“Hydrosalpinx: Symptoms, Impact on Fertility, and Treatment Options”

Tubal factor is the cause of a majority of infertility cases worldwide. The fallopian tubes play a fundamental role in conception by intervening in ovulation, in the path followed by spermatozoa and in the implantation of the embryo.

We are going to discuss today the question of thehydrosalpinx which is characterized by an accumulation of fluid in the fallopian tubes and which is directly linked to infertility or difficulties in achieving pregnancy. For this, we will study its symptoms, its impact on fertility and its treatment.

What is a hydrosalpinx?

A lesion or blockage of the end of a fallopian tube can lead to the passage of a liquid which will fill the latter. This phenomenon is called hydrosalpinx. Hydrosalpinx can prevent a normal pregnancy in the womb when the tube is badly damaged or blocked and not working properly. The fallopian tube being blocked, the secretions accumulate. They can therefore go up in the uterus thus preventing the implantation of the embryo.

As for the cause of hydrosalpinx, it is probably caused by a previous tubal infection. This may have been sexually transmitted. It can also appear following surgery (especially tubal surgery), be caused by severe pelvic adhesions, endometriosis or other infections such as appendicitis.

We are talking unilateral hydrosalpinx when only one fallopian tube is affected and bilateral hydrosalpinx when neither of the two tubes is working properly. Most of the time the hydrosalpinx is unilateral. In this case, it can be a left or right hydrosalpinx.

Symptoms of a hydrosalpinx

Hydrosalpinx is not associated with any specific symptoms except for fertility issues already cited. In some cases, an ectopic pregnancy can reveal a tubal problem. Some women may also complain of regular or permanent pain in the pelvic cavity or lower abdomen, which may intensify in the period before and after menstruation.

In terms of consequences of hydrosalpinx on fertility, the fluid accumulated inside the tubes can prevent the development of embryos. Likewise, it can prevent the implantation of the embryo in the endometrium. Finally, it can also cause contractions of the endometrium which may disrupt the implantation of the embryo.

If the tubes are blocked, the egg cannot travel to the uterus. If only one fallopian tube is blocked, it is still possible to obtain a spontaneous pregnancy because the oocytes of the other ovary can reach the uterus. However, the accumulation of fluid in the affected fallopian tube could overflow into the uterus and prevent implantation of the embryo.

Diagnosis and treatment

There are three diagnostic techniques that make it possible to check whether one or both tubes are blocked.

• Hysterosalpingography (HSG). The specialist injects a special liquid into the tubes and then, using an x-ray, checks the movement of the liquid. If the fallopian tubes are permeable, the injected liquid flows from the ends of these towards the pelvic cavity. If the tubes are blocked, the fluid remains inside, which makes it possible to make a diagnosis of hydrosalpinx.
• Ultrasound. The diagnosis is made by ultrasound after observation of an increase in the volume of the fallopian tube.
• Laparoscopy. This surgical technique makes it possible to observe whether the tubes are blocked.

Can a hydrosalpinx disappear?

Treatment for hydrosalpinx varies depending on the degree of tubal obstruction. A laparoscopy may be indicated to remove scar tissue or other adhesions that may affect fertility.

The salpingectomie consists of total or partial removal of the affected tube. Tubal removal may allow recovery of reproductive function, but may damage surrounding ovarian tissue.

Another treatment, sclerotherapy, consists of guiding a needle under ultrasound to remove the fluid from the affected tube. The specialist then injects a so-called sclerosing substance intended to prevent the fluid from accumulating again.

A 2017 study shows that sclerotherapy can be an attractive alternative to salpingectomy because it can help increase success rates when performed before IVF. Other authors, however, deplore an insufficient number of studies on the subject and indicate that the existing studies do not take into account possible side effects.

ART solutions to achieve pregnancy

A number of solutions are offered to women with hydrosalpinx seeking motherhood. If the tubes are badly damaged, in vitro fertilization (IVF) will be recommended to them. In this case, the fallopian tubes have no role to play but it is certain that the hydrosalpinx can pose a problem at the time of embryo transfer.

L’tubal removal before IVF may lead to better results. Specialists often recommend that the woman concerned undergo tubal surgery before starting this type of treatment.

Come see an IVI specialist

If you are unable to achieve pregnancy, make an appointment with a specialist who can make a diagnosis to confirm whether or not hydrosalpinx is present. If the disease is confirmed, various treatments will be offered to you. The first step, however, is surgical treatment of the hydrosalpinx.

If you are unable to achieve pregnancy after a year of unprotected sex, make an appointment with a specialist. If you are over 35, you will need to consult after six months. At IVI, we can help you if you are affected by hydrosalpinx or any other condition that affects your fertility. Call us or fill out our online form. Our team will welcome you and inform you in French or set you up a first appointment.