What is Hydrosalpinx?
Hydrosalpinx, a term derived from Greek, literally means “water tube.” As a medical term, it’s used to describe a condition in which the fallopian tube is distended with fluid. When both tubes are distended, the condition is referred to as hydrosalpinges and both are common types of tubal problems that causes infertility.
Almost half of all couples that deal with infertility struggle with female-factor conditions or causes. Of these women, more than half have a disease in the upper female reproductive tract, and approximately one-third of them have hydrosalpinges.
What Causes Hydrosalpinx?
A hydrosalpinx is almost always a result of a past pelvic infection. The most common bacteria at fault are gonorrhea, chlamydia, staphylococcus, streptococcus and pelvic tuberculosis. There may be more than one cause of hydrosalpinx, however. Other factors include prior pelvic surgeries, adhesions, endometriosis, and certain tumors may also cause hydrosalpinx.
How Do You Diagnose Hydrosalpinx?
Hydrosalpinx is best detected through either radiographic imaging or surgery. In some cases, a transvaginal ultrasound can odetect a hydrosalpinx, but the majority of them cannot be observed through this method. The usual first line approach is an x-ray called an HSG—hysterosalpingogram (uterus/tube/picture). Opaque dye is instilled through the cervix with a catheter into the uterus and eventually the tubes. A hydrosalpinx is then identified when the tube appears dilated and will not allow the dye to spill out into the peritoneal cavity. If the tube is blocked at the junction of the uterus and tube, however, then the dye will not enter the hydrosalpinx and it will not be seen on the HSG. Consequently, the most accurate way to assess the tube is by laparoscopy. Not only can a surgeon directly visualize a hydrosalpinx, but also evaluate the presence of other pelvic pathology.
Hydrosalpinges can greatly impair fertility. Because the sperm cannot reach the egg for fertilization, the egg cannot be picked up by the tube and an embryo cannot travel back to the uterus for implantation. This means the only way for couples to get pregnant is to repair the tube or bypass it.
How is it treated?
Historically, hydrosalpinges were only repaired surgically. Surgeon’s would make a small abdominal incision to confirm the diagnosis, remove surrounding adhesions and open the distal end of the tube. Despite temporarily relieving the problem, subsequent pregnancy rates were very poor because post-operative adhesions would typically return. Even though there have been a number of advances during the 70’s, 80’s, and 90’s most patients continue to have very disappointing results. Unfortunately, opening an obstructed tube still leaves a patient with a damaged tube unable to pick-up the egg or move the embryo to the uterus.
The most efficient (not to mention cost effective) way to conceive is to bypass the obstruction via In vitro fertilization (IVF). This takes the egg out of the body for fertilization by sperm in a petri dish. IVF is effectively nothing more than replacing than artificially replacing the function of the fallopian tubes and is the most effective way for a patient with a hydrosalpinx to get pregnant.