Горщаник Юлия Владимировна
Врач акушер-гинеколог, репродуктолог, эндокринолог, специалист УЗ-диагностики

What is hydrosalipinx and how does it affect fertility?

The tubes that connect the ovaries and the uterus are known as the fallopian tubes (fallopian tubes).  These structures play an important role in natural conception, this is where the connection of the egg and sperm (fertilization) takes place.  The fallopian tubes also allow you to transfer the resulting embryo to the uterus, where the development of pregnancy will take place.

The fallopian tube has two ends.  On the one hand, it is attached to the uterus, on the other, which is called the ampullary – freely connects with the abdominal cavity and close to the ovary, so that the fimbriae contained at this end of the tube can capture the egg during rupture of the follicle (ovulation) and ensure meeting with  sperm.  Impaired patency of the fallopian tubes significantly determines the likelihood of pregnancy.

 Among the main causes of female infertility, the tubal factor is 25-35%.  In particular, hydrosalpinx is found in 10-30% of couples with infertility.

Що таке гідросаліпінкс і як впливає на фертильність?

Hydrosalpinx is a chronic condition characterized by the accumulation of fluid in the fallopian tube due to the closure of its lumen.  The walls of the fallopian tube initially thicken due to swelling and inflammation, and with prolonged tissue destruction that can occur over several years, the walls lose the muscle layer and the tube expands into a fluid sac.  In the fallopian tube, inflammation can cause the loss of fimbriae (protrusions at the end that allow the egg to enter the fallopian tube) and smoothing, loss of villi, which are very important to support the movement of sperm to the site of fertilization.  for five to six days after fertilization of the egg.

Hydrosalpinx can be both unilateral and bilateral.  The amount of fluid, and hence the size of the tubes, can change during the menstrual cycle, and sometimes hydrosalpinx can only occur during ovarian stimulation, when serum hormones are particularly active.

Hydrosalpinx is rarely an acute condition and is often an accidental finding during ultrasound.  If the fluid becomes infected (pus forms), it is piosalpinx; if it is bloody, hematosalpinx is a condition that needs immediate treatment.

The causes of this condition are different, and the symptoms can vary depending on the specific situation.  Some women do not experience any symptoms, but hydrosalpinx can have a serious effect on fertility.

Why does hydrosalpinx reduce fertility?

It is assumed that hydrosalpinx fluid drains into the uterus and has a toxic effect on the embryo, reduces the receptive sensitivity of the endometrium, adversely affects the opening of the implantation window and the ability of the embryo to attach, the formation of a healthy chorion (future placenta).  leads to the appearance of endometrial polyps, non-uniform thickening (focal hyperplasia).

Hydrosalpinx and Infertility

During conception, the egg moves from the ovary through the fallopian tube to the uterus.  Hydrosalpinx causes obstruction of the fallopian tube by fluid, so the egg cannot pass through the tube.  In addition, the fimbriae, which help pull the egg out of the ovary into the fallopian tube, can stick together and make it impossible to meet the sperm.

If only one fallopian tube is blocked, you can get pregnant without intervention, because an egg from another ovary will still be able to reach the uterus, but the chances of a successful pregnancy remain low.

What are the causes of hydrosalpinx?

There are several different reasons that can lead to the development of hydrosalpinx.  The most common include:

  • inflammatory diseases of the pelvic organs
  • Sexually transmitted infections (STIs) (eg chlamydial or gonococcal infection): Hydrosalpinx is most often the result of adhesions from the pelvic inflammatory process.
  • hypothermia
  • endometriosis
  • operations in the abdominal cavity
  • neoplasms of the pelvic face: primary or secondary tumors of the fallopian tubes
  • ligation of the fallopian tubes for surgical sterilization

Symptoms of hydrosalpinx:

Symptoms of hydrosalpinx can be:

  • pain, discomfort in the lower abdomen (during sports, sexual intercourse).
  • unusual discharge.

However, you can have hydrosalpinx and not experience any symptoms.

Because hydrosalpinx affects infertility, many women find that they have the condition just by trying to conceive.

With this pathology significantly increases the likelihood of tubal pregnancy.  It is ectopic pregnancy and miscarriage may be the first signs of obstruction of the fallopian tubes.

What is dangerous hydrosalpinx?

  •  Loss of pregnancy.
  • Becluding the movement of the embryo, provokes the development of tubal pregnancy.
  • When joining a bacterial infection – the development of an acute condition called piosalpinx (manifested by fever, acute pain, inflammatory changes in the blood until the development of a general toxic reaction of the whole organism)
  • Hydrosalpinx of the big sizes has the increased risk of a torsion of a uterine tube with disturbance of blood supply on it and demands immediate operation.
  • Chronic inflammation of the fallopian tube often leads to changes in the uterine cavity (endometrium), the development of chronic endometritis (inflammation of the endometrium), the development of polyps.

IVF and hydrosalpinx

IVF is now the main way to treat women with hydrosalpinx to achieve pregnancy.

With the advent of IVF, which bypasses the need for fallopian tubes to function, a more successful approach to treatment has become available for women who want to become pregnant.

Hydrosalpinx reduces the likelihood of implantation and increases the risk of miscarriage after embryo transfer by 50%.  Therefore, it is recommended to remove the diseased fallopian tube before embryo transfer into the uterine cavity.

 How to avoid hydrosalpinx?

Given that hydrosalpinx is usually the result of an infection, it is recommended to lead a lifestyle that reduces the risk of sexually transmitted diseases and early intervention with antibiotics in cases of pelvic infection.

 Diagnosis of hydrosalpinx

Hydrosalpinx is well diagnosed during OMT ultrasound, if necessary, MRI may be prescribed.

It is strongly contraindicated to perform metrosalpingography (checking the patency of the fallopian tubes) for hydrosalpinx because during the introduction of contrast there is a high risk of stimulating the spread of infection.

Hydrosalpinx treatment

Most often at hydrosalpinx removal of the struck uterine tube is offered.

When planning a pregnancy and before IVF, it is also necessary to eliminate the source of inflammation, to increase the likelihood of attachment of the embryo and a favorable course of pregnancy.

Treatment of hydrosalpinx – only surgical (additionally prescribed antibiotic therapy to eliminate the root cause – infection).  In each case (depending on the age of the woman and the degree of development of the inflammatory process) a decision is made about the type of operation.  If possible, the fallopian tubes are reconstructed, but there is always a high risk of recurrence.

With significant damage to the fallopian tubes, it is necessary to remove them with subsequent conception by IVF (when planning a pregnancy).

What if I’m not trying to get pregnant, but I have gyrosalpinx?

If a woman is not planning a pregnancy but has symptoms such as severe pain caused by hydrosalpinx that cannot be treated with painkillers, surgical treatment to remove the affected fallopian tube (salpingectomy) should be considered.