Hydrosalpinx: Understanding Your Pathology Report

Section Editor: Kianoosh Keyhanian MD FRCPC
August 31, 2026

Hydrosalpinx is a noncancerous (benign) condition in which a fallopian tube becomes blocked at its outer end and fills with watery fluid. The fallopian tubes carry an egg from the ovary to the uterus. The name comes from two Greek words: “hydro” for water and “salpinx” for tube.

The blockage is almost always at the fringed end of the tube, the end that sits next to the ovary. When that end seals shut, fluid made by the cells lining the tube has nowhere to drain. The tube gradually stretches and can become several centimeters wide. Both tubes are affected in roughly half of cases.

Hydrosalpinx is not cancer, and it does not turn into cancer. Its importance lies elsewhere: a blocked, fluid-filled tube interferes with fertility, and that is usually the reason it is found and treated. This article will help you understand what this diagnosis means on your pathology report, what each term means, and why it matters for your care.

What causes hydrosalpinx?

Hydrosalpinx develops when something damages the fringed end of the fallopian tube,e and it heals shut. The tube’s lining cells keep producing fluid, and with no way out, it collects and stretches the tube.

Previous infection — This is the most common cause. Pelvic inflammatory disease, often following a sexually transmitted infection such as chlamydia or gonorrhea, damages the tube and its fringed end. The infection may have been mild or unnoticed, and the damage may not become apparent until years later.
Endometriosis — Tissue similar to the lining of the uterus growing outside the uterus can scar the tube and surrounding tissue.
Previous surgery — Any operation in the pelvis or abdomen can leave scar tissue. Surgery for a ruptured appendix, a previous ectopic pregnancy, or tubal ligation are all recognized causes.
Adhesions — Bands of scar tissue in the pelvis can pull the tube out of position, kink it, or seal its end.
Tuberculosis — Uncommon in North America but an important cause worldwide.

In some cases, doctors never identify a cause. Hydrosalpinx is not contagious or inherited.

What are the symptoms?

Many people with hydrosalpinx have no symptoms at all. The condition is frequently discovered during tests for difficulty becoming pregnant, which for many people is the first sign that anything is wrong. When symptoms occur, they may include:

Pelvic or lower abdominal pain — Often a dull, ongoing ache on one side. Pain may be worse around the time of a period.
Watery vaginal discharge — Fluid from the tube occasionally drains back through the uterus, producing intermittent watery discharge.
Difficulty becoming pregnant — Often the only sign, and the reason most people are investigated in the first place.
Sudden severe pain — Uncommon, but a stretched tube can twist or become infected, which needs urgent assessment.

How is the diagnosis made?

Doctors usually identify hydrosalpinx before surgery using imaging. On ultrasound, the blocked tube appears as an elongated, sausage-shaped, fluid-filled structure beside the ovary, often with incomplete partitions inside it. Another common test is a hysterosalpingogram, an X-ray in which dye is injected through the uterus. If a tube is blocked at its far end, the dye enters the tube, spreads out, and stops.

Hydrosalpinx is sometimes found unexpectedly during surgery performed for another reason, or during a laparoscopy being done to investigate infertility or pelvic pain.

A pathologist makes the final diagnosis after removing the tube and examining it under a microscope. The pathologist confirms the changes of hydrosalpinx. The pathologist also examines the lining along the length of the tube to make sure nothing else is present. A tumor of the fallopian tube is a rare cause of a blocked, swollen tube, and examining the whole specimen is how that is excluded.

What does hydrosalpinx look like under the microscope?

Hydrosalpinx is a stretched, fluid-filled fallopian tube with a thinned wall and a flattened lining. To the naked eye, the tube is dilated and often sausage-shaped, with a thin, sometimes translucent wall. Under the microscope, the pathologist looks for the following features.

A stretched, thinned wall — The muscle layer of the tube is stretched and thinned by the pressure of the fluid inside.
Flattened lining folds — The inside of a normal fallopian tube has tall, branching folds. In hydrosalpinx, these flatten, become blunted, and sometimes fuse, leaving small gland-like spaces.
Loss of hair-like projections — The lining of a normal tube carries fine hair-like projections called cilia, which help move an egg toward the uterus. In hydrosalpinx, many are lost, and the epithelium may be flattened or worn away entirely.
Chronic inflammation — Inflammation is the body’s response to injury. In hydrosalpinx, it is usually long-standing and mild, reflecting damage that happened some time ago.
Scarring — Fibrosis, or scar tissue, is often present in the wall of the tube and on its outer surface, where it may form adhesions to nearby structures.
No abnormal cells — The lining cells look ordinary, with no crowding and no complex growth.

How does hydrosalpinx affect fertility?

This is the part of a hydrosalpinx diagnosis with the most practical consequence. A blocked tube reduces fertility in two separate ways, and the second one surprises many people.

The first is mechanical. A tube sealed at its outer end cannot pick up an egg from the ovary. Without the hair-like projections, even an egg that enters cannot be moved along. If both tubes are blocked, natural conception through the tubes is not possible.

The second is the fluid itself. Fluid from a hydrosalpinx can drain backward into the uterus, where it appears to interfere with an embryo settling into the lining. This is why hydrosalpinx matters even for people using in vitro fertilization, which bypasses the tubes completely. Studies have consistently found that an untreated hydrosalpinx reduces live birth rates after IVF by roughly half and raises the rates of miscarriage and ectopic pregnancy.

Because of this, fertility specialists generally recommend treating a hydrosalpinx before IVF. The two established options are removing the affected tube, called salpingectomy, or blocking the tube where it joins the uterus, called proximal tubal occlusion. Both have been shown to improve pregnancy rates compared with leaving the tube untreated, and trials comparing them have not shown one to be clearly better. If your tube was removed and the report describes hydrosalpinx, this is usually why.

Does hydrosalpinx increase the risk of cancer?

No. Hydrosalpinx is not a precancerous condition, and having it does not raise your risk of developing cancer of the fallopian tube or the ovary. There is no cancer screening or surveillance program for hydrosalpinx, asoyour doctor will mnot onitor for tit

The connection between hydrosalpinx and cancer runs the other way. A tumor of the fallopian tube can block the tube and produce swelling that resembles hydrosalpinx on a scan. This is uncommon, but it’s why the pathologist examines the lining of the whole tube rather than a single piece. If your report says hydrosalpinx without qualifying words, that examination was done and no tumor was found.

What other findings may be described in the report?

Along with the diagnosis of hydrosalpinx, your pathology report may describe several other features of the tube and the surrounding tissue.

Which side, and whether both — The report states whether the right tube, the left tube, or both were affected. Both are involved in about half of cases.
Size of the tube — The report gives the dimensions of the dilated tube in centimeters.
Adhesions — Scar tissue on the outer surface of the tube, often binding it to the ovary, the uterus, or the bowel.
Findings in the ovary — If an ovary was removed with the tube, it is examined and reported separately. Cysts and other incidental findings are common.
Paratubal cysts — Small fluid-filled spaces beside the tube are often present. A paratubal cyst is a separate, noncancerous finding and is not the same as hydrosalpinx.
The fringed end of the tube — The report may describe whether this end is sealed, scarred, or destroyed. The blockage almost always sits here.

What happens after this diagnosis?

Hydrosalpinx is a benign condition. If the affected tube was removed, the problem it caused has been addressed, and no further treatment of the tube is needed. What comes next depends mostly on whether you are trying to become pregnant. Points your doctor may raise include:

Fertility planning — If you are trying to conceive and both tubes are blocked or removed, IVF is the usual route. Removing a hydrosalpinx before IVF is done specifically to improve the chance of success.
The other tube — If only one tube was affected, the other may still work normally, and natural conception remains possible.
Ovarian function — Removing a fallopian tube does not remove the ovary and does not stop hormone production or bring on menopause.
Pain — If the hydrosalpinx was causing pelvic pain, that often settles after the tube is removed. Ongoing pain may have another cause worth investigating.
Preventing further damage — Because past infection is the most common cause, testing and treating sexually transmitted infections promptly helps protect the remaining tube.

Your doctor will tell you whether any follow-up is recommended in your situation.

Questions to ask your doctor

Was one tube affected, or both?
Was the tube removed, blocked, or left in place?
Was my ovary removed, or only the tube?
Was a cause for the blockage identified?
Was any tumor or abnormal growth found in the tube?
Does this explain my symptoms?
What does this mean for my chances of becoming pregnant naturally?
Was the tube treated to improve my chances with IVF?
Should I be tested for a sexually transmitted infection?
Were any other findings described in the specimen?
Do I need any follow-up imaging or appointments?
What symptoms should prompt me to contact you?