Wednesday, March 30, 2011

Hydrosalpinx & Fertility: The Difference Between Surgically Caused & Naturally Occurring Hydrosalpinx


Hi Doctor,

I was detected with a dermoid cyst in my right ovary in 2005. I underwent laparoscopy in 2006 and my right ovary was also removed. Post surgery I had normal cycles every month however some months my menstrual flow is less. Last week I had some hormonal tests which turned out to be normal. I also underwent an ultrasound which detected a right 22x13 mm hydrosalpinx. Left ovary and tube is normal. Will the right hydrosalpinx be a problem in me conceiving naturally? I am unmarried and it will be at least 5 years before I will have a baby. Please advise.

Thanks in advance for your support. M. from India

Answer: Hello M. from India,

First of all, the presence of a "hydrosalpinx" means that the right tube is blocked. Therefore, it will not be available to pick up the egg to achieve pregnancy. However, if the left tube is normal, that is all you need. You would still be able to become pregnant naturally.

However, there is a second issue. It is known that a "hydrosalpinx" that is visible on ultrasound examination can interfere with implantation in IVF. It is presumed that the hydrosalpinx has inflammatory fluid that back-flows into the uterine cavity leading to a low grade endometritis or inflammation of the endometrium. Pregnancy rates with IVF in this situation are seen to decrease by 50%. For this reason, it is recommended to remove or clip the tube so that it is separated from the uterus before undergoing IVF.

Having said this, however, this policy or recommendation is for hydrosalpinges that are visible on ultrasound AND are in "naturally occurring" hydrosalpinges due to a previous pelvic or tubal infection and NOT for dilated tubes that were caused by a tubal ligation. So the question is was your hydrosalpinx due to the surgery i.e. either the end of the tube was cut or scar tissue was formed from the surgery. In most cases of doing an oophorectomy (remove the ovary), the tube is usually taken with the ovary. If this is the case, the hydrosalpinx is iatrogenic, meaning surgically caused and not due to a previous tubal infection. In that case, it is logical that there would be no inflammatory fluid to leak into the endometrium and so the recommendation to remove it prior would not hold. This particular instance has not been tested by study, however.

So, in your situation, if the hydrosalpinx was not there prior to the surgery, and the tube was not cut/damaged or scarred from the surgery, then the hydrosalpinx subsequently occurred through a pelvic infection, then it could possibly affect your pregnancy rates. Then the left intact tube could have scar tissue as well not visible with ultrasound. However, if it was due to the surgery, then it would not.

I hope this clarifies things for you. As far as waiting five years to have a child, it would not make any difference, depending on your age of course.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.


  1. I had 20 yrs with 3 operations ( Dermatoid cycts laproscopy, myomectomy, removal of cyst on left ovary, and hysteroscopy for leomyoma removal. Leading to Hydrosalpinx on both ovaries, and levorotated uterus with adenomyosis and lost hope of getting pregnant normally anymore. Wondering now should I end the pain before menopause with 5 years even though I stood the pain since age 12.

    I am looking for good surgeon caring Dr. in Castro valley area under Blue Shield PPO. Any recommendations is helpful better than false hope given to me with lots of pain.

    1. I can't quite answer your question because you mention "the pain" but don't explain anything about it. If it is menstrual only pain, then you might want to consider Depo provera to stop your cycles. If it is other pain, then you may need to find the cause of the pain so that you can get the proper treatment.

      Unfortunately, I don't know any doctors in Castro valley to refer you to.



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