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Hydrosalpix on HSG came out to be small outpouching on Laproscopy

Hydrosalpix on HSG came out to be small outpouching

Hydrosalpix on HSG came out to be small outpouching on Laproscopy

34 years old female presented in the OPD with the chief complaint of Primary Infertility of 4years .The couple was trying to conceive from last 4years Her Menstrual history was 2-3/30   ,Regular ,Moderate flow and painless                    Her past medical history was that she had taken Anti Tubercular treatment in the childhood because of chest tuberculosis .All the blood investigations were normal. Her husband’s blood investigation and semen analysis was normal.

HSG was done in U.K and there was a doctor’s note attached which showed that she had hydrosalpinx of right tube with patent left tube and uterine cavity was  normal .She was advised laproscopy and hysteroscopy and removal of the right tube.She was not getting the date for laproscopy so she came to India

On examination,all the investigations were normal ,TVS was  done which showed thickened endometrium on the fundus on Day 6 and both the ovaries were normal .There was no evidence of any tubular dilatation on ultrasound, Laproscopy and hysteroscopy done revealed normal uterus with polypoidal endometrium and both tubes and ovaries appeared normal. On tubal testing both tubes were patent with small outpouching of the right tube at the fimbrial end .

Next plan is to give progesterone for polypoidal endometrium and patient can go ahead with IUI for two cycles  or can opt for ICSI.The point to consider is that the hysterosalpingography or HSG can guide us regarding the tubal status but confirmation is by laproscopy .

Understanding Hydrosalpinx: A Guide for Patients

Hydrosalpinx is a common condition affecting the fallopian tubes, often linked to other diseases like pelvic endometriosis or pelvic inflammatory disease (PID). It occurs when fluid accumulates in a blocked fallopian tube, preventing it from draining properly. PID is the leading cause of this blockage, but it can also result from endometriosis, adhesions from previous surgeries, tubal tumors, and ectopic pregnancies.

Symptoms and Diagnosis

Many patients with hydrosalpinx may not have any symptoms. However, some may experience frequent lower back or pelvic pain. During an ultrasound, hydrosalpinx shows a distinctive "cogwheel" pattern due to the enlarged folds of the fallopian tube. Differentiating it from a cystic ovarian tumor can be difficult, especially if the tube is significantly enlarged (over 10 cm). In such cases, MRI can provide clearer images to help with diagnosis.

Treatment Options

Treating hydrosalpinx can be challenging. Surgical options include:

  • Salpingostomy: Opening the blocked fallopian tube.
  • Fimbrioplasty: Repairing the fimbriae, the finger-like ends of the fallopian tube.

These procedures are suitable for small, thin-walled hydrosalpinx with healthy tissue.

Impact on Fertility

Hydrosalpinx can lower the success rate of assisted reproductive technologies (ART) and increase the risk of ectopic pregnancy and miscarriage, likely due to toxic substances in the accumulated fluid. Treating hydrosalpinx improves the chances of pregnancy regardless of the treatment method used.

  • Salpingectomy: Removing the affected fallopian tube, which has been associated with higher success rates in IVF, including more live births, clinical pregnancies, and implantations compared to other treatments.

Combining hydrosalpinx treatment with ART can result in a 61% cumulative pregnancy rate.

Understanding these aspects of hydrosalpinx can help patients and their healthcare providers make informed decisions about the best treatment options to improve fertility and overall reproductive health.


laparoscopy as gold standard for tubal evaluation


Laparoscopy is often considered the gold standard for tubal evaluation in gynaecological practice. This minimally invasive surgical procedure allows direct visualization of the fallopian tubes, ovaries, and other pelvic structures. Here are some reasons why laparoscopy is highly regarded for tubal evaluation:

  1. Direct Visualization: Laparoscopy provides a clear view of the fallopian tubes and other pelvic organs, allowing for a more accurate assessment of their condition.
  2. Diagnosis and Treatment: Besides diagnosing issues such as tubal blockage, adhesions, or endometriosis, laparoscopy can also be used to treat some of these conditions simultaneously.
  3. Accuracy: Compared to other methods like hysterosalpingography (HSG) or sonohysterography, laparoscopy has higher sensitivity and specificity for detecting tubal pathology.
  4. Minimal Invasiveness: While it is a surgical procedure, laparoscopy is less invasive than open surgery, typically resulting in shorter recovery times and less postoperative pain.
  5. Comprehensive Evaluation: Laparoscopy allows for a thorough examination of the entire pelvis, not just the fallopian tubes, which can help in diagnosing other potential causes of infertility or pelvic pain.
  6. Adjunct Procedures: During laparoscopy, other procedures such as chromopertubation (dye test) can be performed to assess tubal patency.

While laparoscopy is highly effective, it is not always the first-line investigation due to its invasive nature and cost. Non-invasive or less invasive methods such as HSG or ultrasound are often used initially to screen for tubal pathology. If these tests indicate potential issues or if more detailed evaluation is needed, laparoscopy is then employed to provide a definitive diagnosis and possibly treatment.


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