Hydrosalpinx is yet another cause of infertility. A hydrosalpinx occurs when a damaged fallopian tube fills with fluid. In a normal functioning fallopian tube, fluid is both secreted and then later reabsorbed. As tubes become damaged they are still able to secrete fluid but can no longer reabsorb it. In general, a hydrosalpinx occurs when the very end of the tube is blocked and then the tube fills with clear, watery fluid.
Hydrosalpinx is usually a consequence of pelvic infectious/inflammatory disease spreading into the uterine tubes and pelvis via the cervix and uterus. Some of these diseases manifest themselves with significant clinical symptoms (pain, fever, malaise, nausea). Some of them might go unnoticed because the symptoms of pelvic infection/ inflammation are mild and may be misinterpreted as urinary bladder infection or "bowel" problems.
The infection and/or pelvic adhesions (scar tissue) that causes hydrosalpinx can result from any number of factors, including:
- other sexually transmitted diseases
- having a baby
- having an abortion
- having an IUD inserted.
There are several research studies being conducted that are looking at the effects of tubal fluid spilling back into the uterine cavity. It is thought that this process can inhibit implantation and may lead to miscarriage. For patients who have hydrosalpinx on both sides of their tubes, the only possible way to get a chance at "natural" conception is surgery.
Hydrosalpinx and IVF Failure
Multiple studies in the past few years have found that women with a hydrosalpinx have a lower chance for a successful pregnancy when undergoing IVF (in-vitro fertilization) than women with normal fallopian tubes. Some studies show that if the hydrosalpinx is surgically removed before an IVF cycle attempt, that women can then expect similar pregnancy rates to women who have normal fallopian tubes when using the IVF technique. A similar result can be achieved without completely removing the hydrosalpinx by burning the tube surgically. These procedures (tubal removal or cautery) can usually be accomplished with a laparoscopy.
The reason that patients with a hydrosalpinx have lower pregnancy rates with IVF seems to be that the fluid which accumulates in the hydrosalpinx can go back in to the uterus and diminish the chance for an embryo to implant. The fluid itself may be toxic to the embryo, or may just mechanically decrease the chance for implantation. At least one study has concluded that hydrosalpinx fluid is highly embryotoxic and is a likely cause for the decreased fertility in women with a hydrosalpinx. In fact, the spontaneous abortion risk is doubled.
Detecting a Hydrosalpinx
Certainly any patient with tubal factor and good embryos who fails to conceive in an IVF cycle should have a repeat hysterosalpingogram to determine whether a hydrosalpinx may be hiding behind the uterus or in a difficult to detect place.
Statistically it seems as though a woman going through an IVF cycle with a hydrosalpinx will have half the chance of having a successful pregnancy that she would have if the hydrosalpinx was removed or cauterized before the IVF cycle. Because of this, women going through an IVF cycle who may have a hydrosalpinx, should consider laparoscopic surgery to remove or cauterize her tubes prior to undergoing IVF. Surgical repair of the hydrosalpinx (Salpingostomy) has been performed for decades. This would also decrease the small chance of developing an ectopic (tubal) pregnancy with an IVF treatment.
Removal of the tube has been viewed with skepticism because once the tube is removed, there is no way back. There is no way to undo this particular procedure. A number of researchers have questioned changes of the ovarian function in situations where extensive destructive surgery is performed on the tube (sometimes even lesser intervention, i.e., tubal sterilization). The tube and ovary share significant part of the blood supply and destruction of one conceivably can affect the other.
However, surgical treatment options should be discussed carefully with your physician because of the possibility of complications such as infection and bleeding that can occur, not to mention the difficulty that may be encountered with surgery. In addition, there is not a great deal of research available on success rates following surgery.
- Detrimental Effect of Hydrosalpinx Fluid on the Development and Blastulation of Mice Embryos in Vitro° R. Sachdev, E. Kemmann, M. Bohrer, I. El-Danasouri. Dept. of OB/GYN, Div. of Reprod. Endo. & Fertility, Robert Wood Johnson Medical School, New Brunswick, NJ
- Hydrosalpinx Reduces In Vitro Fertilization-Embryo Transfer Implantation Rates and In Vitro Blastocyst Development M. R. Freeman, C. M. Whitworth, G. A. Hill. Center for Assisted Reproduction and Reproductive Endocrinology, Centennial Medical Center, Nashville, TN
- Hydrosalpinx reduced the IVF pregnancy rate by half and doubled the spontaneous abortion rate: Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization-embryo transfer. Zeyneloglu HB, Arici A, Olive D. Fertil Steril 1998; 70:492-9.
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