Hydrosalpinx (Fluid-filled Fallopian Tube)

输卵管积水 is a condition where the fallopian tube becomes blocked at the distal fimbriae and fills with fluid, expanding into a sausage-like structure. It can be unilateral or bilateral.

Impact on IVF Success

The hydrosalpinx fluid is embryotoxic and can flow retrograde into the uterine cavity, preventing implantation or causing miscarriage.

Causes

• Pelvic Inflammatory Disease (Chlamydia, Gonorrhea) — most common
• Endometriosis
• Prior pelvic surgery (appendectomy, ovarian surgery)
• Genital tuberculosis (rare)
• Prior ectopic pregnancy

Symptoms

Many patients are asymptomatic and diagnosed during infertility evaluation. Some may experience:

• Chronic pelvic pain, dyspareunia
• Vaginal discharge
• Infertility or recurrent pregnancy loss

Diagnosis

• Transvaginal ultrasound — shows characteristic sausage-shape adnexal cyst
• 3D ultrasound with SIS — higher accuracy
• HSG (Hysterosalpingogram) — contrast dye visualization
• Laparoscopy — definitive diagnosis and treatment

Treatment Options Before IVF

1. Salpingectomy (Standard)

Laparoscopic removal of the affected tube. Cochrane review confirms this restores IVF pregnancy rates to near normal. Preferred approach.

2. Tubal Occlusion

Blocking the proximal end when full removal is difficult due to adhesions.

3. Salpingostomy

Reconstructive opening of the fimbrial end — for patients wanting natural conception. Low success and high ectopic risk.

4. Ultrasound-guided Aspiration

Draining fluid before embryo transfer. Fluid often reaccumulates within weeks.

Cochrane recommendation: Patients with hydrosalpinx planning IVF should undergo salpingectomy or tubal occlusion before stimulation to significantly improve success rates.