Hydrosalpinx
What it is
Hydrosalpinx is a condition where a fallopian tube is dilated with fluid. A hydrosalpinx can make it difficult for a woman to conceive and increases her risk of an ectopic pregnancy.
The only way for a fallopian tube to become dilated with fluid is if it is blocked at the end of the tube away from the uterus (also referred to as "distal tube occlusion"). Fluid secreted by cells inside the tube can't get out-- so it builds up and dilates the tube.
Hydrosalpinx does not have medical significance other than for fertility, and that it can be confused on ultrasound as an ovarian cyst or tumor.
Symptoms of hydrosalpinx
Sometimes women with hydrosalpinges will have pain, but this is uncommon. Usually, there will be no symptoms of hydrosalpinx.
For women who want a baby, however, hydrosalpinx can be a significant problem.
Women with hydrosalpinx on both sides or "bilateral tubal occlusion" (meaning both tubes are blocked) need in vitro fertilization or tubal reconstructive surgery to get pregnant. Tubal surgery is not done as commonly as it was in the past (1980s and 1990s), however, because IVF has much higher success rates and lower risks for ectopic pregnancy.
A woman with hydrosalpinges will be very likely to have tubal factor infertility. Tubal infertility refers to all cases where fertility problems are a result of problems related to the fallopian tubes. This includes blocked tubes and other tubal damage that does not block the tubes but prevents fertility, which is often a problem with "egg pickup" at ovulation.
Causes
Hydrosalpinx is often caused by tubal infection such as pelvic inflammatory disease (PID), which causes the tubes to become inflamed. After the tubes heal, they are often blocked with residual fluid inside. Continued fluid buildup over time dilates the tube even more, resulting in hydrosalpinges of various sizes. Hydrosalpinx can also occur after an infection from STIs like chlamydia or gonorrhea. Additionally, some women can develop this condition from endometriosis or after pelvic surgery.
How hydrosalpinx is diagnosed
Hydrosalpinx can be detected on ultrasound, during laparoscopic surgery or with a hysterosalpingogram x-ray study.
Hydrosalpinx and IVF
Studies have shown that success rates with IVF are reduced on average with hydros present compared to cases that had hydros surgically removed prior to IVF. Because hydros have a negative impact on IVF outcome, women are usually given the option of having surgery to correct the hydrosalpinx problem. This surgery is usually done by either removing the tube or transecting it close to the junction with the uterus.
Why does hydrosalpinx lower IVF success?
There is speculation about reasons why a hydrosalpinx might reduce IVF success rates:
The mechanism for reducing pregnancy rates with hydros has not yet been proven-- It may be due to a combination of factors.
Surgical treatment for hydrosalpinx
See Fallopian Tube Surgery.
Sources: Advanced Fertility Center of Chicago
Women's Fertility Center by Nora Miller, MD
Hydrosalpinx is a condition where a fallopian tube is dilated with fluid. A hydrosalpinx can make it difficult for a woman to conceive and increases her risk of an ectopic pregnancy.
The only way for a fallopian tube to become dilated with fluid is if it is blocked at the end of the tube away from the uterus (also referred to as "distal tube occlusion"). Fluid secreted by cells inside the tube can't get out-- so it builds up and dilates the tube.
Hydrosalpinx does not have medical significance other than for fertility, and that it can be confused on ultrasound as an ovarian cyst or tumor.
Symptoms of hydrosalpinx
Sometimes women with hydrosalpinges will have pain, but this is uncommon. Usually, there will be no symptoms of hydrosalpinx.
For women who want a baby, however, hydrosalpinx can be a significant problem.
Women with hydrosalpinx on both sides or "bilateral tubal occlusion" (meaning both tubes are blocked) need in vitro fertilization or tubal reconstructive surgery to get pregnant. Tubal surgery is not done as commonly as it was in the past (1980s and 1990s), however, because IVF has much higher success rates and lower risks for ectopic pregnancy.
A woman with hydrosalpinges will be very likely to have tubal factor infertility. Tubal infertility refers to all cases where fertility problems are a result of problems related to the fallopian tubes. This includes blocked tubes and other tubal damage that does not block the tubes but prevents fertility, which is often a problem with "egg pickup" at ovulation.
Causes
Hydrosalpinx is often caused by tubal infection such as pelvic inflammatory disease (PID), which causes the tubes to become inflamed. After the tubes heal, they are often blocked with residual fluid inside. Continued fluid buildup over time dilates the tube even more, resulting in hydrosalpinges of various sizes. Hydrosalpinx can also occur after an infection from STIs like chlamydia or gonorrhea. Additionally, some women can develop this condition from endometriosis or after pelvic surgery.
How hydrosalpinx is diagnosed
Hydrosalpinx can be detected on ultrasound, during laparoscopic surgery or with a hysterosalpingogram x-ray study.
Hydrosalpinx and IVF
Studies have shown that success rates with IVF are reduced on average with hydros present compared to cases that had hydros surgically removed prior to IVF. Because hydros have a negative impact on IVF outcome, women are usually given the option of having surgery to correct the hydrosalpinx problem. This surgery is usually done by either removing the tube or transecting it close to the junction with the uterus.
Why does hydrosalpinx lower IVF success?
There is speculation about reasons why a hydrosalpinx might reduce IVF success rates:
- Toxins in the hydro fluid could have a negative influence on the embryos
- Reduced implantation potential by altering the receptivity of the uterine lining
- Reduced implantation by altering uterine contractility patterns
- A mechanical flushing effect on the embryos by fluid from the tubes
The mechanism for reducing pregnancy rates with hydros has not yet been proven-- It may be due to a combination of factors.
Surgical treatment for hydrosalpinx
See Fallopian Tube Surgery.
Sources: Advanced Fertility Center of Chicago
Women's Fertility Center by Nora Miller, MD