Melanie Cole (Host):  Welcome to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I’m Melanie Cole and I invite you to listen in as we discuss blocked fallopian tubes or hydrosalpinx. Joining me is Dr. William Ziegler. He’s a Specialist in Reproductive Endocrinology and Infertility and he’s the Medical Director of the Reproductive Science Center of New Jersey. Dr. Ziegler, it’s always a pleasure. I’d like you to start by giving us a little bit of a physiology lesson. What do the fallopian tubes do?

Dr. William Ziegler (Guest):  The fallopian tubes are attached to the uterus or to the womb. And normally, the fallopian tubes will pick up an egg each month when it is released or ovulated from the ovary. Sperm then travels from the vagina through the cervix and right up into the uterus, at which time, the sperm have to transverse the fallopian tube and meet the egg in a segment of the fallopian tube called the ampulla. At that point in time, it’s really up to the fallopian tube to move that embryo into the uterus. And it does that by having muscle around the tube which contracts back and forth and inside the fallopian tube are these little hairs called cilia and the embryo secretes signals to tell the tube move me. Get me into the uterus.

Host:  That is so absolutely interesting. What a great lesson that was Dr. Ziegler. So, how do fallopian tubes even get blocked?

Dr. Ziegler:  Fallopian tubes can be blocked by a variety of causes. The most common is a prior pelvic infection. If someone has had gonorrhea or chlamydia in the past, but also any inflammatory process can block the fallopian tubes, even from having prior surgery. Now if inflammation occurs in the pelvis, the body tries to wall those areas off and it walls it off by causing adhesions. And it’s going to pull in anything in with it to help wall off those inflammatory areas and it’s going to pull in bowel, it can pull in fallopian tube, the ovary, the uterus. And in doing so, it can ultimately, affect the fallopian tube and it can block it. Women who have been diagnosed with endometriosis, endometriosis can cause inflammation and again, the body doesn’t like that so therefore it tries to wall it off.

Host:  So, then speak a little bit about hydrosalpinx. How do they form? And can someone with blocked fallopian tubes – does this cause infertility? Can they menstruate? Do they drop eggs? Tell us a little bit about what the complications are. Does it contribute to infertility?

Dr. Ziegler:  Yes it does. And hydrosalpinx if you look at the word it is hydro – water and salpinx – tubes. So, it’s water in the tube. The fallopian tube has fluid it in. It always does. However, it is open at the point that it enters the uterus and at the end at the point that it picks up the egg. So, that fluid is constantly moving. If one side is blocked, then that fluid can build up inside the fallopian tube and that can cause a problem. Fluid in the fallopian tube is like a stagnant pool of water. And when you look at a stagnant pool of water, there’s nothing good that grows in a stagnant pool of water. So, the substances that are in a hydrosalpinx fluid are basically substances that should not be in the uterine cavity. So, things like cytokines, or growth factors or tumor necrosis factor. Those things should not be in the uterus but if one end of the tube is blocked, that fluid can flow back into the uterine cavity and it can actually decrease implantation rate and can increase the risk of miscarriages.

Having a blocked tube is not going to affect a woman’s ability to produce eggs. Eggs will still be produced, still be released because the ovary doesn’t know the tube is blocked. It’s just the eggs will just drop in the peritoneal cavity and will just get absorbed. Menstruation will still occur. Because the endometrial cavity again, it doesn’t know the tube is blocked. And even if a woman has her tubes removed, she’s still going to ovulate, and she is still going to menstruate.

Host:  How does a woman know if she has blocked fallopian tubes? Are there any signs? Is this something that shows up on tests? How does somebody even know and then speak about what you do once you find out.

Dr. Ziegler:  Some of the symptoms of a hydrosalpinx that if you think about, you have a tube that’s being filled up with fluid and as it distends, it can cause some pain. And they can have frequent pain within their lower abdomen. The way we diagnose these is – there’s basically three ways. One is we can do an x-ray, or something called a hysterosalpingogram. This is where in a radiological facility, dye is put inside the uterus to look for polyps or fibroids and then they watch the dye go into the fallopian tubes hoping to see it go out the end. If it’s a hydrosalpinx, the dye is not going to go out the end of the fallopian tubes and it’s going to accumulate in the tube, and it can actually – you can see how big the tube is. Based on those findings, we can actually determine how successful are corrective procedure is going to be. And I’ll go into that in just a second.

Another way is we can do an ultrasound. And if there’s enough fluid in that fallopian tube, we can pick out a hydrosalpinx. It looks like a sausage basically and it’s filled with fluid. So the fluid shows up as being black. So, it looks like a pipe basically on ultrasound. The other way is surgery. If we take a look inside the abdominal cavity and we put dye inside the uterus, to see if the tubes are open; we can see a tube become enlarged and we can see where the obstruction is. And see if there’s some filmy adhesions that we can address at the time of surgery. We take down these filmy adhesions around the tube and now the tube is open or sometimes we have to make a new opening, a neosalpingostomy and that’s where we could do this with a laser, and we could do this with scissors. But we also need to know when we are dealing with a hydrosalpinx, what’s the probability that our surgery is actually going to help this patient. And that’s where we go back to the hysterosalpingogram. And based on the findings of what does the tube look like. We look for something called rugae and these are these little black lines we see inside the fallopian tube because the fallopian tube is not round. It’s basically a star shape opening. So, therefore, we can see the little tiny rugae and that tell us the tube has good integrity.

If that is gone, or if the tube is markedly enlarged, then it tells us repairing that tube is really not going to help this patient, that we really need to remove it. Because we can open any fallopian tube. The question is whether or not it is going to actually stay open. And we really do not want to do a repeat surgery. So, if someone has hydrosalpinxes either diagnosed by ultrasound or by hysterosalpingogram or even at the time of surgery; we have to make a decision of is it better off to open the fallopian tubes and we are going to have functional fallopian tubes or do we need to remove them. In those patients that have tubal disease, in many cases, they need to really, we have to bypass the fallopian tubes and that is where in vitro fertilization comes into play and in reality, the first IVF baby Louise Brown was conceived mainly because her mother had bilateral tubal occlusions.

So IVF was actually indicated for those with tubal disease. If we have hydrosalpinxes present at the time of even going through in vitro fertilization, and that fluid is still in that tube; that fluid can leak down inside the uterine cavity and it can actually decrease the success rates of in vitro fertilization significantly and there’s been reports that it has decreased success rates and then up to 80%. And by taking out the fallopian tubes or disconnecting the tubes from the uterus, so the fluid doesn’t get back inside the uterus; it brings that success rate up back to where it’s supposed to be.

With tubal disease, we really need to make a decision of whether surgery is really indicated or do these patients need in vitro fertilization where the surgery would need to include removing or disconnecting the fallopian tubes from the uterus.

Host:  That’s absolutely fascinating Dr. Ziegler. What a great educator you are. Can they be unblocked naturally if it’s maybe not major or as you said, maybe even caused by an infection of some sort? Is there any way that they would just clear themselves out?

Dr. Ziegler:  There’s always that possibility that they can open themselves up but that’s quite rare. In some cases, if the tube is blocked, it could be from tubal spasm because the uterus is a muscle and therefore, that if the muscle is in spasm, it’s not going to let the dye through but that’s normally close to the uterus. But if someone has enlarged fallopian tubes, the best thing to do is surgery and assess whether or not salvaging those tubes are keeping them in place and having a woman conceive either naturally or with inseminations would be in that patient’s best interest or whether they would really do better going for in vitro fertilization.

Host:  Well then wrap it up for us. What an interesting topic this is. And it was so informative. So, Dr. Ziegler, let patients listening know what you would like them to know about blocked fallopian tubes and how you can help them at the Reproductive Science Center of New Jersey.

Dr. Ziegler:  I think the first thing is they have to realize that if they’re having a difficult time in conceiving, they need an evaluation. And if they do have a hydrosalpinx, that could be the cause of why they are not conceiving. And it could have direct effect on the endometrial lining especially if one tube is a hydrosalpinx and if the other one isn’t. It can also affect the embryos that are created either naturally or through in vitro fertilization. So, if a patient has a history of prior pelvic surgery, prior pelvic infection, or even a history of endometriosis; they should really have an evaluation of their fallopian tubes because they can continue to try to conceive and get more and more frustrated because their tubes are not open, and the egg and the sperm are not getting together.

Host:  Thank you for such an informative segment Dr. Ziegler. What great information and that concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. For more information please visit www.fertilitynj.com to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the other Reproductive Science Center of New Jersey podcasts. And don’t forget to check out all the other interesting podcasts in our library. I’m Melanie Cole.