Hydrosalpinx, hydros are caused by tubal blockage
Treatment options and effects on fertility and IVF success rates
Hydrosalpinx is a fallopian tube dilated with fluid
The plural term is "hydrosalpinges"
- 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. Doctors call this "distal tubal 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
However, for women that want a baby, hydros can be a significant problem.
- Women with hydrosalpinx on both sides - both tubes blocked, "bilateral tubal occlusion" need in vitro fertilization or tubal reconstructive surgery to get pregnant
Tubal surgery is not done commonly as it was in the past (1980's and 1990's) because IVF has much higher success rates and lower risks for ectopic pregnancy.
A women with hydrosalpinges will be very likely to have tubal factor infertility.
- Tubal infertility refers to all cases where fertility problems are due to issues related to the fallopian tubes.
- This includes blocked tubes and other tubal damage which does not block the tubes but prevents fertility - often a problem with "egg pickup" at ovulation.
How to diagnose hydrosalpinx
Ultrasound picture of hydrosalpinx, ovary and uterus
Same image with shading
Hydro at purple areas
Ovary shaded blue
Uterus and cervix (cx) red
Laparoscopy picture of a left hydrosalpinx
Same hydro surgery image with text
Hydro at purple area
Ovary shaded blue
Uterus and surgical probe at right
Hydrosalpinx and IVF
- Studies have shown that success rates with IVF are reduced on the 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.
- The 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 that 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 of hydrosalpinges. Is surgery to remove it better than just ligating it?
Surgical options include:
- Removing the hydros by cutting them off and taking them out of the body
- Ligating or clipping them prior to IVF
- Opening the end of the tube and leaving them in place (not usually recommended)
We know that on the average success is higher after surgically "fixing the hydros" However, it is not clear whether surgery to remove the tube vs. clipping or burning it close to the uterus and leaving the hydro in place is any different.
- There is some concern that removal of the tube could have a negative impact on the blood supply to the ovary. This might result in reduced ovarian response to the IVF medications.
- A reduced response to stimulation means less eggs to work with and a lower chance for pregnancy. The number of eggs retrieved correlates with the chance for IVF success.
How much higher is IVF success after hydro surgery?
The improvement in IVF success rates in studies is substantial but not huge. Some studies suggest that a woman under 35 might have a 35% success rate without surgery and a 50% success rate after having hydros removed. IVF success rates are very clinic-dependent
Therefore, decision making about treating hydros is not a clear-cut "black and white" situation. It is a gray area - and fertility doctors don't all agree about how to treat women with hydros.
- Some doctors say you need to have surgery because it improves the chance for success
- Some prefer not do surgery, and go to IVF - and if the first cycle fails, then think about whether to do surgery before the next IVF attempt.
- Some doctors say it should be whatever the woman wants - have the surgery to fix the hydros, or don't have the surgery and accept a lower chance for success.
- At our clinic we discuss surgery as an option and educate patients so that they can decide whether they want surgery first - or to go straight to IVF.
What causes hydrosalpinx?
Hydrosalpinx is often caused by tubal infection such as pelvic inflammatory disease (PID). The infection causes the tubes to become inflamed. After healing is finished the tubes are often blocked with residual fluid inside. Continued fluid buildup over time dilates the tube more resulting in hydrosalpinges of various sizes.
More about pelvic infection causing tubal damage