How does hydrosalpinx effect female fertility?
What is Hydrosalpinx?
Hydrosalpinx, derived from Greek, is a word literally meaning “water tube”. A Hydrosalpinx is an enlarged fluid filled-fallopian tube usually caused by a block at the far end of the tube.
What causes a Hydrosalpinx to develop?
- Injury to the far end of the fallopian tube causes the end of the tube to close.
- Glands within the tube produce a watery fluid that collects within the tube, producing a sausage-shaped swelling.
- Causes of hydrosalpinx: are sexually transmitted infections like chlamydia and gonorrhea, which can run undetected for years, slowly injuring and destroying the delicate fimbria. Other causes include endometriosis, appendicitis, and abdominopelvic surgery.
What Effect Does Hydrosalpinx Have on Fertility?
Not only does a hydrosalpinx cause infertility, but it can also reduce the success rate of fertility treatment. The blocked tube can communicate with the uterus, and the fluid from the tube can sometimes leak back into the uterine cavity. This fluid is believed to be toxic to the early embryo development and certainly provides an unfavorable environment. A large amount of the fluid flow back into the uterus can produce enough flow that embryos find it difficult to attach.
Does Hydrosalpinx Cause Symptoms?
Many patients with a hydrosalpinx suffer from chronic or recurrent pelvic pain, while others have no symptoms. Patients with a hydrosalpinx are more susceptible to repeated acute tubal infections, which can cause fever and pain.
How Can a Hydrosalpinx Be Diagnosed?
Ultrasound
The best view, most of the time, is obtained with a vaginal ultrasound. A normal fallopian tube is usually not visible; a hydrosalpinx appears as a characteristic sausage-shaped fluid collection between the ovary and fallopian tube.
Laparoscopy
Diagnostic tests such as ultrasound and HSG are not 100% accurate. Laparoscopy usually will confirm the diagnostic tests, but can show that tubes that were thought to be normal actually have significant disease, and vice versa. The risks of anesthesia and surgery dictate that laparoscopy is used for definitive therapy, rather than as a diagnostic test.
Why Remove Hydrosalpinx Before IVF?
There is research evidence to suggest that removal of hydrosalpinx before IVF, significantly improves the success rates by interruption of the leakage of hydrosalpinx fluid into the uterine cavity. This in turn, reduces significantly, the chances of an ectopic pregnancy.
Surgical Options for Treating Hydrosalpinx Before IVF
There are two main ways of dealing with a hydrosalpinx surgically.
- Laparoscopic Salpingostomy (opening the tube) and clipping of the affected tube - Opening up the fluid-filled tube with a small cut over the tube and draining the fluid and Applying a clip to occlude the tube near the uterine end, so as to stop any fluid leaking into the uterus This conserves the tube, but however the fluid can reaccumulate. The clip prevents any reaccumulated fluid leaking into the uterine cavity. This is the preferred option in women with severe scarring where it is difficult to completely remove the tube.
- Laparoscopic Salpingectomy- Removal of the affected tube through a Laparoscope - This is a much more radical operation as compared to the first option; wherein the entire length of the tube is removed. This may not be acceptable to many women. Moreover, there is slight anxiety among reproductive specialists, that this procedure may compromise the blood supply to the ovary (which is very close to the tube).
Both these procedures have more or less similar efficacy in improving the IVF success rates.
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