Hydrosalpinx, hydrosalpinges and IVF

Again the weeks have just flown past with no additional blog entries by yours truly. I have no excuse really. Just too busy, too tired, too overextended…yadda, yadda, yadda. So beat me, slap me and call me dirt.

The issue of blocked fallopian tubes is a very important one, even in patients undergoing IVF. Now on the surface this makes little sense because if IVF is used to bypass the fallopian tubes then who really cares if they are abnormal? A reasonable concern and one that for many years we agreed with as we entered patients into the IVF process. But then a funny thing happened….papers started appearing that suggested that the IVF success rate was lower in patients with blocked and dilated fallopian tubes (hydrosaplinx – as described below). The logical question was then whether removal of the hydrosalpinx would cause pregnancy rates to return to the expected level and the answer was a resounding “yes”.

So now fertility MDs are often placed in the unusual situation of removing the tubes after years of training in how to fix them…go figure.

A few years ago we had a patient with bilateral hydrosalpinges as a result of several operations for Crohns disease. We had to remove her tubes with the help of her general surgeon and ultimately she conceived IVF twins. One day I was visiting her in the hospital and the residents said that she was mad that we took out her tubes needlessly since we had planned to do IVF all along….I popped into her hospital room and we chatted for a while and then I raised the topic of her tubes. In spite of many documented discussions on this topic she said that she really could not remember any such topic being reviewed. Finally, the light bulb over her held lit up and she said “Oh yes, know I remember….the tubes had that nasty fluid in them…” Bingo.

So after weeks of waiting patiently here is today’s relatively pathetic post from the book that needs to fund my 401K from here on out…100 Questions and Answers about Infertility.


28. Why should blocked fallopian tubes be repaired before IVF is attempted?

When the fimbria of the fallopian tubes become damaged, it may result in a tube that is blocked at the very distal end—the part farthest away from the uterus. If the tube then becomes filled with fluid, it is called a hydrosalpinx (“hydro” refers to water; “salpinx” refers to the fallopian tube itself). Women who have a hydrosalpinx should have their fallopian tubes either removed or cut prior to undergoing IVF. The surgery usually involves a simple outpatient procedure called laparoscopy. The tubes are cut or removed so that the tubal fluid, which would be toxic to an embryo or adversely affect the receptivity of the endometrial lining, does not flow backward into the uterine cavity, preventing implantation of the embryo.

It is now well recognized that women with an untreated hydrosalpinx have a substantially reduced chance for pregnancy with IVF. In addition, an untreated hydrosalpinx may increase the chance that a woman will experience a spontaneous abortion or miscarriage. For all these reasons, treating a hydrosalpinx should both increase the IVF pregnancy rate and decrease the chances for an early pregnancy loss. A patient with a single normal fallopian tube and a hydrosalpinx will also have a higher chance of achieving a spontaneous pregnancy after removal or ligation of the damaged tube. A hydrosalpinx, if present, is usually identified during the infertility diagnostic evaluation with a hysterosalpingogram (HSG). This simple x-ray study should be performed in all infertile women unless a diagnostic laparoscopy has already been performed. Preoperatively, we advise all patients that we recommend removal or ligation of her tube(s) if a hydrosalpinx is discovered at laparoscopy.