How it’s tested
A transvaginal ultrasound can detect hydrosalpinx. However, the fluid can slosh around or come and go – so you might have an ultrasound that detects it while another ultrasound misses it!
To make it even harder, you might also have fluid (either perfectly normal or due to scar tissue) in other places, like your pelvis or bowels. It’s hard to tell from an ultrasound whether the fluid is in your tubes or outside them, so the diagnosis can be difficult.
In addition, there’s no clear standard of when a hydrosalpinx is “too big” or when it’s normal.
A hystosalpingogram test can help tease out more information. X-ray dye is placed into your uterus and sent up your fallopian tubes, allowing us to get a better view of the fallopian tube’s size and shape, and how significant the potential hydrosalpinx is.
However, the only truly definitive test is to do the complete laparoscopy. Unfortunately, this means that while you’re unconscious and unable to state your opinion, your surgeon will be faced with the difficult decision of deciding how to operate based on his or her discoveries. Treating a hydrosalpinx is a pretty big deal, because it involves either blocking or completely removing your tube.
How it’s treated
Your tubes normally have little pockets of fluid. But if the structure of your tube is warped from scar tissue, all that fluid can collect in one place. That’s when it becomes a problem.
Unfortunately, the fluid may also be toxic. Even if you still have one working tube and are able to get pregnant, or you get pregnant through IVF, it’s possible for the fluid to leak into your uterus and compromise the pregnancy.
That’s why we usually recommend undergoing treatment, instead of trying to get pregnant while you have hydrosalpinx.
If a hydrosalpinx is discovered, there aren’t many options. Your tube must be removed or obstructed (blocked).
Unless you have a lot of scar tissue blocking the area, removing a tube isn’t actually that complicated for a surgery. But it’s usually less invasive to simply place a clip at the base of your fallopian tube – the same clips used for women who are choosing sterilization.
Another option is to place a “plug” (such as Essure) in your tube during a hysteroscopy. It’s a less invasive option than a laparoscopy surgery.
However, the downside is obvious: surgery isn’t fun, and it can feel like a big step in the wrong direction to purposely remove a tube when you’re trying to get pregnant. That’s why most doctors will only recommend this treatment if they’re extremely confident in their diagnosis, the evidence of hydrosalpinx is overwhelming, and there are no other viable options.