Study question

When we perform unilateral salpingectomy due to unilateral hydrosalpinx on HSG, is really contralateral fallopian tube normal?

Summary answer

With a unilateral hydrosalpinx on HSG, abnormalities in contralateral fallopian tube were found in 45.6% and performed additional surgeries salpingectomy or fimbrioplasty.

What is known already

Tubal factor is about one third causes of infertility. For tubal factor evaluation, the most commonly used tests are hysterosalpingography (HSG) and laparoscopy. HSG has high specificity for diagnosis of tubal occlusion and low sensitivity in cases with peritubal adhesions. Tubal patency on HSG does not necessarily indicate normal tubal function. Among women with patent tubes on HSG, 18% were found to have tubal obstruction or peritubal adhesions on laparoscopy.

Study design, size, duration

This retrospective study included 178 salpingectomy cases due to hydrosalpinx on HSG between January 2010 and December 2014.

Participants/materials, setting, methods

Total 178 cases salpingectomy were performed. 99 cases were excluded (69 cases - bilateral salpingectomy due to bilateral hydrosalpinx, 30 cases – unilateral salpingectomy due to unilateral hydrosalpinx with contralateral tubal obstruction on HSG/previous salpingectomy).

Main results and the role of chance

We analyzed 79 cases with unilateral hydrosalpinx and contralateral normal patency on HSG. Among 79 cases, 43 cases were performed only unilateral salpingectomy (US). 14 cases were performed US and contralateral salpingectomy due to unexpected hydrosalpinx. 22 cases were performed US and contralateral fimbrioplasty or adhesiolysis due to peritubal adhesion or abnormal result on dye test. Therefore in case of unilateral hydrosalpinx on HSG, 45.6% (36/79) were found abnormality of contralateral tube and needed additional surgery.

Limitations, reason for caution

The subjectivity of radiologists may be involved in interpretation of HSG. Also during operation, the subjectivity of surgeon may be involved in decision making of contralateral tubal surgery.

Wider implications of the findings

An abnormal tubal condition affects negatively natural pregnancy or IVF outcomes, therefore proper surgery is needed. Among women with normal tubes on HSG, 18% were found abnormalities on laparoscopy. But with unilateral hydrosalpinx, proportion of requiring opposite fallopian tubal surgery is increased by 45.6%. Therefore, in case of elective unilateral salpingectomy due to unilateral hydrosalpinx on HSG, operators must examine opposite tube carefully and make full explanation about incidental bilateral salpingectomy and possibility of IVF.