hydrosalpinx in one or both fallopian tubes, a number of tests may be performed.
This imaging technique involves introducing liquid into your uterus and then using x-ray imaging to detect where the liquid is able to flow. If your fallopian tubes are normal, the image will show the liquid flowing out of each tube, draining into the pelvic cavity. However, if the liquid is not flowing freely through one or both tubes, it may indicate a blockage.
An ultrasound may be able to detect a swollen fallopian tube. Generally, if the swelling is large enough to be detected by ultrasound, the hydrosalpinx is severe.
A laparoscopy is a minimally invasive surgical intervention technique in which the doctor makes a small incision in the abdomen and inserts a narrow, flexible, instrument called a laparoscope. The end of the laparoscope is equipped with a lighted camera to allow the doctor to view the inside of your pelvic cavity. Your doctor will introduce a dye into your uterus through your cervix, and use the laparoscope to see if the dye flows out of the fallopian tube. If it does not, that may be an indication of a hydrosalpinx.
Treatment Options of Hydrosalpinx
Your doctor may repair the hydrosalpinx by making an incision into it, reopening the sealed end (this is called salpingostomy); other procedures such as needle drainage, may be used. The doctor may prefer to use laparoscopic salpingectomy – the complete removal of the tube – because it provides for permanent correction. Laparoscopic salpingectomy is performed under general anesthesia and the surgery typically takes less than an hour. You should allow about three weeks’ recovery time. Removing the hydrosalpinx often dramatically increases successful IVF outcome.
Pregnancy and Hydrosalpinx
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 success rates are much lower than would be expected. This is why many fertility specialists suggest surgical removal of the hydrosalpinx before beginning IVF treatment. IVF success rates are lower when a hydrosalpinx is present. Another option is artificial blockage of the affected tube at the uterine end, so it is less likely to affect the uterine environment.
At first glance, it would seem logical that an IVF procedure should lead to a successful pregnancy, even with hydrosalpinx. After all, if you have IVF, you are artificially fertilizing the egg, so it shouldn’t matter you have fallopian tube blockage because the fertility specialist manually implants the fertilized egg directly into the uterus.
There’s only one problem. The hydrosalpinx fluid may look like plain old water, but it is toxic and can actually cause a greater-than-50% rate of infertility even with IVF. In layman’s term, just being in the vicinity of the HF may be toxic to the embryo, and it will often result in unsuccessful implantation in the uterus. Because the correlation exists, women with a hydrosalpinx who are trying to conceive should have the problem surgically corrected before they attempt pregnancy, with or without IVF.
Getting pregnant naturally with blockages in one or both fallopian tubes can be very difficult. If you are trying to get pregnant, you may want to talk to your gynecologist about your options.
Hydrosalpinx prevents a fertilized egg from traveling to the womb to the implant. Depending on your condition and your personal medical history, your gynecologist may recommend:
Surgical Treatment of Hydrosalpinx
In some cases, the blockage can be surgically removed to open the tubes. However, some tubal surgeries can be risky and may cause further problems. Talk to your gynecologist about the possible risks and complications.
In-vitro fertilization, or IVF, can help you get pregnant by bypassing the fallopian tubes altogether. In this procedure, the patient is given fertility drugs to stimulate egg production. The eggs are then retrieved with a needle during a surgical procedure, and fertilized with sperm in a lab. The promising embryos are then placed into the patient’s uterus for implantation. Your surgeon may or may not recommend removing the hydrosalpinx before starting IVF.
If you believe you are experiencing symptoms of, or suffering from Hydrosalpinx, or have questions about it, please see your doctor.
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