Written by Shahin Ghadir, MD (Southern California Reproductive Center)
Hydrosalpinx refers to a type of fallopian tube disorder where the tubes are blocked and distended, filled with a watery, clear liquid. The word comes from the Greek “hydro” (water) and “salpinx” (literally a kind of trumpet played in ancient Greece, but “salpinx” has come to mean “tube,” specifically a fallopian tube). In most cases of hydrosalpinx, only the fimbrial end (the end closest to the ovary) of the tube is sealed off; in rare cases, both ends may be sealed. The fertility specialists at Southern California Reproductive Center (SCRC), a highly regarded fertility clinic, commonly encounter hydrosalpinx as a cause of tubal-factor infertility.
What is the cause of hydrosalpinx?
There may be more than one cause of hydrosalpinx, but the most frequent cause is a previous pelvic infection, the most common of these being chlamydia and gonorrhea. Prior pelvic surgeries, adhesions, endometriosis, and certain tumors may also cause hydrosalpinx.
What are the symptoms of hydrosalpinx?
In many cases, hydrosalpinx produces no symptoms. However, when symptoms are present, the chief complaint is pelvic pain. Often, infertility is a symptom in itself and is the tipoff that leads to a diagnosis of hydrosalpinx.
What is the effect of hydrosalpinx on fertility?
The simple answer is that an egg must be released from the ovary, picked up by the finger-like fimbria, and pushed into the fallopian tube, where fertilization takes place prior to implantation in the uterus. But in hydrosalpinx, the fimbrial end of the fallopian tube is sealed off, so the egg cannot enter the tube. And if the egg can’t enter the tube, infertility results.
But there are two fallopian tubes, so there shouldn’t be a problem, right?
The very presence of the hydrosalpinx can negatively impact fertility. Also, bilateral hydrosalpinx (where both fallopian tubes are blocked) is fairly common.
Which methods are used in the diagnosis of hydrosalpinx?
The most useful method for diagnosis of hydrosalpinx is HSG (hysterosalpingogram). HSG is a type of fluoroscopy (an X-ray performing using a contrast medium). HSG is good at assessing tubal patency (free flow through the fallopian tubes) because the fertility doctor performing the procedure can see the movement of the contrast dye through the tubes. If this flow is impeded, that will show up clearly; ultrasound can be used to make a confirmatory diagnosis and eliminate the chance of a false positive HSG result.
If my fertility doctor diagnoses hydrosalpinx, will having IVF allow me to have a normal pregnancy?
On first glance, it would seem logical that an IVF (in vitro fertilization) procedure would lead to a successful pregnancy, even with hydrosalpinx. After all, if you have IVF, or in vitro fertilization, you are artificially fertilizing the egg, so it shouldn’t matter that the fallopian tubes are blocked because the fertility specialist manually implants the fertilized egg (embryo) directly into the uterus. There’s only one problem with this: the hydrosalpinx fluid (HF) 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 other words, 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).
Treatment of hydrosalpinx with minimally invasive surgery
Some fertility doctors may repair the hydrosalpinx by making an incision into it, thus reopening the sealed end (this is called salpingostomy); they may also use other procedures such as needle drainage. At SCRC, our fertility specialists 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 IVF success rates.