Hydrosalpinx (Fallopian Tube Blockage): what to Expect

How does this affect your fertility?

To get pregnant, sperm must meet an egg. Around day 14 of a woman’s menstrual cycle, an egg is released from an ovary and begins its travels down to the uterus to the waiting sperm. If a tube or tubes are blocked, the egg can’t make the journey and pregnancy can’t occur.

What if only one tube is blocked?

Your egg doesn’t release from the same ovary each month. Typically, the sides alternate. On occasion and for some women, an egg may be released from both sides in the same month.

If you have one fallopian tube that’s affected by hydrosalpinx and one that isn’t, pregnancy is technically possible. It isn’t without the potential for risks and complications, however.

For example, a damaged fallopian tube can leak fluid into the uterus during pregnancy. Scientists don’t exactly know what it is about the fluid that causes issues, but recent research suggests that hydrosalpinx may impact blood flow in the uterus and ovaries and affect implantation.

Can I just get IVF and not treat hydrosalpinx?

In vitro fertilization (IVF) is an infertility treatment where the egg is fertilized by the sperm in a laboratory, outside the body. The fertilized egg is then implanted into a woman’s uterus to achieve pregnancy. IVF can help bypass the role of the fallopian tube in the sperm meeting the egg.

Although this procedure is currently considered the best option for women who have experienced hydrosalpinx, it can cause complications if done before the blockage is removed.

Fluid from the affected tube may leak into the uterus and make implantation difficult or increase the risk of miscarriage. Doctors typically suggest having the affected tube removed or separating it from the uterus before trying IVF.

An academic review examined 5,592 women undergoing IVF. Of these women, 1,004 had untreated hydrosalpinx, and 4,588 had another type of untreated tubal blockage. Between these two groups, doctors performed 8,703 total embryo transfers.

The following success rates were observed between the two groups:

• Women with untreated hydrosalpinx had a pregnancy rate of 19.67 percent versus 31.2 percent for women with other types of blockages (the control group).
• Implantation rates were 8.53 percent for women with untreated hydrosalpinx compared to 13.68 percent in the control.
• Delivery rates for women with untreated hydrosalpinx were 13.4 percent versus 23.4 percent for women with other types of blockage.
• Women with untreated hydrosalpinx saw higher rates of early pregnancy loss — 43.65 percent — versus 31.11 percent for the control group.

What treatment options are available?

There are several treatment options you may try if you have one or more tubes affected by hydrosalpinx. Your doctor should be able to help you determine which type of treatment will best help with your unique case.

Surgery to remove affected tube(s)

The surgery to remove the affected tube or tubes is called laparoscopic salpingectomy. This procedure is often a keyhole surgery, though it may also be done more traditionally through the abdomen.

In the salpingectomy, the entire length of the fallopian tube is removed. Some doctors shy away from this treatment because it may affect the blood supply to the ovary. Without good blood supply, the ovarian function may be impaired and cause issues with IVF. Regardless, this is considered the typical treatment approach.

Sclerotherapy

For a less invasive approach, you might consider sclerotherapy. This treatment is done with an ultrasound and may be as effective as surgery, at least according to recent research.

It’s performed by first aspirating the fluid from the tube. To do this, the tube is injected with a certain solution that irritates it. In response, the tube swells shut and pushes out additional fluid buildup.

While this treatment has a faster recovery time than surgery, more research is needed. Some research has suggested that there is a higher chance that the hydrosalpinx will recur with sclerotherapy versus surgery.

Repairing the blocked tube(s)

For some tube issues, repairing the blockage can help. One procedure is called laparoscopic salpingostomy. The affected tube is opened to drain the fluid through a small incision. The tube is then clipped to stop any fluid from leaking into the uterus. While this approach does save the tube, it isn’t necessarily recommended for hydrosalpinx because the fluid often builds back up again.

IVF after treatment

After treatment, you may want to talk to your doctor about pursuing IVF to get pregnant.

IVF takes around two weeks to complete for each cycle. The first step is taking injectable hormones and medications to mature your eggs, prevent premature ovulation, and prepare the lining of your uterus.

A few days after your last injection, your doctor will retrieve your eggs. They’ll use an ultrasound probe to guide a very thin needle to the eggs for removal.

After removal, the eggs are fertilized to create embryos using your partner’s sperm. This can be done through either a fresh or frozen sample. In the last step, the fertilized embryos are transferred into your uterus using a catheter.

If the cycle is a success, you should see a positive blood test 6-10 days after the transfer.

Success rates with IVF after having hydrosalpinx treated with laparoscopic salpingectomy or sclerotherapy may be as high as 38-40 percent.

Outlook

Your ability to get pregnant with a hydrosalpinx will vary depending on the severity of your blockage and your treatment choice. Without treatment, pregnancy is possible, but chances of complications, like miscarriage, are higher. With treatment, the outlook is much better, especially with IVF.

Current research suggests that both salpingectomy and sclerotherapy have similar success rates when combined with IVF. Your doctor is your best resource for information about your specific case and can help guide you to the treatment option that may work best for you.

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