Hydrosalpinx / Tubal Infertility

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Hydrosalpinx severity + fertility plan
   Degree of hydrosalpinx? Natural conception or IVF? Ovarian reserve?
   • Hydrosalpinx + planning IVF → Hydrosalpinx + IVF → salpingectomy/ligation first
   • Mild distal disease, wants natural conception, good ovarian reserve, young → Mild distal → neostomy/fimbrioplasty
   • Bilateral severe / dense pelvic adhesions → Bilateral severe → IVF
2. [End] Hydrosalpinx + IVF → salpingectomy/ligation first
   Hydrosalpinx + planning IVF → salpingectomy (or proximal ligation/clipping) before IVF; the hydrosalpinx fluid reduces embryo implantation and is embryotoxic, so treating it markedly improves pregnancy rates.
3. [End] Mild distal → neostomy/fimbrioplasty
   Mild distal disease, wants natural conception, good ovarian reserve, young → laparoscopic salpingostomy/fimbrioplasty; raised ectopic pregnancy risk afterwards, convert to IVF if it fails.
4. [End] Bilateral severe → IVF
   Bilateral severe/dense pelvic adhesions → direct IVF (remove the hydrosalpinx tubes first if needed); reconstructive surgery has low value.

Source guidelines & references

• Hydrosalpinx and infertility management (ASRM; ESHRE; tubal management before IVF)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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