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

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.

The different sections of this article have been assembled into the following table of contents.

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.

Hydrosalpinx in one or both tubes

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.

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:

• Endometriosis
• Previous surgery on the tubes or other organs of the pelvic cavity
• Insertion of the IUD as a contraceptive
• Previous ectopic pregnancy
• Genital tuberculosis

Factors that contribute to hydrosalpinx

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.

Symptoms

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.

Possible symptoms of hydrosalpinx

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%.

Hysterosalpingography

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.

Laparoscopy

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.

Diagnostic tests for hydrosalpinx

Treatment

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:

Salpingectomy

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.

Surgical treatment of hydrosalpinx

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.

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.

Pregnancy with hydrosalpinx

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.

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.

Effects of hyrdrosalpinx on fertility

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.

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?

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?

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.
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Can I get pregnant naturally if I have hydrosalpinx?

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?

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?

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.

Recommended reading

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.

References