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What About Tubes that are Blocked at the Other End, Near the Ovary?
by Fred Licciardi, M.D.
This we call “distal occlusion” and it can take a few forms. The most obvious and severe is what’s called a hydrosaplinx (or hydro for short), or bilateral hydrosalpinges when both are affected. This type of tube is completely closed near the ovary (the distal end). Such a tube could be closed due to scar from a pelvic infection. The infection could be due to Chlamydia (most common), Gonorrhea or a post surgical infection. Sometimes scarring can occur after surgery without infection. Even when the surgery was on the uterus, myomectomy is a common culprit, the general healing of the pelvis could cause tubal scarring to occur. Occasionally these tubes are filled with fluid and are visible on ultrasound, but usually they are not. The diagnosis here is very straightforward. Either by HSG or at laparoscopy, the tubes are seen to be large, swollen and obvious. Hydros are quite a problem for patients because they can mean surgery, IVF or both. Surgery can work, but the odds of pregnancy after surgery have been reported to be about 20% lifetime (there are a few other studies with higher rates, but 20% seems to be the most commonly quoted number). The reason surgery does not succeed is that in many cases the scar tissue quickly returns and the tubes re-block. Even if the tubes remain open, the interior lining of the tubes, necessary to the transport of egg and sperm, has been permanently damaged.
IVF has a much higher pregnancy rate, so most patients head that way. There are some studies showing a hydro will lower the IVF rate by about 1/3, the predominant theory being fluid inside the tube backs up into the uterus and interferes with implantation, either by flooding the embryo away or poisoning the embryo with toxic substances. Therefore some patients elect to have their hyro tubes removed before IVF to maximize their odds. No one should be forced to have their tubes removed. The pregnancy rate may be lower, but there are tons of pregnancies in women who kept their tubes.
Distal blockage can be not as severe. In these cases there may be tubal enlargement, but they are open on HSG. There can be minor scar tissue around the ends of the tubes that is very treatable. Just cutting away the scar tissue can render the tubes open and very functional.
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