What is Hydrosalpinx?
It is a condition where a fallopian tube becomes filled with fluid. This can occur due to inflammation, infection or scarring often as a result of pelvic inflammatory disease or previous surgeries. It can involve single or both the fallopian tubes
The live birth rate achieved with IVF among women with hydrosalpinges is approximately one half that observed in women without hydrosalpinges.
How does a patient present?
Patients may be asymptomatic or may present with pelvic pain or infertility.
How does it affect fertility?
The accumulation of fluid can prevent the egg from traveling through the fallopian tube to the uterus which makes it difficult for the egg to be fertilized by the sperm leading to infertility. Additionally, the fluid buildup within the fallopian tube can create a hostile environment for the embryo making it less likely for successful implantation to occur even if fertilization does happen. As a result, untreated hydrosalpinx can lead to infertility or an increased risk of ectopic pregnancy if conception does occur
The pregnancy rate observed among women with hydrosalpinges was 49% lower than that observed in women with tubal factor infertility without hydrosalpinges. The likelihood of miscarriage is also found to be 2.3-fold higher among women with hydrosalpinges.
How does hydrosalpinx affect IVF treatment and why should it be treated prior to starting IVF?
Several reports indicate that the presence of unilateral or bilateral hydrosalpinges adversely affects implantation and pregnancy rates achieved with IVF. Presence of HS is associated with significantly lower implantation and pregnancy rates after IVF. Spontaneous abortion rates and the risk for ectopic pregnancy are increased. Embryos appear to have reduced viability.


The negative effects of hydrosalpinx have generally been attributed largely to:
- Mechanical effects
- Embryo and gametotoxicity
- Alterations in endometrial receptivity markers; or dwindled cross talk between embryo-endometrium resulting in hindered implantation, and
- Direct effect on endometrium, leading to intrauterine fluid formation.
- Mechanical washout of embryos
- Negative impact on clinical and ongoing pregnancy rates
How is it diagnosed?
HSG
USG
MRI
Laproscopy
What does it look like on imaging?
- thin- or thick-walled (in chronic cases)
- elongated or folded, tubular, C-shaped, or S-shaped fluid-filled structure, cogwheel appearance
- distinct from the uterus and ovary.
What is the Treatment for Hydrosalpinx?
The presence of hydrosalpinx impairs the outcome of in-vitro fertilization embryo transfer (IVF-ET). Surgical methods to either isolate the affected Fallopian tubes or aspirate the fluid become necessary to improve the outcome. Following options can be considered
- Laproscopic Salpingectomy/proximal tubal occlusion
- Hysteroscopic insertion of device achieving tubal occlusion
- Tuberous sclerosis
- Aspiration of hydrosalpingeal fluid at the time of IVF procedure
Laparoscopic surgical treatment should be considered for all women with hydrosalpinx before IVF. Whenever laparoscopy is not recommended, hysteroscopic insertion of device seems the most effective option for management of hydrosalpinx before IVF.
Proximal tubal occlusion, salpingectomy and aspiration for treatment of hydrosalpinx scored consistently better than did no intervention for the outcome of IVF-ET. In terms of relative ranking, proximal tubal occlusion appeared to be the most effective intervention, followed by salpingectomy
