If tests of tubal patency, such as an HSG (hysterosalpingogram), indicates that you have dilated distally closed tube(s), known as a hydrosalpinx, the advisability of surgical removal or ligation of the tube(s) by laparoscopy will be discussed with you.
HSG showing a large hydrosalpinx
Hydrosalpinx is most commonly caused by an old pelvic infection which may have been caused by a sexually transmitted disease. Other causes include previous surgery or severe scarring.
Hydrosalpinx fluid interferes with embryo implantation decreasing pregnancy rate by as much as 60%. The larger hydrosalpinges, which are often visible on ultrasound, are more likely to interfere with embryo implantation than smaller closed tubes. The presence of hydrosalpinges also increases the risks of severe pelvic infection and ectopic pregnancy.
Some women with hydrosalpinx may have constant or frequent
pain in their lower belly or abdomen. A vaginal discharge
can also be associated with this condition. Most women have no symptoms.
Large right hydrosalpinx at laparoscopy
Frequently, tubal occlusion occurs on both sides. While surgery can open up the tubes, they seldom function normally and recurrence of hydrosalpinx is common. In some cases, the hydrosalpinx is just on one side and the other tube is normal and open. Dr. Chetkowski and collaborators have reported high spontaneous pregnancy rates after removal or ligation of the diseased tube (Dr. Chetkowski’s CV Publications # 30 and 36). Since most conceptions happened shortly after laparoscopy, it is reasonable to try this approach first before starting IVF.