Hydrosalpinx

Overview

A hydrosalpinx is a fallopian tube that has become blocked at its far end and filled with fluid. The fallopian tubes are the passages that carry an egg from the ovary toward the uterus and where fertilization normally takes place. When a tube is damaged and its end seals over, fluid collects inside, swelling the tube. The condition can affect one or both tubes.

Hydrosalpinx is an important cause of fertility problems. A blocked tube prevents the egg and sperm from meeting on that side, and the fluid that builds up can even drain back into the uterus, where it may interfere with embryo implantation and lower the success of treatments such as IVF. Recognizing and treating a hydrosalpinx can therefore improve the chance of pregnancy.

Symptoms

Many people with a hydrosalpinx have no symptoms, and it is discovered only during a fertility evaluation. When symptoms occur, they are often mild and nonspecific.

• Often no symptoms at all
• Difficulty becoming pregnant
• Lower abdominal or pelvic pain, which may be on one side
• Unusual vaginal discharge in some cases
• Sometimes a history of pelvic infection or pelvic surgery

Because symptoms are frequently absent, a hydrosalpinx is commonly found when imaging or tests are done to look into infertility.

Causes

A hydrosalpinx results from damage and scarring that blocks the end of the fallopian tube.

• Pelvic inflammatory disease (PID): The most common cause, often from sexually transmitted infections such as chlamydia or gonorrhea that scar the tubes.
• Previous pelvic or tubal surgery: Including operations that cause adhesions.
• Endometriosis: Which can cause scarring around the tubes.
• Previous ectopic pregnancy or ruptured appendix: Events that can damage and scar the tubes.

Risk Factors

• Past pelvic inflammatory disease or sexually transmitted infections
• Previous pelvic or abdominal surgery
• Endometriosis
• Prior ectopic pregnancy
• History of a ruptured appendix or other pelvic infection

Diagnosis

A hydrosalpinx is usually identified through imaging done as part of a fertility workup.

• Pelvic ultrasound: May show a fluid-filled, sausage-shaped tube.
• Hysterosalpingogram (HSG): An X-ray with dye injected through the cervix to see whether the tubes are open or blocked.
• Laparoscopy: A keyhole surgery that allows direct viewing of the tubes and can confirm the diagnosis and guide treatment.

Treatment

Treatment aims to relieve the blockage's effect on fertility, especially before IVF, since hydrosalpinx fluid can lower success rates.

• Removal of the affected tube (salpingectomy): Often recommended before IVF to prevent fluid from interfering with implantation.
• Tubal blocking or clipping: Sealing off the tube where removal is difficult, to stop fluid reaching the uterus.
• Tubal repair surgery: Occasionally attempted to restore the tube, though success is limited and the risk of ectopic pregnancy remains.
• In vitro fertilization (IVF): Bypasses the tubes entirely and is a common path to pregnancy after the hydrosalpinx is managed.

The best approach depends on whether one or both tubes are affected and on the couple's fertility plans.

Prevention

Preventing the infections and damage that lead to a hydrosalpinx lowers the risk.

• Practice safer sex and get tested and treated promptly for sexually transmitted infections
• Seek early treatment for pelvic inflammatory disease
• Attend follow-up after pelvic surgery or an ectopic pregnancy as advised

When to See a Doctor

See a doctor for a fertility evaluation if you have not conceived after a year of regular, unprotected sex, or six months if you are over 35, particularly if you have a history of pelvic infection, pelvic surgery, or an ectopic pregnancy. Seek prompt medical care for fever with pelvic pain or unusual discharge, which may indicate an active pelvic infection that needs treatment.

Related Topics

Frequently Asked Questions

References

1. American Society for Reproductive Medicine (ASRM).
2. American College of Obstetricians and Gynecologists (ACOG).
3. MedlinePlus, U.S. National Library of Medicine.
4. Centers for Disease Control and Prevention (CDC). Pelvic Inflammatory Disease.