One of the processes that can affect women and decrease the possibility of achieving pregnancy is hydrosalpinx. Although effective diagnostic and treatment practices are now available, this pathology can cause serious discomfort to couples who wish to become parents.
What is hydrosalpinx?
Hydrosalpinx is an obstruction that occurs in the female reproductive system, specifically in the fallopian tubes, which accumulate fluid, causing them to distend and dilate.
As a consequence of this tubal obstruction, the fallopian tubes malfunction, preventing the sperm from reaching the egg and fertilization from occurring.
It can be said that, in general, we do not is in severe process (unless there is a superinfection of the same). but normally women in whom the presence of a hydrosalpinx is identified; and are going to undergo assisted reproduction treatment, must first undergo surgery to remove the diseased or dilated tube(s).
What are the types of hydrosalpinx?
As already mentioned, hydrosalpinx affects the fallopian tubes, occurring in one or both of them. Therefore, its typology depends on how many tubes it affects.
The types of hydrosalpinx are as follows:
- Unilateral hydrosalpinx: occurs when the condition is present in only one of the tubes, and the other remains intact.
- Bilateral hydrosalpinx: in this case the pathology affects both tubes, which become non-functional.
The most common type is unilateral hydrosalpinx.
If it is hydrosalpinx in only one tube, the woman can conceive a new life in her womb without problems. But when both fallopian tubes suffer from this condition, achieving a pregnancy naturally is a challenge. For all these reasons, this pathology is considered a cause of female tubal infertility.
Usually, this condition does not generate symptoms, so its ultrasound diagnosis is sometimes not easy. What often happens is that medical specialists detect it when they are performing fertility studies on women, after they have tried to get pregnant without success.
In some cases, they may notice localized pain in the lower abdomen, which can be frequent and severe at certain times. On the other hand, there are also acute or severe hydrosalpinx that can cause general malaise, fever and foul-smelling vaginal discharge (when they suffer a process of superinfection).
There are also cases in which the condition is detected when women experience an ectopic pregnancy.
Possible causes of hydrosalpinx
The main cause of hydrosalpinx is PID – Pelvic Inflammatory Disease, which is usually caused by a sexually transmitted infection. Usually this infection is gonorrhea or chlamydia.
Any of these infections suffered for years or improperly treated can result in severe inflammation of the fallopian tube. This genital infection causes the release of proinflammatory elements and the accumulation of fluid in the tube.
Additionally, there are other factors that can cause the appearance of hydrosalpinx, such as:
- Some type of surgery in the tubes or in another organ of the pelvic cavity (adhesions).
- Application of the IUD as a contraceptive method.
- Previous ectopic pregnancy.
- Tubal tuberculosis.
Any of these factors can result in scarring or adhesions in the tubes, which can develop into hydrosalpinx.
Diagnosis of hydrosalpinx
To diagnose this pathology in women, one of the following medical tests can be performed:
This medical examination facilitates the visualization of the fluid accumulated in the tubes.
It consists of a transvaginal ultrasound. A simple and comfortable procedure for the woman, although it should be noted that its ability to diagnose with certainty is low.
It allows to observe in detail the dilatation of the tubes, and to detect the existence of obstructions, by means of X-rays and contrast.
Although it may be a little uncomfortable for the patient, it does not cause pain.
It uses a contrast called Sonovue, which is administered through a cervical cannula, and with ultrasound control (and not radiological) it is possible to visualize the passage of contrast through the tubes, as well as possible intracavitary space-occupying lesions (polyps, myomas). Its advantage is the non-use of X-rays. It is the technique currently used.
This diagnostic technique is more complex and invasive, as it involves surgery. In the same surgical act it is possible to establish the diagnosis and treatment of hydrosalpinx or tubal non-permeability by performing a salpinguectomy.
This mechanism requires anesthesia and is performed in an operating room.
The appropriate treatment will depend on factors such as the cause, the time of development, and whether the woman wishes to procreate.
In the event that the condition was caused by an infection that is still present in the patient’s body, the medical specialist will apply an antibiotic treatment.
If the hydrosalpinx remains after treatment, surgical alternatives will be considered. Laparoscopy is usually chosen to perform a salpinguectomy.
Among the surgical treatments used to resolve hydrosalpinx are the following:
- Salpingectomy: consists of the removal of the tube where the hydrosalpinx is present. Generally, it is applied in cases where the hydrosalpinx measures more than 3 cm.
- Tubal occlusion: this is a proximal blockage of the fallopian tube by means of electrocoagulation.
The purpose of these procedures is to prevent the hydrosalpinx fluid from reaching the uterus and negatively influencing embryo implantation.
Is pregnancy with hydrosalpinx possible?
The answer to this question is yes, although the probability of achieving it is lower. There is also a greater possibility of becoming pregnant, but with an extrauterine pregnancy, located in the diseased tube. However, women must resort to an assisted reproduction method to achieve procreation.
The most indicated method is in vitro fertilization (IVF), since the eggs can be obtained from the ovary of the future mother, taken to the laboratory for fertilization, and the embryos are transferred to the uterus.
IVF is used when the patient does not have functional fallopian tubes.
When the hydrosalpinx is unilateral, and one of the tubes is completely healthy, a natural pregnancy can be achieved. A decision can also be made to opt for artificial insemination.