David Kreiner, MD Causes of Infertility, Hydrosalpinx Leave a Comment

A hydrosalpinx is a fallopian tube that is blocked at its distal end on the opposite side from the entrance to the uterine cavity. It may be diagnosed by a hysterosalpingogram or in severe cases by pelvic ultrasound. The hydrosalpinx is filled with inflammatory fluid and is most likely the end result of a pelvic infection. This inflammatory fluid can flow into the uterus and provide a hostile environment that will prevent implantation of an embryo. Research has shown that removing the hydrosalpinx (salpingectomy) or closing it off from the uterus such as with a tubal ligation significantly improves success with embryo transfer by preventing the flow of this inflammatory fluid into the uterus. Furthermore, transferred embryos will not uncommonly be pushed into the fallopian tubes after a uterine contraction. A healthy fallopian tube will sweep that embryo back into the uterine cavity with its cilia or microscopic hairs. A hydrosalpinx does not have healthy cilia so many of these embryos that find their way into the fallopian tube become trapped and may implant there resulting in a dangerous ectopic pregnancy that needs to be removed surgically if unable to destroy it medically.

A prophylactic salpingectomy or tubal ligation may be performed laparoscopically, using a tubular scope placed through the abdominal cavity to look inside the pelvis. Other instruments are placed through the lower abdominal wall and are used to remove the tube or close off the tube entrance to the uterus. Laparoscopy is performed under general anesthesia in the hospital.

Recently, the use of a contraceptive device, Essure, has been used to obstruct flow of the inflammatory fluid from the hydrosalpinx into the uterus. The Essure is a small coil that is inserted hysteroscopically through a woman’s vagina without cutting into the fallopian tube. It takes 3 months to induce adequate scar closure of the tube and is as effective as a tubal ligation. A hysterosalpingogram is performed after the 3 month period to prove adequate damming of the flow of inflammatory fluid. This procedure may be performed in an office based surgical unit and is sometimes performed without anesthesia.

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