Hydrosalpinx: what is it, what causes it and how to treat it.

By (gynecologist), (embryologist), (embryologist), (embryologist) and (biochemist).
Last Update: 03/26/2024

Hydrosalpinx is an alteration of the female reproductive system characterized by obstruction and accumulation of fluid in the fallopian tubes, causing them to dilate and distend.

The consequence of this tubal pathology is a malfunction of the tubes, which causes infertility by preventing sperm from meeting with the egg for fertilization.

In most cases, the woman will need in vitro fertilization (IVF) treatment to achieve pregnancy with hydrosalpinx. Another option would be artificial insemination (AI), as long as the hydrosalpinx only affects one fallopian tube.

Types of hydrosalpinx

Hydrosalpinx is a tubal pathology characterized by an obstruction in the distal part of the fallopian tubes and accumulation of fluid inside them.

Since the female reproductive system has two fallopian tubes, there are two types of hydrosalpinx:

Unilateral hydrosalpinx
only one of the tubes is affected, the other remains intact.
Bilateral hydrosalpinx
both tubes are blocked and not functional.

The most common is that the hydrosalpinx is unilateral, that is, it can affect both the right and left tube equally.

When both fallopian tubes present this alteration, natural pregnancy is complicated, as the obstruction will prevent the sperm from reaching the egg to fertilize it.

Hydrosalpinx, therefore, is a cause of female sterility by tubal factor, so assisted reproduction may be necessary to achieve a pregnancy with this condition.

If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

Causes of hydrosalpinx

The main cause of hydrosalpinx is pelvic inflammatory disease (PID) usually caused by a sexually transmitted infection, usually chlamydia or gonorrhea.

An infection such as this mistreated or undiagnosed for years can lead to chronic inflammation of the tube, also known as salpingitis which results in the release of pro-inflammatory mediators in the tube and the accumulation of liquid inside it.

Risk factors

Other reasons that can result in hydrosalpinx are the following:

These actions or pathologies can lead to the appearance of adhesions and scar tissue in the tubes and, as a consequence, to the appearance of hydrosalpinx finally.


Generally, hydrosalpinx are asymptomatic and therefore difficult to discover. The most common is to detect them during a fertility study in the woman when she is unable to get pregnant.

Occasionally, a woman may feel pain in the lower belly, which may be constant or worsening at certain times. On the other hand, more severe hydrosalpinx can cause fever, general discomfort, and foul-smelling vaginal discharge.

In other cases, some women discover that they have hydrosalpinx when they suffer an ectopic pregnancy.

Diagnosis of hydrosalpinx

The medical tests used to diagnose hydrosalpinx are as follows:

Transvaginal ultrasound
allows to visualize the liquid accumulated in the horn in large hydrosalpinx. It is easy for the gynecologist to perform and very comfortable for the patient, but its diagnostic capacity is low, around 15%.
is the most commonly used technique to evaluate fallopian tubes. It is possible to observe the dilation of the tubes and if there is obstruction thanks to the use of X-rays. It is uncomfortable for the woman but not painful.
is an invasive and more complex technique since it consists of making an incision in the abdomen of the woman through which an endoscope is inserted that allows the abdominal cavity to be visualized. In addition, it is possible to perform diagnostic and surgical laparoscopy at the same time, thus solving the hydrosalpinx problem. It requires anesthesia and an operating room to perform it.


In order to establish a treatment plan for hydrosalpinx, it is necessary to evaluate its cause, the development time, and if the patient wants to become a mother.

Should the pathology stem from an infection that is still active in the patient, the specialist will request the administration of antibiotic treatment. Doxycycline is usually the antibiotic of choice.

If the hydrosalpinx is not resolved once the antibiotic treatment is finished, it will be necessary to resort to surgical options. In these situations, surgery by laparoscopy is usually the option.

Below are the most common techniques used as surgical treatment of hydrosalpinx:

removal of the tube containing the hydrosalpinx. In general, it is made for all hydrosalpinx greater than 3 cm.
Tubal Occlusion
it consists of making a proximal block of the tube by electrocoagulation. In cases where surgery is not recommended, hysteroscopic placement of the Essure device may also be tried.

The aim of all these interventions is to prevent the hydrosalpinx fluid from reaching the uterus and negatively influencing embryo implantation if the woman wishes to become pregnant.

Pregnancy with Hydrosalpinx

Whether by hydrosalpinx itself or by its treatment, women seeking to become pregnant with this condition will need to resort to assisted reproduction, especially if the hydrosalpinx is bilateral.

The appropriate treatment for this is in vitro fertilization, in which the eggs are obtained directly from the ovary, fertilized in the laboratory and the embryos obtained are transferred directly into the uterus.

IVF is the assisted reproductive treatment used when a woman does not have functional Fallopian tubes.

If the hydrosalpinx is unilateral and the other fallopian tube is healthy, a natural pregnancy would be possible, as the unaffected tube should allow contact between the egg and sperm. Artificial insemination may also be attempted.

In spite of this, as we have already said, it is very important to remove or seal the tube with hydrosalpinx so that it does not influence the embryo implantation.

Hydrosalpinx and fertility

Hydrosalpinx not only causes infertility by a tubal obstruction, but also by the negative effect of fluid from the tubes, which affects the conditions of implantation and embryo development.

Therefore, although IVF is the ideal treatment for achieving pregnancy in women with hydrosalpinx, its effectiveness may be diminished if the tubes have not been correctly occluded or removed before.

The presence of hydrosalpinx can decrease the IVF pregnancy rate by up to 50% and also increases the rate of miscarriage and ectopic pregnancy.

Here you can find all the reasons why hydrosalpinx, that is to say an accumuloation of fluid in the Fallopian tube, has negative effects on female fertility:

  • The fluid accumulated in the tubes is toxic to the embryos, which impedes their implantation and evolution.
  • This same liquid lacks the nutrients necessary for the development of the embryo in the uterus.
  • The mechanical action of the liquid can drag the embryos and prevent their contact with the endometrium for implantation to occur.
  • Appearance of antibodies against microorganisms such as Chlamydia, which can also affect embryos.
  • The fluid accumulated in the tubes is also toxic to sperm and can affect their capacitation and acrosomal reaction.
  • Fluid can affect endometrial receptivity by preventing some genes from being expressed in endometrial cells.
  • Embryos can become trapped in the Fallopian tube and result in an ectopic pregnancy.

This is why it is so important to perform salpingectomy or tubal occlusion before starting the IVF cycle, even though this may frighten the woman at first. With the disappearance of the hydrosalpinx liquid, all the previous inconveniences will disappear.

Whether you need to undergo IUI or IVF to become a mother, we recommend that you get your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

Video about hydrosalpinx

Michelle Emblenton, biochemist at inviTRA, talks to us in this video about hydrosalpinx:

Hydrosalpinx is characterized by a blockage in the fallopian tubes due to liquid accumulating in them. In the female reproductive system we have have two fallopian tubes.

FAQs from users

Can hydrosalpinx be cured with medication? Is surgery the only treatment option?

By Sara Salgado B.Sc., M.Sc. (embryologist).

If the condition is caused by an infection, the doctor will prescribe antibiotics and anti-inflammatory drugs to the patient. However, if it occurs for another reason, such as endometriosis for example, the cause has no possible cure.

In any case, a surgical intervention will be necessary, since the liquid remains accumulated in the tube.

What are the advantages of the operation to remove a hydrosalpinx before an IVF cycle?

By Javier Liñayo Chouza M. D. (gynecologist).

There are several studies that confirm that the presence of a hydrosalpinx is related to a poor outcome in IVF cycles.

What happens is that the accumulated fluid can have a negative influence on the embryo, since it is toxic for the embryo. In addition, this fluid also affects endometrial receptivity. For all these reasons, surgical intervention of the hydrosalpinx is advisable, but always taking care not to interrupt the vascular connections.
Read more

Can I get pregnant naturally if I have hydrosalpinx?

By Sara Salgado B.Sc., M.Sc. (embryologist).

If one of the tubes does not have hydrosalpinx or any other alteration, a natural pregnancy can occur, as the sperm can reach the egg in the unaffected tube. However, if both tubes are obstructed, there can be no natural pregnancy or artificial insemination. IVF would be necessary.

In addition, the fluid accumulated in the tube can be harmful to the embryos and make it difficult or impossible to implant them, so it would be necessary to assess whether it is advisable to intervene before attempting a pregnancy.

What is piosalpinx and how does it heal?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

Piosalpinx is an acute inflammation of the fallopian tubes, which are obstructed by pus-filled tubes.

The treatment of piosalpinx is based on antibiotics for the infection to subside. In this case, the piosalpinx becomes hydrosalpinx because the tubes may still be blocked.

How can I prevent hydrosalpinx?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

Mainly, the measures to avoid suffering from hydrosalpinx are related to avoiding contracting sexually transmitted diseases. Therefore, it is essential to use barrier contraceptives and avoid having multiple sexual partners.

In addition, if a woman is diagnosed with a reproductive tract infection, medical treatment should be initiated as soon as possible to avoid complications.

We have talked about the removal of the fallopian tubes as a solution for the most severe hydrosalpinx. If you want to know what this procedure consists of, you can continue reading here: What is a salpingectomy?

You can also find out about other pathologies that affect the Fallopian tubes and cause sterility in the following article: Tubal Factor Infertility – Causes & Treatment.

We make a great effort to provide you with the highest quality information.

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Angela Riccio, Gabriele Lisi, Maria Enrica Miscia, Gilda Di Paolo, Giuseppe Lauriti, Pierluigi Lelli Chiesa. Secondary hydrosalpinx in adolescents: a challenging decision-making process for surgical choice and future fertility preservation. Pediatr Med Chir. 2021 Feb 15;42(2). doi: 10.4081/pmc.2020.233. (view)

Lorente J, López A, Pomares E. Manejo del hidrosalpinx. H.U. Reina Sofía. Córdoba.

Martínez-Cañavate MJ, Quea G, González S. Factor tubárico: hidrosálpinx. En: Remohí, Bellver, Matorras, Ballesteros, Pellicer. Manual práctico de esterilidad y reproducción humana. 4ª edición. Madrid: Editorial Médica Panamericana S. A.; 2012. p. 119–125.

Michael Mohseni, Leslie V Simon, Johnathan M Sheele. Epidemiologic and Clinical Characteristics of Tubo-Ovarian Abscess, Hydrosalpinx, Pyosalpinx, and Oophoritis in Emergency Department Patients. Cureus
. 2020 Nov 23;12(11):e11647. doi: 10.7759/cureus.11647. (view)

Qingli Wang 1, Haiquan Ai, Xia Li, Haiqing Tian, Bingxue Ning, Meng Zhang, Xiaolin La. Association of miRNA-145 with the occurrence and prognosis of hydrosalpinx-induced defective endometrial receptivity. Bosn J Basic Med Sci. 2021 Feb 1;21(1):81-92. doi: 10.17305/bjbms.2020.4538. (view)

Romeu M, Romeu A. Manejo del hidrosálpinx en reproducción asistida. Rev Iberoamer Fert 2013; 30:4-13.

FAQs from users: 'Can hydrosalpinx be cured with medication? Is surgery the only treatment option?', 'What are the advantages of the operation to remove a hydrosalpinx before an IVF cycle?', 'What is hydrosalpinx?', 'Can I get pregnant naturally if I have hydrosalpinx?', 'What causes hydrosalpinx?', 'What is piosalpinx and how does it heal?', 'What are the symptoms of hydrosalpinx?', 'How can I prevent hydrosalpinx?', 'How is hydrosalpinx diagnosed?', 'How is hydrosalinx treated?', 'Can you pregnant with hyrdosalpinx?', 'How does hydrosalpinx affect fertility?', 'Can I get pregnant naturally with hydrosalpinx?' and 'What measures can be taken to prevent hydrosalpinx?'.

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Authors and contributors

 Javier  Liñayo Chouza
Javier Liñayo Chouza
M. D.
Dr. Liñayo Chouza completed his medical degree at the University of Santiago de Compostela and specialized in Gynecology and Obstetrics. In addition, the doctor has completed several masters and expert courses related to the field of fertility and assisted reproduction. More information about Javier Liñayo Chouza
Member number: 283203567
 Marta Barranquero Gómez
Marta Barranquero Gómez
B.Sc., M.Sc.
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
 Sara Salgado
Sara Salgado
B.Sc., M.Sc.
Degree in Biochemistry and Molecular Biology from the University of the Basque Country (UPV/EHU). Master's Degree in Human Assisted Reproduction from the Complutense University of Madrid (UCM). Certificate of University Expert in Genetic Diagnosis Techniques from the University of Valencia (UV). More information about Sara Salgado
 Zaira Salvador
Zaira Salvador
B.Sc., M.Sc.
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Michelle Lorraine Embleton
Michelle Lorraine Embleton
B.Sc. Ph.D.
PhD in Biochemistry, University of Bristol, UK, specialising in DNA : protein intereactions. BSc honours degree in Molecular Biology, Univerisity of Bristol. Translation and editing of scientific and medical literature.
More information about Michelle Lorraine Embleton

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