Verified on 06/23/2022 by PasseportSanté
Hydrosalpinx is a cause of obstruction of the fallopian tubes in women. It is often secondary to an untreated sexually transmitted infection that has reached the upper genital tract. The consequence is infertility. Its treatment is necessary in case of parental project and before IVF. We take stock.
What is hydrosalpinx?
Hydrosalpinx (also called in medical language “fluid tubal distention due to obstruction of the fallopian tubes”) is one of the causes of obstruction of the fallopian tubes.
The fallopian tubes (or uterine tubes) are a component of the female reproductive system. Its function is to receive the oocyte from the ovary and then push it towards the uterus. It is in the fallopian tubes where fertilization usually takes place, that is, the meeting between the sperm and the egg.
Hydrosalpinx, in the vast majority of cases, is the consequence of a pelvic infection (Chlamydia trachomatis, gonococcus, etc.). In this sense, hydrosalpinx would affect about 30% of women affected by one or more infections of the upper genital tract1.
Hydrosalpinx is asymptomatic and usually goes unnoticed. It is rarely responsible for heaviness, pelvic pain and pain during sexual intercourse. It is usually discovered during a medical check-up for infertility since the hydrosalpinx considerably reduces a woman’s fertility.
The treatment of hydrosalpinx is only surgical and in most cases it is necessary before resorting to in vitro fertilization (IVF).
What are the symptoms of hydrosalpinx?
Hydrosalpinx is usually asymptomatic. However, some inconspicuous signs are evocative such as:
- pelvic pain;
- a feeling of heaviness in the lower abdomen;
- pain during intercourse, etc.
However, the main sign of hydrosalpinx is female infertility. A balance of infertility should investigate its possible existence.
What causes hydrosalpinx?
A hydrosalpinx corresponds to the obstruction of the fallopian tubes. The latter is secondary to lesions in the marginal cells.
The fringes are found at the ends of the fallopian tubes. When they are damaged, fluid builds up in the ducts, causing them to dilate and become blocked. There are several factors that trigger this phenomenon:
- An untreated sexually transmitted infection (STI), mainly gonorrhea and chlamydia (the most common cause);
- A non-gynecological infection (such as complicated appendicitis);
- Using an intrauterine device or IUD (IUD);
- Abdominal surgery.
What are the consequences of hydrosalpinx?
There are several consequences for hydrosalpinx.
In a woman with hydrosalpinx, the tube that connects the uterus to the ovaries is blocked by a buildup of fluid. Therefore, fertilization is impossible: the egg is lost and the sperm cannot reach the fusion zone.
Failure of IVF (in vitro fertilization)
Hydrosalpinx has been shown to have a proven deleterious effect on IVF outcome, but its precise mechanism is unknown despite multiple hypothesestwo. Surgical intervention should be proposed in case of hydrosalpinx and in case of repeated implantation failures.
Since hydrosalpinx is asymptomatic, the disease can go unnoticed for years. It is usually discovered during an infertility checkup. Several tests can confirm the diagnosis:
- A hysterosalpingogram (examination of the female genitalia that requires the injection of an iodinated contrast product into the uterus);
- A pelvic ultrasound (medical imaging technique that uses ultrasound. It allows the organs of the pelvis to be visualized. This examination is performed via the endocavitary route (transvaginal ultrasound);
- An MRI (MRI).
These different tests confirm the diagnosis of hydrosalpinx. They also allow to determine if only one of the tubes is affected or if both are affected.
In the case of hydrosalpinx, it will be necessary to determine the cause. In particular, the gynecologist may prescribe complementary tests (urine or pelvic samples and/or blood tests) to determine the possible existence of a genital infection.
Finally, if the patient is wearing an IUD, its removal should be considered.
What are the treatments for hydrosalpinx?
Aside from any desire for pregnancy, hydrosalpinx does not require treatment. However, possible causes (sexually transmitted infections, IUD, endometriosis) should be monitored and searched for and treated.
In case of STIs, antibiotic treatment is most often prescribed.
On the other hand, within the framework of a parental project and in the presence of infertility, it is necessary to treat the hydrosalpinx. The treatment is only surgical and prior to in vitro fertilization (IVF) treatments.
The types of surgery differ depending on the patients and the damage:
- Removal of blocked fallopian tube(s) or salpingectomy: This surgical procedure renders the patient infertile, but pregnancy through IVF is still possible;
- Permanent tubal occlusion or tubal ligation (this surgery involves the patient’s infertility, but pregnancy through IVF is still possible);
- Tubal repair surgery or “tubal plastic surgery”: this surgical procedure consists of restoring the patency of the tubes, thus making it possible to treat infertility.
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