Hydrosalpinx is an infertility condition in women that is frequently undiagnosed until conception becomes a problem. Research shows that around 10-20% of all infertility cases are caused by hydrosalpinx. 

This condition clogs the fallopian tubes with fluid, which can severely inhibit natural pregnancy, making it a serious issue to treat for gynaecologists and future doctors, too. Hence, having a thorough understanding of its causes, signs, diagnosis, and current treatment options is essential to help intervene effectively. 

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Keep reading to learn more about hydrosalpinx.

What is Hydrosalpinx?

Hydrosalpinx is a medical disorder that happens when one or both of the fallopian tubes get clogged and fill with fluid. This causes the affected tube(s) to swell and makes it harder for them to reproduce. The term hydrosalpinx comes from Greek, with “hydro” meaning water and “salpinx” meaning tube. 

In normal circumstances, the fallopian tubes serve as a pathway for an egg to move from the ovary to the uterus and for sperm to encounter the egg. The fluid in hydrosalpinx blocks the pathway for fertilisation or movement of the embryo towards the uterus, which can impact the chances of conception and increase the risks of infertility.

What are the Symptoms of Hydrosalpinx?

In many cases, several women find out that they have hydrosalpinx after they have trouble getting pregnant. However, if there are signs or symptoms, they include the following:

• Infertility: This is one of the most common hydrosalpinx symptoms. A fluid-filled blockage in the fallopian tubes can prevent the sperm from meeting the egg or prevent a fertilised egg from reaching the uterus. 
• Pelvic or Lower Abdominal Pain: Pain can be chronic or acute, and it may get intense during menstruation or after side effects from menstruation. This is due to inflammation or the accumulation of fluid from the blockage.
• Unusual Vaginal Discharge: A discharge that is discoloured or sticky may occur, and this is an important indication of underlying inflammation.
• Pain with Intercourse (Dyspareunia): Some women report, especially with inflammation or with some adhesions present, pain with sexual activity.
• Menstrual Irregularities: Some women may experience irregular periods due to an associated disturbance from the issue with the reproductive system, although this is less common.
• Other Possible Symptoms: Although rare, changes in weight and hormone-associated symptoms may also be some signs of hydrosalpinx.

What are the Causes of Hydrosalpinx?

Hydrosalpinx can result from various conditions. The possible causes are as follows:

• Sexually transmitted infections (STIs)
• Endometriosis
• Scarring resulting from surgery for appendicitis and other issues
• Infection in a fallopian tube
• Inflammation due to appendicitis
• Previous surgery on the fallopian tube

What is the Diagnosis of Hydrosalpinx?

Diagnosis of hydrosalpinx involves a combination of taking a medical history, performing a physical examination, and conducting certain imaging tests to establish fluid accumulation and blockage of the fallopian tubes. Here are the major diagnostic methods:

• Pelvic Ultrasound: It is quite often the first step in identifying any abnormality. While normal fallopian tubes are not normally seen on ultrasound, tubes with hydrosalpinx can be seen as swollen, stretched, or sausage-like due to fluid collection.
• Hysterosalpingography (HSG): A standard diagnostic procedure, HSG involves injecting a contrast dye into the fallopian tubes and uterus, followed by X-ray imaging. 

If the dye seeps freely into the pelvic cavity, the tubes are patent. If it’s blocked, it means there is a blockage—more likely a hydrosalpinx.

• Sonohysterography (Saline Infusion Sonography): In this technique, sterile saline is injected into the uterus, and an ultrasound is conducted. Although it does not see the tubes directly, it will be able to detect uterine and certain tubal abnormalities, such as fluid accumulation.
• Laparoscopy: In this method, a laparoscope (a miniature camera) is inserted through small abdominal incisions to provide a direct view of the fallopian tubes. Dye tests can be performed simultaneously to assess tubal patency.
• MRI (magnetic resonance imaging) or CT (computed tomography) Scan: Although not initial examinations, these imaging tests can be utilised in challenging cases to evaluate the surrounding pelvic structures and to diagnose hydrosalpinx when other examinations are inconclusive.

What is the Treatment for Hydrosalpinx?

Here are the major hydrosalpinx treatment methods adopted in order to treat this health condition: 

• Antibiotic Therapy

If hydrosalpinx is caused by an active infection, as is often the case with pelvic inflammatory disease (PID) or a sexually transmitted infection (STI), antibiotics are administered to treat the infection. Antibiotics, however, cannot restore normal functioning to damaged fallopian tubes.

• Salpingostomy or Neosalpingostomy

This is one of the most widely practised and successful treatments, particularly for women being treated with IVF (in vitro fertilisation). The removal of the damaged tube prevents the poisonous fluid from seeping into the uterus, greatly enhancing embryo implantation and IVF success rates.

In this laparoscopic surgery, the occluded fallopian tube is opened at the end so that it can drain. Although it will repair the functioning of the tube, it has a greater chance of ectopic pregnancy and overall lower success rates of fertility than IVF.

• Sclerotherapy

This is a less invasive treatment option that involves draining fluid from the tube via ultrasound-guided sclerotherapy and then injecting a chemical (sclerosing agent) to prevent the reaccumulation of fluid. For some patients, it can serve as a preparatory procedure before undergoing IVF.

• In Vitro Fertilisation (IVF)

IVF circumvents the fallopian tubes altogether and is frequently the indicated fertility therapy in cases of hydrosalpinx in women. However, research indicates that surgically removing or treating the hydrosalpinx prior to IVF can significantly improve pregnancy rates.

• Tubal Repair Surgery

For those who wish to treat these fallopian tubes and try natural conception, tubal ligation repair surgery is an option. This aims to eliminate blockage and re-establish function, although its success rate is variable and it is not always as effective as IVF.

• Fertility Counselling and Support

Infertility’s emotional and physical effect makes counselling useful for women experiencing treatment choices. It educates, offers emotional support, and advises on reproductive choices.

FAQs About Hydrosalpinx

1. What are the potential consequences of leaving hydrosalpinx untreated?

If hydrosalpinx is left untreated, it decreases the likelihood of getting pregnant and increases the risk of miscarriage and complications like ectopic pregnancy. Treatment considerably improves the probability of having a healthy pregnancy.

2. What bacteria are responsible for causing hydrosalpinx?

A hydrosalpinx typically arises from a previous pelvic infection. The bacteria most frequently responsible include streptococcus, gonorrhoea, staphylococcus, chlamydia, and pelvic tuberculosis.

3. How does the hydrosalpinx discharge appear?

Hydrosalpinx discharge is sometimes white or yellowish. In some cases, it may be sticky or even have an odour, which may indicate infection.

4. Is a woman capable of getting pregnant with hydrosalpinx?

It has been known that hydrosalpinx blocks the fallopian tubes and complicates early pregnancy, resulting in increased rates of failed pregnancies.

5. What is bilateral hydrosalpinx?

Bilateral hydrosalpinx is a condition characterised by obstruction and fluid accumulation in both fallopian tubes. This blockage hinders the meeting of the egg and sperm, significantly complicating natural conception.

Hydrosalpinx may have a harsh effect on a woman’s fertility journey. It tends to obstruct the fallopian tube with fluid. Therefore, a timely diagnosis and proper intervention—whether surgical or through IVF — brings hope for treating the condition.

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