Hydrosalpinx and IVF: Why Blocked Fallopian Tubes May Need to Be Removed First

Written by Mannat Fertility Editorial Team | Medically reviewed by Dr. Archana Agarwal, MBBS, DipGO, RCOG (Associate), Medical Director, Mannat Fertility Clinic, Bangalore

Have you been told that you have a hydrosalpinx, and that it should be treated, sometimes surgically, before you even start your IVF? It can feel completely counterintuitive when you hear it. The tube is already blocked, so what difference is it going to make to a process which does not use the tubes at all? The answer here has everything to do with what the fluid sitting inside that tube does to your uterine environment, and the evidence behind this recommendation is considerably stronger than most patients realise.

What Is Hydrosalpinx?

A hydrosalpinx is a fallopian tube which has become blocked at its distal end, meaning the ovarian end, and has then filled up with watery fluid. The blockage itself is usually the result of a previous pelvic infection, or of endometriosis, or of surgical scarring. Because IVF bypasses your fallopian tubes entirely, it becomes very tempting to assume that a hydrosalpinx is simply irrelevant to the whole procedure. However, the evidence shows otherwise.

Why Does Hydrosalpinx Reduce IVF Success Rates?

You might not be aware, but the fluid which is trapped inside that tube does not necessarily stay there. In a proportion of women who have hydrosalpinges, the fluid leaks back through the proximal end of the tube, which is the uterine end, and into the uterine cavity itself. This happens particularly during stimulation, when the elevated oestrogen is able to alter the tubal dynamics. Once it is inside the cavity, that fluid creates an environment which is hostile to embryo implantation, and it does this through several mechanisms:

• It has a direct embryotoxic effect, which impairs the early development of the embryo
• It alters your endometrial receptivity by affecting the expression of the genes which are involved in implantation, including HOXA10
• It may mechanically displace an embryo away from the uterine wall before the implantation has been able to occur

A meta-analysis published in Fertility and Sterility found delivery rates per IVF cycle of 13.4% in women who had a hydrosalpinx, as compared with 23.4% in those who did not, and that is a substantial difference as well as a clinically meaningful one. Moreover, the same data set showed a 2.3-fold higher miscarriage rate in women with hydrosalpinges who were undergoing IVF. A further PMC review confirms both the direct embryotoxic properties of the fluid and the endometrial disruption which it causes.

What Are the Treatment Options Before IVF?

Salpingectomy

Surgical removal of the affected tube, which is called a salpingectomy, is the intervention which is most definitively effective. Removing that tube eliminates the source of the toxic fluid entirely. Studies have consistently shown improved implantation and clinical pregnancy rates following salpingectomy in women with hydrosalpinges who are undergoing IVF, and the procedure can typically be performed laparoscopically with a recovery time which is short.

A concern which comes up commonly is whether a salpingectomy reduces your ovarian reserve. The evidence from multiple studies, and this includes a large series of over 1,600 patients, shows that salpingectomy does not significantly affect the antral follicle count or the ovarian response to stimulation, provided it is performed carefully and with attention paid to the blood supply of the ovary.

Proximal Tubal Ligation or Occlusion

For women in whom a salpingectomy is technically difficult, whether that is because of dense adhesions or because of prior surgery, blocking the tube at the proximal or uterine end achieves a similar effect, because it prevents the fluid from reaching the uterine cavity even though the tube has not been removed. In suitable cases this can often be performed hysteroscopically, which means without any abdominal incisions.

Ultrasound-Guided Aspiration

Draining the hydrosalpinx fluid under ultrasound guidance is a less invasive option for you, and it is sometimes performed at the time of the egg retrieval. However, the fluid commonly re-accumulates afterwards, and the evidence for any lasting benefit on the implantation rates is weaker than it is for the surgical approaches above.

Does Removing the Tube Affect Natural Conception Chances?

A hydrosalpinx already indicates that the affected tube is not functioning for natural conception anyway, because a blocked fallopian tube cannot transport an egg, and this holds regardless of whether the tube is present or absent. So a salpingectomy is removing a tube which is already non-functional. For women who are using IVF in order to conceive, the relevant question is what gives their embryo the best chance of implanting, and the evidence points very clearly towards addressing that hydrosalpinx first.

If you have a confirmed hydrosalpinx and you are planning an IVF cycle, our team at Mannat Fertility can assess whether surgical management is appropriate in your particular case and then guide you through the timing and the sequencing of the treatment. Book a consultation with our specialists in Bangalore.

This article is for general educational purposes and is not a substitute for personalised medical advice from your fertility specialist.