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Hydrosalpinx pictures - blocked fallopian tubes dilated with fluid in infertile women

Background

A hydrosalpinx is a blocked fallopian tube that is filled with fluid. It can be dilated to varying degrees from the accumulated fluid. Doctors can diagnose a hydrosalpinx in several ways including ultrasound, surgery such as laparoscopy, or with a specialized x-ray test called a hysterosalpingogram, or HSG. Tubal blockage and tubal infertility is usually a result of previous pelvic infection such as pelvic inflammatory disease, but also can be caused by endometriosis and other conditions. Because fertility specialists are lazy, they often use the nickname "hydro".

Women with bilateral (both sides) tubal damage and hydrosalpinx are infertile and will need either tubal surgery, such as neosalpingostomy, or in vitro fertilization in order to get pregnant.

Hydrosalpinx and IVF success rates

If a woman going through IVF has a hydrosalpinx visible by ultrasound, then the average expected IVF success rate is lower as compared that expected in a similar patient without a hydrosalpinx. If there is are bilateral hydrosalpinges (hydros on each side - the plural of hydrosalpinx is hydrosalpinges) visible on ultrasound, studies have shown that the expected IVF success rate is even lower than with a hydro on one side.

The medical studies on hydrosalpinx and IVF outcome agree that there is a decrease in success rates, but they do not all agree on the amount of the decrease caused by the presence of the hydro. In general, studies suggest that the chances for a live birth are about 20-30% reduced with a hydro present that is visible on ultrasound. So if a 30 year old woman with tubal infertility is having IVF at a fertility clinic with a 50% live birth rate for patients such as herself with no hydro, then if she has a hydro and does not get it removed, we should expect her chances for the first IVF cycle resulting in a live birth to be about 35-40% (70-80% of the 50% success rate). If the IVF center she chooses has a 30% live birth rate for such cases without hydros, then we should expect her chances for success with a hydro present for one IVF cycle to be about 21-24% (70-80% of the 30% success rate).

IVF success rates vary significantly between different centers - it is wise to research IVF live birth rates carefully before choosing a clinic for the treatment.

It is believed that hydrosalpinx fluid may have a toxic effect on the lining of the uterine cavity, or directly on the embryos, or both. It is also possible to have compromise from a "flushing" effect. Fluid from the tube can sometimes leak back into the uterine cavity. This could displace the embryos from the proper area in the uterus if it occurred at a critical time before the embryos are firmly implanted.

The good news is that careful ultrasound examination should be able to detect a significant hydrosalpinx. Studies have shown that if surgery is performed to remove the fallopian tube (or tubes), the expected IVF success rate is then normalized. Another approach that is effective is disconnecting the tube from the uterus and leaving it in the body. This is often done in cases with severe scarring where it is difficult to completely remove the tube. Some IVF doctors insist that women with hydros have laparoscopic surgery to remove or disconnect them from the uterus prior to performing in vitro fertilization. Other fertility specialists will counsel the patients about the potential risks and benefits of having the surgery before the IVF:
 

• Surgery first, then IVF

  • Higher potential for IVF success, but need to have surgery, with some pain, some risk of a surgical complication, time off work, and delay until IVF
    
     

• Go straight to IVF, no surgery

  •  Lower potential for IVF success, but avoid surgery, no delay for IVF, etc.

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A left fallopian tube that is blocked and dilated with fluid (hydrosalpinx)
This is evidence of previous pelvic inflammatory disease - PID
Pelvic scar tissue is also present between the tube and ovary
This woman has tubal infertility - which is treatable
"P" is a probe used in the surgical procedure

A normal left tube for comparison
The tube is floating in water for better visualization
"F" is the fimbriated end of the tube that picks up the egg at ovulation

View looking down at a blocked right fallopian tube
The end of the tube is stuck in scar tissue down behind the ovary - "O"
The "T"s mark the course of the right tube
A probe is touching the blocked and stuck end of the tube
The labeled adhesion (scar tissue) is between the bowel and the abdominal wall

Below is an ultrasound picture of the same woman's tube
The black tubular structure is the hydrosalpinx fluid within the tube

Laparoscopy surgery picture from another woman with blocked tubes
The right tube is blocked and stuck in scar tissue to the side of the ovary
This woman had a small hydrosalpinx visible with pelvic ultrasound