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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