Double trouble – hydrosalpinx & sperm morphology

Dear Professor Winston,
Thank you for taking time out for this. I recently had one tube clipped for hydrosalpinx, and had dye passed through my other tube which showed it was currently patent, which I know is rare. My husband on the other hand had surgery to remove a large fat mass surrounding his testes which his urologist believes may be interfering with spermatogenesis, by increasing the local temperature of the testes. He has an isolated problem with sperm morphology. I was dubious about him having surgery, but in the end we decided upon it. We have a 3rd semen sample booked in October. Do you think that there could be a chance that this scrotal fat would have made any difference to his sperm shapes? His count is great, ok motility. I was thinking maybe it’s all genetics? Our fertility clinic thinks it was still something that should be addressed and advised, should his morphology improve, then we ought to consider clomid and try naturally. I have one supposed working tube – will clomid make me ovulate more to increase the chances of conception? Or should I insist on IUI or IVF? Obviously if morphology fails to improve we will be looking at ICSI. Also one last question – sorry, if we have a good count and motility, how important is morphology? WHO recommends 4 %, which is not mega high even for a fertile man although my husband’ s morphology has been 0-1%, which is fairly poor. L

Dear L,

I am interested in your observation that you think it is rare to have one tube open and the other with a hydrosalpinx. If the blockage of the tube, the hydrosalpinx, was not a result of a congenital deformity, it suggests that you may have had some damage probably due to an infection. Congenital hydrosalpinx is indeed rare so it would be helpful to scrutinise any photos of your laparoscopy to confirm that it looks like a congenital deformity if they exists. Also quite often small adhesions on the patent side can be a useful indicator of something wrong with an apparently open normal tube. Nearly all cases of hydrosalpinx are due to infection. I must emphasise that this does not indicate some sexually transmitted disease – there are a whole number of causes of inflammation of the tubes due to infection which are really common. So if the hydrosalpinx you had was not congenital, it most likely that any infection affected both tubes. It is extremely rare to have infectious damage just on one side so it is not unlikely that there is some microscopic damage to your remaining tube even though it is fully patent. Unquestionably, if this has been damaged in this way it will reduce your fertility as the Fallopian tube is not merely a static pipe but it is actively involved in feeding the egg and embryos and transporting it at the right speed and time into the uterus. In any case, if you only have one tube working this cuts down your fertility by 50% because half the time you will be ovulating from the ‘wrong’ ovary. Eggs occasionally cross from side to side, but research I did in the 1970s shows that this is unusual.

The information above, plus the fact that your husband has a problem as well makes me feel that IVF is probably the right course of action now. I don’t advocate IVF unnecessarily (you might care to read my book “The Essential Fertility Guide” about to be published – proceeds go to Genesis Research Fund) and you will see that my stance has always been to avoid IVF if possible. But here I think there is a good case for it. IUI is not the answer and statistically has not shown to improve the chances of people like yourself greatly. This is also likely to be true of Clomid in this situation though the figures are a bit less clear.

I should add that it might well be worthwhile getting an x-ray of the womb and tubes – a hysterosalpingogram – before IVF because carefully done this may reveal subtle abnormalities in your remaining open tube. If that is the case, there is a stronger case for IVF. I would also be very happy to review any digital copies of such x-rays if sent by email as sometimes these photographs are occasionally reported as normal when there is an underlying problem.

I hope this is helpful
Robert Winston