Hydrosalpinx

Abstract

Occlusion of the fallopian tubes is a common cause of infertility. Distal occlusion of the fallopian tubes, usually a sequela of salpingitis, can result in the collection of fluid within the tube, a condition known as hydrosalpinx. Transvaginal ultrasonography, performed as part of an infertility evaluation, can be used to reliably detect hydrosalpinges. Although a fallopian tube can be surgically opened, the chance of successful intrauterine pregnancy after surgical treatment of a hydrosalpinx is relatively poor. Therefore, in vitro fertilization (IVF) is commonly the best option for treatment of infertile women with bilateral hydrosalpinges. However, the presence of a hydrosalpinx is associated with a significant reduction in live birth rates in women undergoing IVF with larger hydrosalpinges appearing to have the greatest effect. Although the mechanism(s) by which hydrosalpinges cause a reduction in IVF success is still unknown, several studies have demonstrated a significant improvement in IVF pregnancy rates after surgical treatment or removal of a hydrosalpinx or hydrosalpinges. Various methods of treatment of hydrosalpinges have been evaluated, and to date, both laparoscopic removal and proximal tubal occlusion are the most tested methods of treatment. This chapter reviews the etiology, assessment, and treatment of hydrosalpinges and the effects of treatment of this condition in infertile women.