What Is Hydrosalpinx? – Causes, Symptoms and Treatment

By MD (gynecologist), BSc, MSc (embryologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 05/27/2019

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.

Definition of hydrosalpinx

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.

Causes

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 salpingitiswhich favours the release of pro-inflammatory mediators in the tube and the accumulation of liquid inside it.

Other reasons for hydrosalpinx are as follows:

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.

Diagnosis

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
it 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 a little painful for women, but today there are improvements such as the use of the Exem Foam Kit that make it much easier.
Laparoscopy
it 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.

Treatment

When a diagnosis of hydrosalpinx is made, surgery by laparoscopy is generally the recommended treatment option. The most commonly used techniques are as follows:

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.

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.

On the other hand, if the cause of hydrosalpinx is an infection or PID, it will also need to be treated with antibiotics to prevent it from spreading. Doxycycline is usually the antibiotic of choice.

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 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 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.
  • 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.
  • The fluid can cause embryos to become trapped in the tube and result in an ectopic pregnancy.

This is why it is so important to perform salingectomy 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.

Interview with Dr. Elena Martín

In the following video, Dr. Elena Martín talks about the pathology of hydrosalpinx and what are the reproductive options to achieve pregnancy.

Usually, hydrosalpinx is of infectious origin, in the majority of cases, often after a sexually transmitted disease.

In the case of bilateral hydosalpinx, in vitro fertilization should be used.

In the case of a unilateral hydrosalpinx, a natural pregnancy may be possible but with a risk of ectopic pregnancy since the embryo could develop in the fallopian tube, which would prevent the pregnancy from being carried to term.

FAQs from users

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

By Sara Salgado BSc, MSc (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.

Can I get pregnant naturally if I have hydrosalpinx?

By Sara Salgado BSc, MSc (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 BSc, MSc (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.

Suggested for you

We have seen that one of the origins of hydrosalpinx could be endometriosis. If you would like to know more about this pathology, we invite you to read the following article: What Is Endometriosis? – Causes, Symptoms and Treatment

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.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

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.

Reproducción Asistida.ORG - video of Dr Elena Martín on hydrosalpinx from 08/02/16 [See original video here]

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?', 'Can I get pregnant naturally if I have hydrosalpinx?' and 'What is piosalpinx and how does it heal?'.

Read more

Authors and contributors

 Elena Martín Hidalgo
Elena Martín Hidalgo
MD
Gynecologist
Bachelor's Degree in Medicine & Surgery from the University of Salamanca. Specialty in Gynecology & Obstetrics with training at the Virgen de la Salud Hospital of Toledo. Specialist in Reproductive Medicine with over 20 years of experience. Contributor of the Spanish Fertility Society (SEF) as a teacher and trainer of students of Master's Degree in Human Reproduction. Medical Director of clinic Reprofiv. More information about Elena Martín Hidalgo
License: 28454504653
 Sara Salgado
Sara Salgado
BSc, MSc
Embryologist
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
BSc, MSc
Embryologist
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:
 Marie Tusseau
Marie Tusseau
inviTRA Staff
Editorial Director of Babygest magazine in French and English More information about Marie Tusseau

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