Hydrosalpinx is a condition where a fallopian tube becomes blocked, typically near the ovary, and fills with fluid. This fluid accumulation causes the tube to swell, preventing the egg and sperm from meeting or the resulting embryo from traveling to the uterus for implantation. Hydrosalpinx is a form of tubal factor infertility, often discovered when a person seeks help conceiving. For those with only one affected tube, conception is still physiologically possible because the reproductive system contains two fallopian tubes and two ovaries. However, unilateral hydrosalpinx introduces complex challenges beyond the mechanical blockage of one side.
Conception When Only One Tube is Open
The fundamental mechanics of conception rely on the remaining healthy fallopian tube to capture the egg and transport it to the uterus. Ovulation, the release of an egg from an ovary, does not always alternate perfectly between the left and right sides each month. The healthy tube can potentially pick up an egg released from either the ovary on its side or the ovary connected to the blocked tube. This offers a chance for natural pregnancy, even when the egg is released adjacent to the hydrosalpinx.
If the remaining tube is completely open and functional, the theoretical chance of conception is approximately halved compared to having two healthy tubes. This estimate is often optimistic because the egg does not release from the same ovary every cycle. A successful natural pregnancy depends entirely on the healthy tube capturing a mature egg and performing its function of collection and transport without interference.
Why Hydrosalpinx Still Poses a Risk to the Uterus
Even when only one fallopian tube is affected, the fluid accumulation within the hydrosalpinx negatively impacts the overall reproductive environment. The fluid, sometimes referred to as “hydrops,” is not inert; it often contains inflammatory markers, cellular debris, and other embryotoxic substances harmful to an embryo.
The primary concern is that this fluid can leak backward from the blocked tube into the uterine cavity. Once in the uterus, this fluid may mechanically flush out a newly transferred or naturally conceived embryo, preventing it from settling into the uterine lining. The fluid can also chemically alter the endometrium, making the uterine lining less receptive to implantation. Studies show that the presence of hydrosalpinx, even if unilateral, reduces success rates for both natural conception and assisted reproductive technology like In Vitro Fertilization (IVF).
Medical Strategies to Improve Conception Chances
For individuals with unilateral hydrosalpinx, medical intervention is often recommended to isolate the negative effects of the blocked tube and improve fertility outcomes. The goal is to either remove the source of the toxic fluid or permanently block its passage into the uterus. This is especially true if a patient is considering assisted reproductive technologies.
Surgical Intervention (Tubal Clipping or Salpingectomy)
The most definitive and commonly recommended treatment is a salpingectomy, which is the surgical removal of the affected fallopian tube. This procedure eliminates the source of the toxic fluid entirely, preventing any leakage into the uterus. Salpingectomy is considered the standard approach, particularly before undergoing IVF.
Another option is proximal tubal occlusion, which involves surgically clipping or cauterizing the tube where it connects to the uterus. This action effectively disconnects the hydrosalpinx from the uterine cavity, stopping the backflow of fluid. Studies have indicated that both salpingectomy and tubal occlusion can significantly increase the chances of spontaneous pregnancy in women with a healthy contralateral tube.
Assisted Reproductive Technology (ART)
In Vitro Fertilization (IVF) is a highly effective treatment for tubal factor infertility, as it bypasses the need for the fallopian tubes to function. The eggs are retrieved directly from the ovaries, fertilized in a laboratory, and the resulting embryo is transferred straight into the uterus. However, the success of IVF is still compromised by an untreated hydrosalpinx.
The presence of the toxic fluid can reduce IVF success rates by half and double the rate of spontaneous miscarriage. For this reason, the affected tube is typically removed or occluded before an IVF cycle begins. Once the hydrosalpinx is treated, the success rates of IVF for these patients often rise to levels comparable to those without tubal issues.