What is the relation of Tubal infection and Infertility?
The normal function of Fallopian tube is to catch an egg each month as it is released from the ovary. The tubes are the meeting place for egg and sperm and the mechanism by which the fertilized egg travels to the uterus. Damage to this tiny and delicate passage can inhibit conception and pregnancy.
Hydrosalpin is the medical name for a fallopian tube that has become filled with fluid due to infection or injury. It usually affects both the fallopian tubes (even when only one tube is affected there is usually some residual damage to the other)
What are the causes of Hydrosalpinx?
- Bacterial infection like Chlamydia ,Gonococci, staphylococcus and tuberculosis
- Following septic abortions
- Infected appendix/ruptured appendix
- Endometriosis_due to excessive tissue buildup
- Pelvic inflammatory disease
- Abdominal surgery
The inflammation and healing process resulting from such infection destroys the delicate finger like fimbria, which extend from the end of the fallopian tube to the ovary. Fimbria are responsible for carrying the egg to waiting sperm and moving egg and sperm together for fertilization. When the fimbria become fused together due to infection the tubes gets closed. Fluid then collected in the fallopian tubes making it impossible for them to function.
How can we diagnose hydrosalpinx?
Ultrasound: A normal fallopian tube is usually not visible on ultrasound. A tube filled with fluid will appear larger and sausage shaped.
Hysterosalpingogram(HSG): It is a type of X-ray using special dye that can display tubal blockage.
Sonohysterosalpingography: Here saline fluid and sterile air are passed through a woman’s cervix and into the uterus. A transvaginal ultrasound is then used to look at the reproductive organs to see if blockage is present.
Laparoscopy: It is direct visualization of tubes, ovaries and uterus under general anesthesia.
Can I just IVF and not treat Hydrosalpinx ?
Although this procedure is considered but it can cause complication if done before the blockage is removed.
Fluid from the affected tube may leak into the uterus and make implantation difficult or increase the risk of miscarriage. Hence it is better to remove the affected tube or separating it from the uterus before trying IVF to get good success rate.
Diagnosing hydrosalpinx before undergoing IVF can prevent failed cycles and unnecessary distress.
What are the chances of conceiving naturally after tubal correction surgery?
In some cases laparoscopic surgery can open blocked tubes or remove scar tissue that is causing problems. Unfortunately this treatment does not always work, because the anatomy and physiological process is disturbed. There is lot of cilia and risk of ectopic pregnancy is higher after surgery for tubal blockage.
What are the treatment options for patients with hydrosalpinx ?
The ability to get pregnant will vary depending on the severity of blockage and whether it is unilateral or bilateral. If pregnancy occurs then chances of miscarriage are higher. With treatment the outlook is better especially with IVF.
IVF is recommended fertility therapy in Patients with bilateral hydrosalpinx . After bilateral salpingectomy because IVF completely avoids fallopian tubes.
What are the chances of pregnancy when one fallopian tube is blocked and other is normal?
The chances of pregnancy are reduced.
How does hydrosalpinx effect embryo implantation?
Hydrosalpinx adversely affects embryo implantation and contributes to poor implantation rates after embryo transfer, embryo transport depends on concomitant intra uterine fluid motion induced by uterine wall motility.
Fluid accumulation in fallopian tube increases tubal pressure and there by induce a pressure gradient between the fundus and cervix which effects adversely intra uterine peristalsis and thrust embryos away from the implantation site.