Fertility Specialists of Texas

Tubal Factor Infertility

Our experienced doctors can treat tubal factor infertility

To conceive naturally, a woman needs patent, or open, fallopian tubes. Blocked fallopian tubes can occur as a wanted consequence of prior surgery, such as a tubal ligation. A woman can also have tubal factor infertility due to adhesion or scar tissue formation. Prior pelvic infections like chlamydia, gonorrhea or tuberculosis can also damage the tubal architecture.

A hydrosalpinx is a fallopian tube with fluid in it. Injury to the end of the fallopian tube, the ampulla, and its delicate fingerlike endings, the fimbria, 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 that is characteristic of hydrosalpinx.

Evaluation of tubal factor infertility

We can evaluate a hydrosalpinx in several ways.

The hysterosalpingogram (HSG) involves placing dye through the cervix and into the uterus and fallopian tubes. This X-ray test occurs in-office within the first 10 days of your cycle. The X-ray picture on the left reveals the outline of the uterus and tubes.

A hydrosalpinx appears as a large sausage-shaped dilation of the tubes. The folds inside the tube disappear and we can see a flat bulbous shape. Dye does not spill out of the tube.

Ultrasound Diagnosis of Tubal Disease

Ultrasound uses sound waves to image the tubes and is somewhat safer than an HSG and is more comfortable. The best view, most of the time, comes from a vaginal ultrasound probe. A normal fallopian tube is usually not visible. A hydrosalpinx appears as a characteristic sausage-shaped fluid collection between the ovary and fallopian tube. The wall of the hydrosalpinx is often thick and flat. Ultrasound provides a quick and painless screen of the pelvic organs.

Laparoscopy

Laparoscopy is another means of assessing the tubes. It involves the use of a small camera, which we insert through the belly button. We can visualize the pelvic organs on a TV screen. Laparoscopy is the gold-standard test for evaluation. This is because looking at the fallopian tubes will usually provide the best view of their anatomy.

Diagnostic tests such as ultrasound and HSG are not 100% accurate and can be misleading, sometimes missing significant tubal disease and showing abnormal results when the tubes are actually quite normal. 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.

How Does a Hydrosalpinx Form?

Hydrosalpinx is a result of injury to the tube, usually from an infection. The classic causes of hydrosalpinx are chlamydia and gonorrhea. This can run undetected for years, slowly injuring and destroying the delicate fimbria. IUDs, endometriosis, and abdominal surgery sometimes are associated with the problem. As a reaction to injury, the body rushes inflammatory cells into the area and inflammation and later healing result in loss of the fimbria and closure of the tube. These infections usually affect both fallopian tubes and although a hydrosalpinx can be one-sided, the other tube on the opposite side is often abnormal. By the time it is detected, the tubal fluid is usually sterile and does not contain an active infection.

Not only does a hydrosalpinx cause infertility, it can also reduce the success rate of fertility treatment, even those treatments that bypass the fallopian tubes, namely in vitro fertilization (IVF). The blocked tube can communicate with the uterus and the fluid in the tube can be expressed out of the tube into the uterus. This fluid is probably somewhat toxic to early embryo development and certainly provides an unfavorable environment. The large volume of the fluid flows back into the uterus and can produce enough flow that embryos find it difficult to attach since they have no ability to move against the tide. Fertility drugs may cause the fluid to build-up in the tube since the tubes are responsive to the ovarian hormones produced during fertility drug therapy.

Complications

Hydrosalpinx can be hazardous during fertility evaluation and treatment since it is prone to reinfection. Hysterosalpingogram (HSG) can be a particular problem, since the dye can inadvertently introduce bacteria into the tubes, and a serious infection can result. Fertility procedures like insemination and embryo transfer can cause similar problems. Infection in a hydrosalpinx, salpingitis, can be a serious surgical emergency and result in hospitalization.

Treatment

Hydrosalpinx is a classic fertility problem that prevents embryos from reaching the uterus and limits pregnancy rates. It can interfere with fertility therapy and cause problems for IVF. Fortunately, excellent methods are available to manage the hydrosalpinx. With the proper expertise, success rates are excellent.

IVF is the recommended fertility therapy in patients with bilateral hydrosalpinx. The ability to bypass the fallopian tubes and enable sperm to fertilize eggs from the ovary allows women with hydrosalpinx to achieve pregnancy.

We can repair a hydrosalpinx in carefully selected cases, but pregnancy rates remain rather low. Hydrosalpinx can be treated laparoscopically, a procedure known as neosalpingostomy. In neosalpingostomy, an incision is made in the end of the hydrosalpinx and the edges of the incision are folded or flowered back, leaving an open tube. Unfortunately, the tube often closes back up, and the hydrosalpinx has a high recurrence rate.

A hydrosalpinx can have adverse effects on pregnancy rates with IVF. As success rates with IVF have improved dramatically over the past few years, surgical repair of the fallopian tubes holds less appeal. Removal of a damaged tube reduces the risk of complications of therapy and improves success rates with IVF techniques.

Today, most patients with a hydrosalpinx do not try to repair it. Repair can occur in certain young patients with minimal damage to their tubes. However, should not occur with a large hydrosalpinx in an older woman. In these patients, the surgeon should remove the tube via laparoscopic salpingectomy. Salpingectomy is an easy procedure that takes less than an hour. The risks with an experienced surgeon are low, and the benefits substantial. It is important to choose an experienced surgeon. Contact us to learn more.