A hydrosalpinx is a condition that occurs when the fallopian tube is blocked and fills with serous or clear fluid near the ovary (distal to the uterus). The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in diameter. The blocked tubes cause infertility.
A fallopian tube filled with blood is a hematosalpinx and with pus a pyosalpinx.
For most of the past century patients with tubal infertility due to hydrosalpinx underwent tubal corrective surgery to open up the distally occluded end of the tubes (salpingostomy) and remove adhesions (adhesiolysis). Unfortunately, pregnancy rates tended to be low as the infection process often had permanently damaged the tubes, and in many cases, hydrosalpinges and adhesions formed again. Further, ectopic pregnancy is a typical complication. Surgical interventions can be done by laparotomy or laparoscopy.
Hydrosalpenx : Why İt is important in In-vitro Fertilization Treatment
With the advent of IVF which bypasses the need for tubal function a more successful treatment approach has become available for women who want to conceive. IVF has now become the major treatment for women with hydrosalpinx to achieve a pregnancy.
Several studies have shown that IVF patients with untreated hydrosalpinx have lower conception rates than controls and it has been speculated that the tubal fluid that enters the endometrial cavity alters the local environment or affects the embryo in a detrimental way. Thus, many specialists advocate that prior to an IVF attempt, the hydrosalpinx should be removed
Non-infertile patients who suffer from severe chronic pain due to hydrosalpinx formation that is not relieved by pain management may consider surgical removal of the affected tube(s) (salpingectomy) or even a hysterectomy with removal of the tubes, possibly ovaries.
Can I just get IVF and not treat hydrosalpinx?
In vitro fertilization (IVF) is an infertility treatment where the egg is fertilized by the sperm in a laboratory, outside the body. The fertilized egg is then implanted into a woman’s uterus to achieve pregnancy. IVF can help bypass the role of the fallopian tube in the sperm meeting the egg.
Although this procedure is currently considered the best option for women who have experienced hydrosalpinx, it can cause complications if done before the blockage is removed.
Fluid from the affected tube may leak into the uterus and make implantation difficult or increase the risk of miscarriage. Doctors typically suggest having the affected tube removed or separating it from the uterus before trying IVF.
An academic review examined 5,592 women undergoing IVF. Of these women, 1,004 had untreated hydrosalpinx, and 4,588 had another type of untreated tubal blockage. Between these two groups, doctors performed 8,703 total embryo transfers.
The following success rates were observed between the two groups:
- Women with untreated hydrosalpinx had a pregnancy rate of 19.67 percent versus 31.2 percent for women with other types of blockages (the control group).
- Implantation rates were 8.53 percent for women with untreated hydrosalpinx compared to 13.68 percent in the control.
- Delivery rates for women with untreated hydrosalpinx were 13.4 percent versus 23.4 percent for women with other types of blockage.
- Women with untreated hydrosalpinx saw higher rates of early pregnancy loss — 43.65 percent — versus 31.11 percent for the control group.