28 Sep Hydrosalpinx – does it reduce fertility?
A hydrosalpinx is a tubal blockage. Until it’s diagnosed, you may never have heard of it. But if you’ve had problems getting or staying pregnant, a hydrosalpinx could be the cause. So what exactly is a hydrosalpinx and how does it affect fertility? Here are the facts.
A hydrosalpinx is a collection of toxic fluid in a fallopian tube. It’s also called a distal tubal occlusion. Fluid is secreted by cells in the tube, often as a delayed side effect to a past STD like chlamydia or gonorrhoea. The fluid has nowhere to go. It bulges into the tube, like a sausage, blocking it. You may not have any symptoms. But a hydrosalpinx is a trouble maker, affecting a women’s fertility in two ways.
First, a blocked tube means your egg can’t travel down it. So fertilisation won’t occur. If one tube is out of action, this may reduce your chances of a natural pregnancy. If you’ve got hydrosalpinges in both tubes – a bilateral tubal occlusion – your conception chances are virtually nil. The only solution is IVF treatment.
But you’re not out of the woods yet. A hydrosalpinx is still a danger for fertility patients. While assisted conception bypasses the tubes and transfers the embryo into your uterus, the threat from an untreated hydrosalpinx remains. The fluid can drip into your womb. This can play havoc with the uterine environment in the early weeks of pregnancy – and often before implantation. Fluid gushing onto the actual embryo can be fatal. For fertility patients, a hydrosalpinx can reduce the chance of success by up to 50 per cent.
A hydrosalpinx will show up in a transvaginal ultrasound scan, HSG or laparoscopy. IVF patients usually spot the problem more quickly than women trying to conceive naturally, since they have routine scans before and during treatment. But non-fertility patients may have tried to get pregnant for months, or years, without knowing that a hydrosalpinx existed. That’s why, if you’re trying for a baby, you should have regular scans.
So what can be done? Two options exist: clipping the tube or removing it. Clipping, known as a laparoscopic salpingostomy, uses keyhole surgery to drain the fluid and block the tube at the uterine end. Removing the tube, called a laparoscopic salpingectomy, is a more radical option but it ensures no further build-up of fluid. Some studies suggest tubal removal can have an adverse effect on future ovarian response during IVF cycles.
Which procedure should you have? Looking at the many published studies, and taking into account what our clinic has advised patients, removing the tube affected by the hydrosalpinx seems to be the optimal route. But every patient is different, so speak to your doctor. New research even suggests that IVF patients could have the hydrosalpinx dealt with during egg retrieval. Quite how many fertility clinics would do this is another matter.
Some fertility patients may be inclined to chance it and do nothing, perhaps seeing if the first treatment cycle works despite the presence of the hydrosalpinx. If you’ve got a number of viable embryos that could be frozen for future attempts, this approach may have traction. But the general rule is: fix the hydrosalpinx first.
A hydrosalpinx is a significant barrier to a successful IVF outcome. Until we see a reduction in pelvic inflammatory disease – a key cause of the problem following STD infection – hydrosalpinges will continue to affect a woman’s fertility. The good news? They’re treatable.