Tubal-factor infertility and tubal surgery

A 31-year-old woman is referred after 18 months of trying. Her cycles are regular, her day-3 hormones are normal, her partner's semen is fine — and the transvaginal ultrasound shows a tubular fluid-filled structure beside the left ovary. That is a hydrosalpinx, and it changes the plan entirely. Tubal-factor infertility rewards the clinician who grades the damage, weighs the woman's age, and knows which tube to fix and which to bypass with IVF. It punishes the one who chases patency without asking whether the lining of the tube is still alive. This topic is that judgement.[5][6]

Overview and definition

Tubal-factor infertility is subfertility caused by disease of the fallopian tubes or the tubo-ovarian relationship. Tubal disease accounts for roughly 20% of female infertility, and its share rises wherever pelvic infection and untreated sexually transmitted infection are common.[6][10]

Two ideas organise the whole topic: [1][5]

• The tube does two jobs. It must be patent (open, so sperm and ovum can meet) and functional (healthy ciliated mucosa to transport the embryo). Patency without function is a patent tube that still causes ectopics. This is why a hydrosalpinx matters even though it is technically "open."
• Three questions decide surgery versus IVF. Is the tube patent? Is the mucosa healthy? And what is the woman's age and ovarian reserve? Answer all three before you choose.[1][6]

References13Show ledgerHide ledger

1. [1]Melo P, Georgiou EX, Johnson N, et al. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation Cochrane Database Syst Rev, 2020.PMID 33091963
2. [2]Dreyer K, van Rijswijk J, Mijatovic V, et al. Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women N Engl J Med, 2017.PMID 28520519
3. [3]Wang R, van Welie N, van Rijswijk J, et al. Effectiveness on fertility outcome of tubal flushing with different contrast media: systematic review and network meta-analysis Ultrasound Obstet Gynecol, 2019.PMID 30740799
4. [4]Wang R, Watson A, Johnson N, et al. Tubal flushing for subfertility Cochrane Database Syst Rev, 2020.PMID 33053612
5. [5]Zeyneloglu HB, Arici A, Olive DL Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization-embryo transfer Fertil Steril, 1998.PMID 9757878
6. [6]Capmas P, Suarthana E, Tulandi T Management of Hydrosalpinx in the Era of Assisted Reproductive Technology: A Systematic Review and Meta-analysis J Minim Invasive Gynecol, 2021.PMID 32853797
7. [7]Strandell A, Lindhard A, Waldenström U, et al. Hydrosalpinx and IVF outcome: cumulative results after salpingectomy in a randomized controlled trial Hum Reprod, 2001.PMID 11679529
8. [8]Alcázar JL, Martinez A, Duarte M, et al. Two-dimensional hysterosalpingo-contrast-sonography compared to three/four-dimensional hysterosalpingo-contrast-sonography for the assessment of tubal occlusion in women with infertility/subfertility: a systematic review with meta-analysis Hum Fertil (Camb), 2022.PMID 32484066
9. [9]Alcázar JL, Martinez-Astorquiza Corral T, Orozco R, et al. Three-Dimensional Hysterosalpingo-Contrast-Sonography for the Assessment of Tubal Patency in Women with Infertility: A Systematic Review with Meta-Analysis Gynecol Obstet Invest, 2016.PMID 26824833
10. [10]Wallace LA, Scoular A, Hart G, et al. What is the excess risk of infertility in women after genital chlamydia infection? A systematic review of the evidence Sex Transm Infect, 2008.PMID 18055580
11. [11]van Welie N, Pham CT, van Rijswijk J, et al. The long-term costs and effects of tubal flushing with oil-based versus water-based contrast during hysterosalpingography Reprod Biomed Online, 2021.PMID 33077355
12. [12]Roest I, van Welie N, Mijatovic V, et al. Complications after hysterosalpingography with oil- or water-based contrast: results of a nationwide survey Hum Reprod Open, 2020.PMID 31976383
13. [13]Mohiyiddeen L, Hardiman A, Fitzgerald C, et al. Tubal flushing for subfertility Cochrane Database Syst Rev, 2015.PMID 25929235