What is a hydrosalpinx?
Hydrosalpinx is a Greek term that literally means “water tube.” To a variable degree, the fallopian tube is distended with fluid. If both tubes are distended, they are called hydrosalpinges. This type of tubal problem is fairly common and can cause infertility. Nearly half of all couples suffering from infertility have a female-related cause. Of these women, over half have a disease in the uterotubal complex (i.e., upper female reproductive tract), and approximately one-third of them have hydrosalpinges.
What causes a hydrosalpinx?
A hydrosalpinx is almost always caused by a past pelvic infection. The most common bacteria at fault are chlamydia, gonorrhea, staphylococcus, streptococcus, and pelvic tuberculosis. Bacteria infect the upper reproductive tract, causing tubal wall destruction, adhesions, and abscesses. After the infection has cleared, the end result is a dilated fallopian tube that is often shrouded with surrounding adhesions in the pelvis. The lateral end, or fimbria, of the tube is usually agglutinated together, essentially blocking the opening between the ovary and the tubal conduit that leads to the uterus. Due to the distal obstruction and poor tubal wall motion, it is thought that the uterotubal derived fluid, which normally drains out the end, becomes trapped and distends the tube.
How is one diagnosed?
Radiographic imaging or surgery is usually the best method for assessing the upper reproductive tract. A transvaginal ultrasound can often detect a hydrosalpinx, but many of them cannot be seen (sensitivity = 34%). The usual first line approach is an x-ray called an HSG—hysterosalpingogram (uterus/tube/picture). Using a catheter, an opaque dye is instilled through the cervix into the uterus and eventually the tubes. This test often causes uncomfortable cramps when the muscular uterus contracts. A hydrosalpinx is evident when the tube appears dilated and will not allow the dye to spill out into the peritoneal cavity.
Occasionally, the presence (specificity = 83%) or absence (sensitivity = 65%) of a hydrosalpinx may be incorrectly determined by an HSG. For example, if the tube is blocked at the junction of the uterus and tube, then the dye will not enter the hydrosalpinx, and it will not be seen. As such, a more accurate way to assess the tube is by laparoscopy. Not only can a surgeon directly visualize a hydrosalpinx, but he or she can also evaluate the presence of other pelvic pathology.
What impact does it have on fertility?
Hydrosalpinges are blocked or severely compromised tubes that greatly impair fertility. The sperm is unable to reach the egg for fertilization, the egg cannot be picked up by the tube, and an embryo cannot make its way back to the uterus for implantation. The only way for couples to get pregnant is by repairing the tube or bypassing it.
How is it treated?
Historically, hydrosalpinges were surgically repaired. Initially in the 1970’s, the surgeon would make a small incision in the abdominal to confirm the diagnosis, remove surrounding adhesions, and open the distal end of the tube. At that time, the postliminary pregnancy rates were very poor (fewer than 15% per year) because post-operative adhesions would typically come back. During the 1970 – 80’s, in order to minimize the extent of post-operative adhesion formation, microsurgical repair was encouraged. In the late 1980’s – early 1990’s, the primary approach became laparoscopy since even fewer adhesions would form. While surgical repairs may offer some hope, the majority of patients continue to have very disappointing results. Opening an obstructed, dilated tube still leaves a patient with a damaged tube incapable of picking up the egg or moving the embryo to the uterus.
If the obstacle to conception is a hydrosalpinx, then the most cost-effective and efficient way to conceive is to bypass the obstruction. In vitro fertilization (IVF) brings the egg out of the body for fertilization by sperm in a Petri dish. After a few days, the embryo is gently transferred into the uterus. Essentially, in vitro fertilization works by replacing the functions of the fallopian tube. It is the most successful way for a patient with a hydrosalpinx to get pregnant.
Recently, a significant number of reports are detailing the negative impact a hydrosalpinx has on IVF success rates. It has been shown that implantation rate is considerably reduced (about 50%), while the miscarriage rate is increased. These effects lead to a substantial reduction of the pregnancy and take-home baby rates. Several studies have discovered that the fluid retained in the tube is embryotoxic and may impair the endometrium’s receptivity to allow the implantation of the embryo. Some theorize that the blood flow to the ovary is compromised due to the enlarged tube, causing a poorer response to gonadotropins. Several studies have shown the subsequent success rate of IVF can be improved by removing the hydrosalpinx. It is now generally advised to remove these tubes before one proceeds to IVF. Surgically removing the hydrosalpinx, however, is not without risk, so it is important to be properly evaluated to develop an appropriate treatment plan.
If you would like more information or would like to schedule an evaluation for hydrosalpinx with one of our highly skilled infertility specialists in Idaho Falls, Idaho, we invite you to contact Idaho Fertility Center at (208) 529-2019 today!