What are hydrosalpinx and how they can affect my fertility?

Dr Ángela Llaneza
Fertility Specialist at Clinica Tambre, Clinica Tambre

Category:
Fertility Assessment, Reproductive surgery

From this video you will find out:

What is hydrosalpinx?
How does this condition affect fertility?
How is it diagnosed?
In what ways can it be treated?

What are hydrosalpinx and how they can affect my fertility?

During this webinar, Dr Ángela Llaneza, Fertility Specialist at Clinica Tambre explained what Hydrosalpinx is, how it impacts your reproductive health, its causes, symptoms, and potential consequences for fertility. Dr Ángela Llaneza, also discussed the complexities of hydrosalpinx, offering valuable insights into its diagnosis and treatment options.

Hydrosalpinx, as the name suggests, is an abnormal accumulation of fluid within the fallopian tube. This fluid can be either liquid or, in some cases, blood, known as hematosalpinx. The presence of this fluid can lead to blockages and dilation of the fallopian tubes, making it challenging for conception to occur.

Causes and early signs

Infections are the primary cause of hydrosalpinx, with conditions like chlamydia infection and inflammatory pelvic disease contributing to its development. While often unilateral, it can affect both tubes. Early symptoms may include chronic pelvic pain, dyspareunia, menstrual disorders, and difficulties in achieving pregnancy.

Hydrosalpinx significantly affects fertility, disrupting the normal process of sperm meeting the ovulated egg within the fallopian tubes. Blockages and obstructions hinder fertilization, making conception more challenging.

Diagnosis

Two primary diagnostic methods exist, sonohysterography and hysterosalpingography. The latter involves the introduction of a contrast medium into the cervix and uterus to visualize the tubes and any blockages. This procedure can be invasive and somewhat painful.

Hysterosalpingography has evolved, and today, we have hysterosalpingo-contrast sonography (HyCoSy), a less painful and more accessible option for diagnosing hydrosalpinx. It offers a clearer view of the uterine cavity, aiding in early detection.

In cases of confirmed hydrosalpinx, the preferred treatment is in vitro fertilization (IVF). Removing the hydrosalpinx before embryo transfer is essential, as the fluid within the tubes can negatively impact pregnancy outcomes and endometrial receptivity.

Conclusion

Understanding hydrosalpinx and its implications for fertility is crucial for those facing difficulties conceiving. With advancements in diagnostic techniques and treatment options like IVF, there is hope for individuals dealing with this condition to achieve their dream of parenthood.

- Questions and Answers

How soon should I seek treatment for hydrosalpinx if I’m planning to conceive, and what is the success rate of treatment in terms of improving fertility?

If you know that you have hydrosalpinx, the medical advice is to get it removed. There are different approaches, but the most advised one is removing the fallopian tube affected by the hydrosalpinx. So, if you do have hydrosalpinx, it is recommended to treat it before attempting to conceive. The success rate of the treatment depends on other factors, including certain markers. Your gynaecologist should address all these topics before proceeding with treatment.

Are there other reasons for fluid in the uterus?

Yes, there can be other reasons for fluid in the uterus. One reason could be the physical blockage of the sharing of endometrium and menstrual fluid, such as fibroids, especially in the middle third of the uterine cavity. In some cases, abnormal endometrial functioning can lead to the accumulation of mucus inside the endometrial cavity. These issues are often related to hormonal imbalances or histopathological anomalies in the endometrium. The approach to addressing this should be individualized based on your specific case and ultrasound findings.

Can hydrosalpinx be caused by endometriosis?

Endometriosis can indirectly contribute to the development of hydrosalpinx. While the main effect of endometriosis is not the formation of hydrosalpinx themselves, it can lead to pelvic inflammatory disorder (PID) in some cases. Inflammation associated with PID can result in adhesions, where the fallopian tube becomes stuck to nearby structures, potentially leading to hydrosalpinx. Additionally, endometriosis can cause retrograde menstrual bleeding into the tubes, which may contribute to the development of hydrosalpinx.

Is there a direct relationship between hydrosalpinx caused by infectious causes and chronic endometritis?

While there is a physiological and pathological possibility that hydrosalpinx caused by infectious agents could be related to chronic endometritis, it’s not the most common scenario. Chronic endometritis is typically not related to acute infections. It is often associated with hormonal imbalances or other unknown causes. While it’s a plausible explanation, it’s not the most prevalent one.

I had fluid in the uterus while preparing for a natural cycle frozen embryo transfer, but it cleared on time. The doctor suggests removing the tubes before the next transfer, even though there was no hydrosalpinx seen on any scan. What can you advise in this situation?

If all possible causes of fluid in the uterus have been ruled out, and you’re considering removing the tubes, it’s a decision that should be carefully discussed with your healthcare provider. Diagnostic laparoscopy is no longer advised for endometriosis according to the latest guidelines. A well-performed 3D ultrasound can often provide valuable information about fibroids and rule out hydrosalpinx It’s essential to have a thorough discussion with your doctor before deciding on further surgery.

Can open myomectomy result in hydrosalpinx?

It’s unlikely that an open myomectomy (surgery to remove fibroids) would directly result in hydrosalpinx. While hydrosalpinx can be related to pelvic inflammation and adhesions, they are not typically a direct outcome of myomectomy. However, any surgery can have potential complications, so it’s crucial to discuss your specific case and concerns with your healthcare provider.

Should patients with hydrosalpinx be treated broadly with antibiotics, considering most cases are infectious?

While hydrosalpinx may initially be related to infection, broad antibiotic treatment is not the standard approach. If there is a strong interest in preserving the fallopian tubes, prophylactic antibiotic treatment may be considered. However, the primary treatment for hydrosalpinx is usually surgical, either to aspirate the fluid or remove the affected tubes.

After surgery to remove hydrosalpinx, is there still a chance to get pregnant naturally?

There is a minimal chance of getting pregnant naturally after surgery to remove hydrosalpinx. While it’s not impossible, the odds are quite low, likely less than 1%. Removing the tubes decreases the risk of ectopic pregnancy, but it also reduces the chances of natural conception.

What are the risks during the removal surgery for hydrosalpinx?

The surgery to remove hydrosalpinx is generally considered straightforward and low-risk. It’s a common procedure, and complications are rare, especially when dealing with isolated hydrosalpinx. However, more complex surgeries may be required if there are additional factors involved, such as deep infiltrating endometriosis. But for typical cases, the procedure is safe and well-tolerated.

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Authors

Dr Ángela Llaneza

Dr Ángela Llaneza is a Fertility Specialist at Clinica Tambre, Madrid, Spain.

Event Moderator

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.

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