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Hydrosalpinx & Fertility: Everything You Need to Know

Hydrosalpinx can sound daunting, but understanding it is the first step toward feeling more in control of your fertility. Here’s all you need to know: what it is, how it’s treated, and how it may impact your path to pregnancy.

Author

Tassia O’Callaghan

Reviewed by

Kayleigh Hartigan

16 min read

Updated 19 August 2025

Condition spotlight:

Hydrosalpinx is when a fallopian tube becomes blocked and fills with fluid, often affecting fertility. [1]
It’s usually caused by inflammation or scarring — commonly from past infection, surgery, or endometriosis. [2]
The condition can reduce the chances of both natural conception and IVF success, and may increase the risk of miscarriage or ectopic pregnancy. [2,3,4,5,6,7]
Many people have no symptoms, and it’s often only found during fertility testing or investigations into failed IVF. [8]
Treatment is possible — including surgery to open or remove the affected tube, or blocking the tube before IVF to improve outcomes. [9,10,11,12]

What is hydrosalpinx?

Hydrosalpinx is when one or both fallopian tubes become blocked and fill with fluid. The word comes from Greek: hydro (fluid) and salpinx (tube). These blocked, swollen tubes can twist, leak, or cause inflammation — and may stop sperm from reaching the egg, or stop a fertilised egg from reaching the uterus.

Hydrosalpinx is a type of tubal factor infertility, and it’s often diagnosed in people trying to conceive, either during routine fertility testing or while investigating failed IVF cycles. [4]

To understand hydrosalpinx, it helps to know how the fallopian tubes usually work. Each month, during ovulation, an egg is released from the ovary. The nearby fallopian tube collects it — this is typically where sperm meets egg and fertilisation happens. If fertilised, the embryo then travels down the tube into the uterus, where it can implant and begin developing into a pregnancy. [1]

But in hydrosalpinx, this process is disrupted. The affected tube is blocked at the end closest to the ovary, so fluid builds up inside and the tube stretches. That fluid isn’t harmless. It can contain inflammatory compounds, immune cells, and toxins that are harmful to embryos. If this fluid leaks into the uterus, it can make it harder for an embryo to implant or increase the risk of early pregnancy loss. [8]

Hydrosalpinx is also linked to higher rates of ectopic pregnancy — when an embryo implants in the tube rather than the uterus. This is a medical emergency and can be life-threatening if not treated. [7]

While it may not always cause symptoms, hydrosalpinx is a clear signal that the fallopian tube is not functioning as it should — and for those trying to conceive, that knowledge can be powerful. Diagnosis opens the door to effective treatment options that can dramatically improve outcomes. [3]

How rare is hydrosalpinx?

Hydrosalpinx isn’t extremely common — but it’s not rare either, especially among people struggling to conceive. It’s a type of fallopian tube problem, and tubal issues are behind around 1 in 4 cases of infertility in women. Hydrosalpinx makes up a smaller portion of that (between 10-30%), so overall it’s thought to affect around 2 to 8 in every 100 people struggling to conceive. [4]

If you’re not actively trying to conceive, you might never know you have it. Many people with hydrosalpinx have no symptoms, and it often only shows up during fertility investigations like an HSG or ultrasound. So while it’s not something most people will experience, it’s something fertility specialists are very familiar with — and there are clear pathways for diagnosis and treatment. [3]

How serious is hydrosalpinx?

Hydrosalpinx is considered medically significant — especially if you’re trying to conceive. Even when it doesn’t cause pain or noticeable symptoms, it can reduce fertility by interfering with embryo implantation and increasing the risk of miscarriage or ectopic pregnancy. [7,12]

Outside of fertility, rare complications like infection (which can become pyosalpinx, an infection of the fallopian tube), torsion (twisting of the tube), or abscess formation are rare but possible — and when they do occur, they can be serious. So while it’s not always an emergency, it’s also not something to ignore. [13,14,15]

Can hydrosalpinx be cancerous?

Hydrosalpinx itself isn’t cancer, but in postmenopausal people, it can (very rarely) be linked to underlying gynaecological cancers — especially of the ovary, endometrium, or fallopian tube. That’s why further investigation is usually recommended if there’s no obvious cause. [16]

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What causes hydrosalpinx?

Hydrosalpinx is most often caused by inflammation or damage to the fallopian tubes. That inflammation can be triggered by:

Pelvic inflammatory disease (PID): Often from untreated STIs like chlamydia or gonorrhoea. This is one of the most common causes. [2]
Previous abdominal or pelvic surgery: Including C-sections, appendectomies, or surgery for ectopic pregnancy. [2]
Endometriosis: Endometrial tissue growing on or near the fallopian tubes can lead to inflammation and scarring. [2]
Tubal ligation (sterilisation) reversal: Particularly if the tubes were already damaged or inflamed beforehand. If both ends of the fallopian tube become sealed off (for example, from previous infection and then sterilisation surgery), fluid can build up inside, leading to a swollen, blocked tube. This is more likely if sterilisation was done using cauterisation or clips, and it can happen months or even years after the procedure. [17,18]
Tubo-ovarian abscess: Both tubo-ovarian abscesses (TOA) and hydrosalpinx are complications of pelvic inflammatory disease (PID), and when an abscess forms in or around the fallopian tube, it can leave behind scarring and blockages. Over time, this damage can cause the tube to fill with fluid, resulting in a hydrosalpinx. [15]
Congenital (primary) abnormalities: Structural issues in the tube’s length, shape, or mobility — though this is more often seen in paediatric cases. [8]
Post-infectious adhesions: From past infections (such as STIs like chlamydia or gonorrhea) or inflammatory conditions that create scar tissue around the tube. [8]
Pelvic or ovarian tumours: In very rare cases, growths near the fallopian tube can obstruct it. [16]

Some people may have more than one contributing factor — and in certain cases, the cause isn’t always clear.

What are the symptoms of hydrosalpinx?

Hydrosalpinx doesn’t always cause symptoms. In fact, many people only find out they have it during fertility tests.

When symptoms are present, they may include: [8]

Trouble trying to conceive: Often the first or only sign, particularly if both tubes are affected.
A feeling of pressure or fullness: Especially with larger or swollen tubes.
Pelvic or lower abdominal pain: A dull ache or intermittent sharp pain, often on one side. Some describe it as a dragging or heavy feeling.
Back pain: In some cases, inflammation or swelling can irritate the lower back.
Unusual vaginal discharge: Watery, sometimes smelly discharge may be present — though this can also be a sign of infection and should be investigated urgently.
Pain during sex (dyspareunia): Linked to inflammation or tubal swelling.
Ectopic pregnancy: In some cases, this may be the first sign that the tube is damaged.
Acute pain with nausea or vomiting: Could indicate torsion (twisting of the tube), which is a medical emergency.

Not everyone will experience all of these — and in many cases, hydrosalpinx is only discovered through imaging like ultrasound or during surgery. Some of these symptoms can also be caused by other gynaecological conditions, so it’s important to speak to a doctor for an accurate diagnosis.

Can hydrosalpinx affect fertility?

Yes — hydrosalpinx can have a significant impact on fertility. Because the fallopian tube is blocked and filled with fluid, it prevents sperm from reaching the egg or stops a fertilised egg from travelling to the uterus. Even if conception happens, the toxic fluid inside the swollen tube can leak into the uterus and disrupt implantation, increase the risk of early miscarriage and recurrent miscarriage, or even lead to an ectopic pregnancy.

Studies show that hydrosalpinx can reduce IVF success rates by up to half. That’s why many fertility specialists recommend removing or blocking the affected tube before IVF, which has been shown to improve both pregnancy and live birth rates. [2,3,4,5,6,7]

How is hydrosalpinx diagnosed?

Hydrosalpinx is usually diagnosed during fertility testing, imaging, or surgery. Because it doesn’t always cause symptoms, it’s often first picked up when someone is struggling to conceive or experiencing unexplained pelvic pain.

Hysterosalpingogram (HSG): The most common way to check for hydrosalpinx. An X-ray where contrast dye is passed through the cervix into the uterus and fallopian tubes. If the tubes are blocked and filled with fluid, the dye will be trapped, helping identify a hydrosalpinx. However, HSGs aren’t perfect and can sometimes give false positives. [3,19]
HyCoSy (hysterosalpingo-contrast sonography): A test that’s similar to HSG that uses ultrasound instead of X-ray, along with a special contrast solution. It’s often preferred in fertility clinics because it’s less invasive and doesn’t use radiation. It also allows the clinician to see the shape of the tubes and whether they’re open or swollen in real time.
Ultrasound: A transvaginal ultrasound may detect hydrosalpinx, especially if the tube is enlarged or has a classic “sausage-shaped” or folded appearance. However, it’s not always sensitive enough to catch smaller or less obvious cases.
Laparoscopy: This keyhole surgery allows direct visualisation of the fallopian tubes and is considered the most accurate method. During the procedure, dye may also be passed through the tubes to check for blockages, and treatment can sometimes be done at the same time. [20]

When to look into hydrosalpinx

If you’ve been trying to conceive for 12 months (or 6 months if you’re 36 or over) and pregnancy hasn’t happened yet, it’s a good idea to speak to a GP. One of the standard checks for people assigned female at birth is an evaluation of the fallopian tubes — especially if there’s a history of pelvic infection, surgery, or symptoms like persistent pelvic pain. [21]

A hydrosalpinx may not always be obvious, but if your fertility tests show blocked or swollen tubes, further imaging — like a HyCoSy, HSG, or laparoscopy — might be recommended to investigate more closely. And if IVF is being considered, you should be offered the option to remove the affected tube(s) first, as this has been shown to improve IVF outcomes. A fertility specialist can help you decide what’s right for your body and goals.

Can you treat hydrosalpinx?

Yes — hydrosalpinx can be treated, but the right approach depends on how severe the damage is, your fertility plans, and whether you’re trying to conceive naturally or through IVF. Some treatments aim to preserve the fallopian tube, while others remove or bypass it to improve fertility outcomes.

Treatment options include:

Salpingostomy: Opening the blocked end of the fallopian tube via keyhole surgery (laparoscopy); best suited to milder cases where natural conception is still an option. [4]
Salpingectomy: Surgical removal of the affected fallopian tube, often recommended before IVF to significantly improve success rates. [9,10,11]
Drainage: Occasionally done, but fluid often reaccumulates. [22]
Tubal ligation (clipping or sealing the tube): To stop toxic fluid reaching the uterus. [18]
Tubal occlusion: Placing a device to block the affected tube instead of removing it; this is less commonly used and generally considered less effective than salpingectomy before IVF. [23]

For severe or advanced hydrosalpinx, salpingectomy is currently the most effective way to support IVF success. For those hoping to conceive naturally, your doctor will weigh up the risks — like ectopic pregnancy — with the potential benefits of surgery.

What happens if hydrosalpinx is left untreated?

It may lead to long-term fertility problems, higher miscarriage risk, or complications like ectopic pregnancy. If you’re not trying to conceive and it’s symptom-free, some doctors may take a watch-and-wait approach. It doesn’t always cause complications — but when fertility is the goal, early diagnosis and personalised treatment can make a meaningful difference.

How to conceive with hydrosalpinx

Conceiving with hydrosalpinx can be more complex — but it’s not impossible. The best path forward depends on whether one or both fallopian tubes are affected, the severity of the damage, and your broader fertility health. Here’s what you need to know to navigate your options with clarity and confidence.

If only one tube is affected

You may still be able to conceive naturally if the other tube is open and functioning well — especially if you’re ovulating regularly and have no other fertility concerns. But it’s worth speaking to a specialist about whether the hydrosalpinx is likely to interfere with implantation or increase risk of ectopic pregnancy, even on the unaffected side.

If both tubes are blocked or swollen

When both tubes are impacted, natural conception becomes much less likely. That’s because the fluid in a hydrosalpinx can disrupt the endometrial environment, making it harder for an embryo to implant — and significantly reducing the success rates of IVF. [12]

When both fallopian tubes are affected by hydrosalpinx, treatment often focuses on improving the chance of conception through assisted reproductive techniques. In some cases, the affected tubes may be removed or surgically opened, depending on their condition and your hopes for natural conception. IVF is typically the next step, as it bypasses the tubes entirely — but managing the hydrosalpinx beforehand can make a meaningful difference to your chances of success. [10]

Find the right clinic for you

Choosing a clinic is one of the biggest decisions you’ll make. We’ll find the best options for you and arrange your pre-treatment tests, empowering you from this point onwards.

How does hydrosalpinx affect fertility treatment?

Not everyone with hydrosalpinx will need fertility treatment — but if you do, it’s important to understand how this condition can affect your options.

IVF

Hydrosalpinx can significantly impact the success of fertility treatment — particularly IVF. Even though IVF is designed to bypass the fallopian tubes, the presence of hydrosalpinx fluid can lower implantation and pregnancy rates by as much as 50%, while increasing the chance of miscarriage. [24]

This is partly due to the toxic effect of the fluid itself, which can leak into the uterus and interfere with the delicate hormonal and immune signals needed for implantation. Studies have found high levels of inflammatory cells and cytokines like IL-2 in the endometrium of people with hydrosalpinx, which can make the uterine lining less receptive to an embryo — even if the embryo is healthy. [25]

Surgical removal of the affected tube(s) before IVF (salpingectomy) has been shown to improve implantation and live birth rates, likely because it helps restore a more supportive endometrial environment.

Overall, managing hydrosalpinx before starting IVF is widely considered best practice to improve your chances of a successful pregnancy.

IUI

Hydrosalpinx can make intrauterine insemination (IUI) significantly less effective — especially if the affected tube is swollen and blocked at the far (distal) end. While IUI is sometimes considered for people with unilateral (one-sided) tubal issues, research shows that distal tubal problems like hydrosalpinx are linked to lower pregnancy rates and minimal benefit from repeated IUI cycles. [26]

That’s because the fluid from the hydrosalpinx can still leak into the uterus, disrupting implantation even when sperm are placed directly into the womb. Treating the tube first — either by removing it or blocking it off — has been shown to improve chances of conceiving naturally or with IUI. Without treatment, hydrosalpinx may reduce the likelihood of IUI working, and may also increase the risk of ectopic pregnancy.

Egg freezing

Hydrosalpinx doesn’t directly affect the number or quality of eggs you can freeze — because egg retrieval happens in the ovaries, not the fallopian tubes. But it can still influence your egg freezing experience and any future plans for embryo transfer.

Sperm freezing

Hydrosalpinx doesn’t affect sperm freezing — it’s a condition that only affects the fallopian tubes, so it has no impact on sperm quality or the process of sperm preservation. If you or your partner are freezing sperm as part of fertility planning alongside hydrosalpinx treatment, both can still be done safely and independently.

What to do next

If you’ve been diagnosed with hydrosalpinx — or you’re facing the possibility — it’s normal to feel unsure about what comes next. The good news is that there are effective, evidence-backed treatments available, and many people go on to conceive with the right support. The key is understanding your options, knowing what questions to ask, and finding care that aligns with your needs and goals.

We at Seen Fertility are here to help you do exactly that. Whether you’re looking for a clinic experienced in treating tubal issues, exploring IVF, or simply trying to make sense of your diagnosis, our Clinic Match tool connects you to clear, personalised information. You’ll find transparent clinic reviews, success data, and practical guides that make complex decisions feel that bit more manageable. Because when it comes to your fertility path, clarity and confidence make all the difference.

Hydrosalpinx FAQs

Is hydrosalpinx endometriosis?

No, hydrosalpinx is not the same as endometriosis — but the two conditions can be closely linked.

Hydrosalpinx is a specific type of tubal damage, where the fallopian tube becomes blocked and filled with fluid. Endometriosis, on the other hand, is a broader condition where tissue similar to the lining of the uterus grows outside the womb, often causing inflammation, scarring, and pain. In some cases, endometriosis can lead to tubal damage or blockages, including hydrosalpinx. This is known as tubal endometriosis, and it can be one of several possible causes of fluid build-up in the fallopian tubes. [27]

How big can a hydrosalpinx get?

Hydrosalpinx can vary in size — but when it’s described as “severe,” that often means the affected fallopian tube is visibly swollen, typically with a diameter of more than 2.5cm (25mm). In some studies, hydrosalpinges measuring over 3cm have been associated with significantly poorer fertility outcomes, including lower implantation and pregnancy rates, and higher miscarriage and ectopic pregnancy risk. [5]

While not every case of hydrosalpinx is this large, size is one of the factors doctors use to assess how serious the damage is — and whether surgery might be recommended before fertility treatment. The larger the hydrosalpinx, the more likely it is to interfere with conception or IVF success.

Is hydrosalpinx an STI?

No, hydrosalpinx is not a sexually transmitted infection (STI) — but it can be caused by STIs.

Hydrosalpinx refers to a fallopian tube that’s become blocked and filled with fluid, usually due to inflammation or scarring. One of the most common causes of that inflammation is pelvic inflammatory disease (PID), which itself is often the result of untreated STIs like chlamydia or gonorrhoea. So while hydrosalpinx isn’t an infection and can’t be passed between partners, it can be a long-term complication of infections that were. [28,29]

That said, not all cases are linked to STIs. Hydrosalpinx can also be caused by endometriosis, previous pelvic surgeries, sterilisation procedures, or other non-infectious issues — and it’s even been found in people with no sexual activity at all. If you’ve been diagnosed, your doctor will look at your full medical history to understand what might have caused it in your case. [30]

Sources

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