Hydrosalpinx

Hydrosalpinx is a dilation of the fallopian tube containing serous fluid, while pyosalpinx — clinically often referred to as sactosalpinx when the content is infected — indicates tubal distension with purulent material. Both conditions result from tubal obstruction, but pyosalpinx is more closely associated with an active or prior inflammatory or infectious process.

From an imaging standpoint, pyosalpinx tends to present thicker walls and heterogeneous content, while in hydrosalpinx the content appears typically fluid and homogeneous.

Ref.: [1]

Many patients with hydrosalpinx do not present specific symptoms. When the condition is clinically manifest, the most common complaints include pelvic pain or lower abdominal pain, abnormal vaginal discharge, sometimes intermenstrual or post-coital bleeding, dyspareunia, and, in some cases, urinary symptoms.

Infertility is often the main reason leading to diagnostic workup. It is also known that a relevant proportion of cases may result from subclinical pelvic infections.

Ref.: [2, 3]

Yes, natural conception is possible if the hydrosalpinx affects only one tube and the contralateral tube is normal and patent. However, the probability of pregnancy may be reduced compared with the population without tubal pathology. In the literature, high rates of spontaneous conception have been reported in selected patients after surgical treatment of unilateral hydrosalpinx.

It should be noted, however, that even unilateral hydrosalpinx can negatively affect in vitro fertilization outcomes.

Ref.: [4, 5]

The most common cause is pelvic inflammatory disease. In most cases, this condition is related to sexually transmitted organisms, particularly Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium, or organisms associated with bacterial vaginosis. The infectious process ascends from the lower genital tract toward the tubes, causing inflammation, tissue damage, adhesions, and occlusion.

More rarely, pyosalpinx may be associated with enteric infections or genital tuberculosis.

Ref.: [3, 7, 8]

No. Once established, hydrosalpinx is generally an expression of chronic structural tubal damage and does not resolve with antibiotic therapy alone. Antibiotics are indicated for the treatment of acute infection but are unable to restore tubal patency or permanently eliminate the fluid collected within the tube.

In assisted reproductive technology pathways, surgery, particularly salpingectomy or tubal occlusion, has been shown to be more effective in improving reproductive outcomes compared with medical therapy alone.

Ref.: [9, 10, 11]

The main examinations include: transvaginal ultrasound, which can identify hydrosalpinx as a tubular fluid-filled structure with characteristic morphology; hysterosalpingography, for the assessment of tubal patency; hystero-salpingo-contrast-sonography (HyCoSy), a radiation-free alternative; pelvic MRI, useful for characterizing tubal content in selected cases.

Laparoscopy with chromopertubation constitutes the definitive diagnostic reference for direct evaluation of tubal pathology.

Ref.: [1, 6, 12, 13, 14]

Hydrosalpinx is associated with a significant reduction in implantation rates, clinical pregnancy rates, and live-birth rates in IVF cycles. Proposed mechanisms include reflux of tubal fluid into the uterine cavity with a possible embryo "washout" effect, reduced endometrial receptivity, and a potential embryotoxic effect of the tubal content.

Available evidence shows that surgical treatment prior to IVF, particularly salpingectomy, improves reproductive outcomes and may restore them to levels comparable to those of patients without hydrosalpinx.

Ref.: [4, 11, 15]

Salpingostomy is a conservative tubal surgery procedure that involves opening the occluded distal segment of the tube, draining the contained fluid, releasing adhesions, and attempting to maintain a new functional tubal opening. It is considered primarily in women who wish to conceive naturally and present with mild or moderate hydrosalpinx with limited tubal damage.

Reproductive outcomes are variable and depend on the severity of the anatomic findings: spontaneous pregnancy rates are more favorable in less severe forms, while a non-negligible risk of ectopic pregnancy persists.

Ref.: [11, 17, 18, 19]

Untreated pyosalpinx may lead to permanent tubal infertility due to inflammatory and scarring damage, increased risk of ectopic pregnancy, chronic pelvic pain secondary to adhesion-related sequelae, progression to tubo-ovarian abscess requiring drainage or emergency surgical treatment, and sepsis in cases of uncontrolled acute infection.

Diagnostic or therapeutic delay in pelvic inflammatory disease is associated with worsened long-term reproductive outcomes, with potential irreversible loss of tubal function.

Ref.: [3, 20]

Yes, the association is well documented. Hydrosalpinx reflects tubal damage that alters embryo transport toward the uterine cavity and therefore increases the risk of ectopic implantation. The same conditions that cause inflammation, adhesions, and tubal occlusion constitute recognized risk factors for ectopic pregnancy.

Even after conservative treatments such as salpingostomy, a risk of ectopic pregnancy persists that must be discussed with the patient during preoperative counseling.

Ref.: [11, 16, 21, 22, 23]