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Hydrosalpinx - It is a Disease

Hydrosalpinx (a fallopian tube closed at the end and distended with fluid) has been known to the medical profession for ages. It is usually a consequence of pelvic infectious/inflammatory disease spreading into the fallopian tubes and pelvis via the cervix and uterus. Some of these diseases manifest themselves with significant clinical symptoms (pain, fever, malaise, nausea). However, some of them might go unnoticed because the symptoms of pelvic infection/inflammation are mild and may be misinterpreted as urinary bladder infection or "bowel" problems.

For patients who have hydrosalpinx on both sides of the fallopian tube, the only possible chance for having a "natural" conception is surgery. Because of the delicacy and intricacy of tubal surgery, new microsurgical techniques were developed by surgeons interested and experienced in this particular area.

The Society of Reproductive Surgeons was formed many years ago. Besides the repairing of fallopian tubes, the Society also became interested in other efforts of surgical correction of diseases which may affect the ability to conceive and cause numerous other health problems. Since the invention of In Vitro Fertilization (IVF), surgery on fallopian tubes has been pushed off the main interest of infertility specialists, but not forgotten. Unfortunately, there are some centers were the only expertise available to infertility patients is IVF. Surgical experience and know-how might not be available.

Within the last year, a number of centers have reported the harmful effect of hydrosalpinx and a lower conception rate in patients who are undergoing attempts of IVF without repairing the tubal disease. Frankly, it is not surprising. There is no question that hydrosalpinx is a disease and disease is never good for any type of living organism, including the patient (carrier of the disease) and her embryos. In scientific reports, terms like "highly toxic fluid of hydrosalpinx" or "significantly toxic fluid" are routinely used to describe what happens to small embryos transferred into the uterine cavity that contains traces of fluid from hydrosalpinx leaking from the tube into the uterus. What is missing is information on the effect of this toxic substance on the well-being of the mother herself.

Microsurgery on fallopian tubes is making a comeback. Various centers recommend removal of the tube or closure of the connection from the hydrosalpinx into the uterus. However, a surgical repair of the hydrosalpinx remains the best way to deal with the diseased pelvic organs and their toxic effect on the mother and her baby.

Removal of the tube (salpingectomy) has been viewed with skepticism because once the tube is removed, there is no way to undo this particular procedure. A number of researchers have studied changes in ovarian function in situations where extensive destructive surgery is performed on the tube (or sometimes even lesser intervention, i.e., tubal sterilization). The tube and ovary share a significant part of the blood supply and destruction of one conceivably can affect the other.

Closure of the part connecting the hydrosalpinx with the uterus is not advisable. Normally, fluid from the fallopian tube leaks inside the uterine cavity, and thus does not cause excessive distention. Once this channel is blocked, the fluid has nowhere to go and the tube balloons up. Clinical experience has taught us that patients whose tubes are closed at both ends usually have extremely large hydrosalpinx, which sooner or later necessitates surgical intervention.

Surgical repair of the hydrosalpinx (salpingostomy) has been performed for decades. The success of the surgery was improved by careful pre-operative and post-operative management and the introduction of the surgical microscope and microsurgical techniques and instruments such as laparoscopy. This usually means a significant prolonging of the operating time itself, and not all physicians are willing to spend several hours in the operating room doing their best to re-establish the patency of the fallopian tubes. Thus, the domain of this type of surgery has been limited to a few reproductive surgeons. With the proper use of the available surgical techniques and pre and post-operative management, the results of reparative surgeries have been improving continuously since the mid-1960's.

It has been our firm belief that disease should be treated and wherever possible, eliminated. In today's systems of delivery of medical care, patients might hear more and more frequently that this or that disease, including hydrosalpinx, does not need to be treated. It does!

Based on 50 years of experience and recent scientific data, we believe that hydrosalpinx should be treated even in patients who are not planning to get pregnant and definitely in those who are hoping to conceive.



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Last modified: 06/09/04