What is a hydrosalpinx?

A hydrosalpinx is a fallopian tube that is both blocked and filled with fluid. If you want to become pregnant then having a hydrosalpinx is a problem because the blockage prevents your egg and sperm meeting and the fluid inside the tube may be toxic to eggs and embryos. There are a number of possible approaches to treatment including hydrosalpinx surgery to re-open the blockage and in-vitro fertilization (IVF). Choosing the best treatment for you will involve consulting a highly experienced fertility specialist who is expert at all of the available treatment options including surgery and IVF.

Normal fallopian tubes

A normal fallopian tube picks up an egg each month as it is ovulated (released) from the ovary. Once in the fallopian tube, the egg meets sperm after it has travelled upwards through the vagina, cervical mucus, and uterus. Fertilisation occurs when the egg and sperm join together in the fallopian tube to form an embryo (fertilised egg). The embryo then travels through the tube into the uterus, and when it implants in the uterine wall, you are pregnant. 

Hydrosalpinx (blocked fallopian tubes)

If you have a hydrosalpinx, one or both of your fallopian tubes are blocked, filled with fluid, and enlarged (dilated). This blockage stops egg and sperm from meeting, so fertilisation and pregnancy cannot occur. (If you have a hydrosalpinx in one fallopian tube only, you may still be able to fall pregnant, as the other fallopian tube may still be working normally. Your fertility specialist will be able to advise you on treatments in this situation.)

How could I have developed a Hydrosalpinx?

 A hydrosalpinx is usually caused by an old or chronic infection in the fallopian tubes. Or it might have been caused by a previous surgery (particularly a surgery on the tube) or marked adhesions (scar tissue) within your pelvis.

Symptoms of hydrosalpinx

Many women with a hydrosalpinx have no symptoms. Others have significant pelvic and/or abdominal pain, usually associated with scar tissue (adhesions) and/or chronic inflammation. You might also notice an unusual vaginal discharge.

Tests for hydrosalpinx

There are three ways your fertility specialist can check to see if you have a hydrosalpinx:

• 1. Hysterosalpingogram or a Sono-hysterogram
• 2. Laparoscopy

• 3. Ultrasound

A Hysterosalpingogram or a Sono-hysterogram

One option is to have an x-ray called a hysterosalpingogram (HSG) or a specialised ultrasound examination (sono-hysterogram). In these tests a contrast fluid is inserted into your fallopian tubes. If your fallopian tubes are open, the contrast will flow out of the ends of the tubes. If, they're blocked, the fluid will be trapped, and your fertility specialist will be able to tell that you have a hydrosalpinx.

NOTE: Sometimes an HSG may falsely suggest that your fallopian tubes are blocked in the region where they join your uterus (a 'false positive' test). This false positive finding can occur in approximately 15% of women. For more information on these investigations please refer to our hydrosalpinx fact sheet.

A Laparoscopy

Your fertility specialist could perform a laparoscopy. During this telescopic (keyhole) surgery, your fertility specialist will look directly at your fallopian tubes to see if they're blocked. S/he will insert dye through your cervix into the uterus and fallopian tubes, then watch to confirm that it passes through the ends of your tubes. For more information on laparoscopy please refer to our fertility surgery web page.

An Ultrasound Examination

Your fertility specialist may perform an ultrasound examination in order to assess your fallopian tubes. Note, however, that while fluid-filled fallopian tubes can be seen during an ultrasound examination, there can also be false positive results as other fluid-filled structures can occur in your pelvis that have the potential to look like a hydrosalpinx.

What treatments are available for hydrosalpinx?

Hydrosalpinx surgery

If your fertility specialist has undergone extensive training in fertility surgery, s/he could open your fallopian tubes, usually with laparoscopic (keyhole) surgery.

Success rates of hydrosalpinx surgery

Generally, the success rate of surgery varies between 20% and 60%, depending upon whether your fallopian tube(s) are damaged. Specifically:

• how well preserved the ends of your fallopian tubes are (the fimbraie);
• how dilated (enlarged) your tubes are;
• how thick the walls of your tubes are;
• how much scar tissue (adhesions) is present; and

• whether your tubes are blocked at more than one point.

Salpingoscopy

If you are having hydrosalpinx surgery, your fertility specialist may be able to look inside your fallopian tube(s) at the same time in order to check if the tubal mucosa (the inside lining of the fallopian tube) is damaged, and so give you more accurate information about whether surgery is likely to succeed. This type of procedure is called salpingoscopy or falloposcopy. The information provided by a salpingoscopy can be very important in helping you decide on what to do next.

Risks of hydrosalpinx surgery

There is an 8-10% risk of getting a tubal (ectopic) pregnancy following hydrosalpinx surgery.

In-vitro fertilisation (IVF)

If you aren't suited to hydrosalpinx surgery, or you don't want surgery, you'll need a treatment that doesn't involve your fallopian tubes (one that sidesteps them altogether). This treatment is called in-vitro fertilisation (IVF).

In IVF, your egg and your partner's sperm are fertilised in a laboratory. Then your fertility specialist places the fertilised egg (embryo) into your womb (uterus). For more information on IVF please refer to our IVF web page.

IVF complexities introduced by hydrosalpinx

For unknown reasons, IVF may not work if you have hydrosalpinx. This may be because the fluid in the tube is toxic to embryos. So your fertility specialist may recommend that your fallopian tube(s) be removed or separated from your uterus, before you start IVF treatment.

More research is required to determine whether it's better to remove the tube altogether or merely block it, by placing a clip across the tube where it joins the uterus (similar to a sterilisation operation).

Note that if you you've had multiple operations in the past such as for a bowel condition (e.g. colitis), fallopian tube surgery may be too risky. Instead, your fertility specialist may advise a procedure whereby your fallopian tube is drained through a needle (under anaesthetic) just before your eggs are collected for IVF.

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