Hydrosalphinx Causes Treatment and impact in Fertility – DR. Pavitra.`

Hydrosalphinx Causes,Treatment and impact in Fertility

Hydrosalpinx refers to a fallopian tube that’s blocked with a watery fluid. To break down the term, “hydro” means water and “salpinx” means fallopian tube.

This condition is typically caused by a previous pelvic infection  or sexually transmitted disease, a condition like endometriosis, or previous surgery. Although some women don’t experience any symptoms, others may experience constant or frequent pain in the lower abdomen or unusual vaginal discharge.

In all cases, the condition can have an impact on your fertility.

How does this affect  fertility?

To get pregnant, sperm must meet an egg. Around day 14 of a woman’s menstrual cycle, an egg is released from an ovary and begins its travels down to the uterus to the waiting sperm. If a tube or tubes are blocked, the egg can’t make the journey and pregnancy can’t occur.

What if only one tube is blocked.

Egg doesn’t release from the same ovary each month. Typically, the sides alternate. On occasion and for some women, an egg may be released from both sides in the same month.If  one fallopian tube that’s affected by hydrosalpinx and one that isn’t, pregnancy is technically possible. It isn’t without the potential for risks and complications, however.For example, a damaged fallopian tube can leak fluid into the uterus during pregnancy. Hydrosalpinx may impact blood flow in the uterus and ovaries and affect implantation.

In vitro fertilization (IVF) is an infertility treatment where the egg is fertilized by the sperm in a laboratory, outside the body. The fertilized egg is then implanted into a woman’s uterus to achieve pregnancy. IVF can help bypass the role of the fallopian tube in the sperm meeting the egg.

Although this procedure is currently considered the best option for women who have experienced hydrosalpinx, it can cause complications if done before the blockage is removed.

The following success rates were observed between the two groups:

  • Women with untreated hydrosalpinx had a pregnancy rate of 19.67 percent versus 31.2 percent for women with other types of blockages (the control group).
  • Implantation rates were 8.53 percent for women with untreated hydrosalpinx compared to 13.68 percent in the control.
  • Delivery rates for women with untreated hydrosalpinx were 13.4 percent versus 23.4 percent for women with other types of blockage.
  • Women with untreated hydrosalpinx saw higher rates of early pregnancy loss — 43.65 percent — versus 31.11 percent.

Treatment options for hydrosalphinx.

There are several treatment options you may try if you have one or more tubes affected by hydrosalpinx.

Surgery to remove affected tube(s)

The surgery to remove the affected tube or tubes is called laparoscopic salpingectomy. This procedure is often a keyhole surgery, though it may also be done more traditionally through the abdomen.

In the salpingectomy, the entire length of the fallopian tube is removed. The ovarian function may be impaired and cause issues with IVF. Regardless, this is considered the typical treatment approach.

Sclerotherapy

For a less invasive approach, you might consider sclerotherapy. This treatment is done with an ultrasound.

It’s performed by first aspirating the fluid from the tube. To do this, the tube is injected with a certain solution that irritates it. In response, the tube swells shut and pushes out additional fluid buildup.

While this treatment has a faster recovery time than surgery, more research is needed. Some research has suggested that there is a chance that the hydrosalpinx will recur with sclerotherapy versus surgery.

Repairing the blocked tube(s)

For some tube issues, repairing the blockage can help. One procedure is called laparoscopic salphingostomy. The affected tube is opened to drain the fluid through a small incision. The tube is then clipped to stop any fluid from leaking into the uterus. While this approach does save the tube, it isn’t necessarily recommended for hydrosalpinx because the fluid often builds back up again.

Hydrosalpinx and IVF:

During the past decade, the influence of the presence of hydrosalpinx on IVF success rates has been an issue of debate and research. Several retrospective studies have shown an impaired outcome of IVF in the presence of hydrosalpinx and the results have been compiled and presented in meta-analyses, demonstrating a reduction by half in the probability of achieving a pregnancy in the presence of hydrosalpinx and a doubled rate of spontaneous abortion . According to the theory that the hydrosalpinx fluid plays a causative role, any surgical intervention interrupting the communication to the uterus would remove the leakage of the hydrosalpinx fluid and restore pregnancy rates. It has been shown that removal of a hydrosalpinx by laparoscopic salpingectomy improves pregnancy rates, It is believed  that the fluid holds a key position in impairing implantation potential.

Possible mechanisms

The hydrosalpinx fluid may act on two different target systems: directly on the transferred embryos or on the endometrium and its receptivity for implantation, or both.

Embryotoxic properties of hydrosalpinx fluid

From studies on embryo development, it may be concluded that hydrosalpinx fluid does not appear to host a common potent factor deleterious to embryo development, and the lack of essential substrates is more likely to be responsible for the impaired development of embryos in undiluted hydrosalpinx fluid.

Oxidative stress

The presence of oxidative and antioxidant systems in various reproductive tissues has evoked interest in the role of oxidative stress in reproductive diseases. Oxidative stress has been defined as an elevation in the steady-state concentration of various reactive oxygen species on a cellular level and has been suggested to be of importance in hydrosalpinx cases. A first report on this issue described a positive effect of low levels of reactive oxygen species in relation to blastocyst development, as compared with absence of reactive oxygen species in hydrosalpinx fluid . The low levels were suggested to be within a physiological range, and no high levels were detected to demonstrate a negative effect.

Conclusion

There is certainly impairment of embryo development in the presence of pure hydrosalpinx fluid in vitro. If there is no direct toxic factor present, is the low energy content in the hydrosalpinx fluid meeting the embryo after transfer low enough to impair the cleavage rate and implantation ability? The positive effect of salpingectomy supports this theory and the studies on embryotoxicity and endometrial effects may also be in agreement. Studies showing obvious embryotoxicity at low concentrations of hydrosalpinx fluid (≤10%) were all conducted on five or less samples of hydrosalpinx fluid, and this small sample size may not be representative of hydrosalpinx fluids in general. If fluids from certain individuals host potent embryotoxic factor(s), how do we find these individuals? Would a mouse assay on aspirated hydrosalpinx fluid be reliable and clinically feasible?

The influence of hydrosalpinx fluid in the uterine cavity on the secretion and expression of certain cytokines and integrins, essential for early embryo–endometrial interactions and implantation, certainly needs to be explored.

It is intriguing to have an effective treatment (salpingectomy) without knowing why it works. It is not only of academic interest to know, it is also of clinical value. If only some hydrosalpinges have embryotoxic or anti-implantation properties, it would be most valuable to be able to select the patients who would benefit from salpingectomy.

The pure mechanical explanation, i.e. the fluid creates a mechanical barrier and/or causes an increased peristalsis in the uterine cavity, also needs to be investigated.

 

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