How to restore peristalsis of the fallopian tubes. Treatment of fallopian tube obstruction. How is obstruction diagnosed?

The desire to become pregnant does not always come true without any problems. About 30% of women who cannot conceive a child are diagnosed with tubal infertility. This complication usually occurs as a result of obstruction fallopian tubes. However, there are quite a few cases where, after treatment of tubal infertility, women have a chance to become a mother.

Female infertility is the inability of a woman of childbearing age to produce offspring. There are two degrees of infertility:

1st degree - pregnancy has never occurred;
2nd degree of infertility - there was a history of pregnancy.

There are also absolute and relative infertility: the first is caused by irreversible abnormalities in the development of the female reproductive system, the second can be corrected during treatment. Tubal infertility is considered relative.

Tubal infertility occurs due to the appearance of adhesions or fluid in the fallopian tubes, which prevent the mature egg from passing into the uterus and interfere with the meeting with the sperm, and, accordingly, the conception itself.

There are partial and complete obstruction of the pipes. If only one of the two fallopian tubes is obstructed or the lumen is not completely blocked, then pregnancy is possible.

If you are diagnosed with “incomplete obstruction,” the possibility of getting pregnant still exists, but for women with such diagnoses, gynecologists usually prescribe special medications to stimulate ovulation.

What are the causes of the disease?

There are cases where obstruction of the fallopian tubes is caused by congenital pathologies of the development of the uterus, tubes and appendages. In addition, there are many reasons that can provoke tubal infertility in an initially healthy woman. In the first place among the causes are inflammatory diseases of the female reproductive system. A history of sexually transmitted infections, the presence of fibroids, surgical interventions, abortions, the formation of adhesions in the pelvic organs. Endometriosis is another one of the most common reasons tubal infertility.

There are cases when this disease is not associated with the above factors, but is caused by hormonal imbalances or metabolic processes in the body.

In cases where the fallopian tubes are completely passable, but in some areas there are narrowings that impair functionality or the tubes are partially obstructed, this should not be ignored; such disorders can be no less dangerous and can cause an ectopic pregnancy. Read more about ectopic pregnancy

Often, a woman may not even realize that she is suffering from obstruction of the fallopian tubes; in principle, there are no signs of the disease; it can only be detected through diagnostics. You should be concerned if you are periodically bothered by nagging pain in the lower abdomen - this may be a symptom of tubal obstruction and, therefore, a symptom of tubal infertility.

How is obstruction diagnosed?

Currently, there are several methods for diagnosing tubal infertility, which help determine how obstructed the fallopian tubes are. It is worth noting that diagnostics should only be carried out when complete absence inflammatory process and infections in the genital area.

The most accessible and accurate method is considered diagnostics of CHT (kymographic hydrotubation). The fallopian tubes are purged using a special apparatus that has an air reservoir, which allows the volume of air introduced to be determined.

The kymograph allows you to note changes in pressure in the tubes and uterus; based on the resulting curve, the doctor makes a conclusion about the degree of patency of the tubes. This research method allows not only to determine the condition of the fallopian tubes, but also is therapeutic method, providing a therapeutic effect, thus it turns out that the woman receives double benefit.

The next research method we will consider is hysterosalpingography . Diagnostics using this method allows you to find out which particular pipe is impassable and where the adhesions are concentrated.

During this procedure, a special substance is injected into the uterus, and then pictures are taken. The first picture is taken immediately, the next one after 10 minutes, and the final one after 24 hours from the moment of administration of the substance. Based on the results of the images, the doctor makes a conclusion about the condition of the fallopian tubes and uterus.

Note that hysterosalpingography can cause an exacerbation of the inflammatory process in the uterine cavity and tubes, which in turn can lead to rupture of the fallopian tube. That is why, before deciding on a research method, you should consult a gynecologist and find out about alternative diagnostic methods.

It is also worth considering that women with diagnosed infertility are not recommended to undergo X-rays more than 2 times a year.

Female infertility of tubal origin can be diagnosed using bicontrast gynecography , which allows us to identify adhesions that are located around the ovaries and fallopian tubes. The study is recommended to be carried out in the second half of the cycle, however, it is strictly contraindicated for women suffering from heart disease, hypertension, and tuberculosis.

This diagnosis cannot be carried out in case of inflammation of the genital organs or uterine bleeding. This method makes it possible to quite accurately determine the functions that pipes are capable of performing, and is also indispensable for determining the breadth of the adhesion process.

Another method for identifying pathologies is laparoscopy . This study examines tissues that are involved in the inflammatory process. This diagnostic method is widely used in preparing women for surgery to restore tubal patency.

So, as can be seen from the above, a sufficient number of methods are currently used in medicine to detect obstruction of the fallopian tubes and diagnose tubal infertility. But it is worth remembering that it is better to consult your gynecologist in advance about the diagnostic method, who will help you choose the most suitable option for your case.

Is infertility caused by tubal factor treatable?

Despite the fact that tubal infertility is considered one of the most complex shapes, there are ways to combat this disease.

First of all, women who are diagnosed with suspected infertility are examined for the presence of infections, and if detected, anti-inflammatory treatment is prescribed. Of course, such therapy is not able to cope with the problem of infertility, but it is necessary before intrauterine interventions: diagnosis and treatment of tubal obstruction.

Anti-inflammatory treatment helps fight infection, but it is recommended to eliminate the consequences of inflammation with the help of physiotherapy, which can restore nervous reactions in tissues, soften and even remove adhesions.

Blowing out the fallopian tubes (hydrotubation) is another step in the treatment of tubal infertility. But it's worth remembering that this procedure, carried out repeatedly, can cause rupture of the fallopian tube, so it is carried out strictly according to indications and under the supervision of the attending physician.

Most effective method treatment of tubal infertility is considered operative laparoscopy , this method is used to cut adhesions that have caused pipe obstruction. The method has significantly more advantages than abdominal operations: after the intervention, the woman quickly recovers and returns to her normal life, the risk to health is minimal, and relapses adhesive disease practically doesn't happen.

Note that surgical laparoscopy may be useless in some cases.

Quite often there are situations when, after treatment and restoration of tubal patency, a woman still cannot become pregnant. This happens when there is no peristalsis or microvilli in the pipes - such pipes are called dead.

What to do if, after treatment for tubal infertility, the desired pregnancy does not occur?

Alternative methods of pregnancy

If two years or more have passed after treatment, and pregnancy has not occurred, then you should contact a specialist and find another way to solve the problem. Tubal infertility is an indication for IVF.

This procedure begins with tracking menstrual cycle, then ovulation is stimulated. The maturation of the egg is carefully monitored in order to extract it in time.

According to statistics, the cause of female infertility in 20-25% is a violation of the transport of an egg or an already fertilized egg through the fallopian (uterine) tube. Sometimes pregnancy with obstruction of the fallopian tubes is still possible if the process is unilateral or partial. However, it usually ends in ectopic (extrauterine), most often tubal location and development of the embryo. As a result, there is a need for urgent surgical treatment regarding the threat or already occurred rupture of the fallopian tube, accompanied by heavy intra-abdominal bleeding.

Brief anatomy and causes of tubal obstruction

Brief anatomy and mechanism of fertilization

The fallopian tubes are paired tubular formations. The average length of each of them at reproductive age is from 10 to 12 cm, and the diameter of the lumen in the initial section does not exceed 0.1 cm. There is liquid in the lumen of the tubes. Anatomically, they are divided into three sections:

Interstitial, located in the thickness of the muscular wall of the uterus (1-3 cm) and communicating through its lumen with its cavity.
Isthmus (3-4 cm), which passes between the two layers of the broad uterine ligament.
Ampullary, ending in a funnel, the lumen of which (orifice) communicates with the abdominal cavity. The mouth of the funnel is covered with fimbriae (villi, thin threads), the longest of which is fixed to the ovary located under the ampulla. The remaining fimbriae, with their vibrations, capture the matured egg released from the ovary and direct it into the lumen of the tube.

The walls of the fallopian tube consist of three membranes:

External, or serous.
Internal, or mucous membrane, in the form of branched folds. The inner layer of the mucous membrane itself is ciliated epithelium with villi (outgrowths). The thickness of the shell is uneven, and the number of folds is unevenly located. The villi undergo fluctuations, the speed of which is maximum during the period of ovulation and some time after it, which depends on the hormonal level.
Muscular, which in turn consists of three layers - two longitudinal and one transverse, which ensures peristalsis (wave-like movement) of the pipe walls. This resembles peristaltic contractions of the intestine, promoting the movement of food masses through its lumen.

In addition to the broad ligament, the cardinal and round ligaments are attached to the uterus. All of them provide fixation and a certain position of the uterus with appendages in the pelvis.

A general understanding of the structure of the organ allows us to better understand the causal mechanisms and how to treat tubal obstruction, as well as the importance of prevention inflammatory diseases the uterus and its appendages to implement the mechanism of fertilization.

The sperm penetrates through the cervical canal and the uterine cavity into the fallopian tube, where it connects with the egg. Vibrations of the villi, tubal peristalsis, relaxation of the uterine muscle in the area where it connects with the tube, as well as the directed flow of fluid in the tube ensure the movement of the egg, and after its fertilization, the fertilized egg, through the tube into the uterine cavity. Here it attaches (implants) to the endometrium (the lining of the uterus). The mechanism of the transport function is realized under the influence of hormones, mainly progesterone and estrogens, secreted yellow body ovary.

Causes of obstruction

All processes of fertilization in the whole organism are in close relationship with the hormonal function of the glands internal secretion and central nervous system. The consequence of dysfunction of any link in this complex chain is infertility. One of these links is the patency of the fallopian tubes. Depending on the reasons for its violation, obstruction is distinguished:

mechanical, arising as a result of anatomical obstacles - adhesions (films) in the lumen of the fallopian tubes, tightening the tube or changing its position and shape and leading to a decrease in the diameter of the lumen, as well as adhesions or other formations that close the mouth of the tube from the uterus or ampullary end;
functional, caused by a violation of the peristalsis of the tube (slowdown or, conversely, excessive strengthening) or the dynamics of the fimbriae and villi of its mucous membrane.

The treatment of fallopian tube obstruction and the choice of fertilization method depend on the identified causes. Factors causing these reasons include:

Congenital malformations - embryonic cyst of the tube or broad ligament, atresia (fusion of the walls) of the tube or broad ligament, underdevelopment of the fallopian tubes and some others.
Acute and chronic inflammatory processes in the uterus (endometritis), ovaries (oophoritis), tubes (salpingitis), caused by tuberculosis of the fallopian tubes or a common infection. Inflammation can be triggered by the presence of endometriosis (with subsequent formation of adhesions), intrauterine device, therapeutic and diagnostic manipulations in the uterus or pelvis, childbirth, spontaneous or artificial termination of pregnancy.
Acute and chronic inflammation caused by infectious agents sexually transmitted diseases - gonorrhea, trichomoniasis, chlamydia, genital herpes virus, mycoplasmosis, gardnerellosis. In women, very often these diseases occur without severe symptoms or without them at all and almost immediately acquire chronic course, especially trichomoniasis.
Inflammatory processes and surgical interventions on the pelvic or abdominal organs, as well as peritonitis and pelvioperitonitis (inflammation of the peritoneum of the abdominal cavity and pelvis). The cause of such operations or peritonitis can be torsion of ovarian cysts, uterine fibroids, accidental perforation (perforation) of the uterus during instrumental abortion, perforated gastric ulcer, appendicitis and perforation of intestinal diverticulum, acute intestinal obstruction and many others. They are always accompanied by the subsequent formation of adhesions in the abdominal cavity, which can deform or completely compress the fallopian tubes, leading to its obstruction.
Mechanical damage to the mouth of the fallopian tubes during diagnostic curettage or instrumental abortion with subsequent formation of adhesions, tubal submucosal myoma.
Uterine fibroids compressing the mouth, or a large polyp in this area, ovarian cyst.
Long-term nervous tension or frequent stressful conditions, endocrine diseases or hormonal dysfunctions, as well as innervation disorders, for example, due to diseases or injuries in the area lumbar region spinal cord.

Impairment of patency can be unilateral or bilateral, complete or partial.

Symptoms and diagnosis

As a result of examination of women for infertility, in 30-60% the cause is anatomical or functional obstruction, and complete occlusion of the lumen of the fallopian tubes is detected on average in 14%, partial - in 11%.

Usually there are no subjective symptoms of tubal obstruction. The main symptom is the absence of pregnancy in a woman with regular sexual activity without the use of contraception.

Also possible:

presence of chronic pain syndrome in the pelvic area;
pain in the lower abdomen with severe physical activity;
(painful menstruation);
dysfunction Bladder manifested by symptoms of dysuria;
dysfunction of the rectum, accompanied by pain during defecation, constipation;
painful intercourse;
dyspareunia.

However, the listed symptoms are not typical and are intermittent and optional. They are caused by the presence of connective tissue adhesions (adhesions). In other cases, a sign of pathology is usually a complication in the form of a tubal pregnancy.

Diagnostics

Basic diagnostic methods:

Hysterosalpingography.
Sonohysterosalpigoscopy.
Therapeutic and diagnostic laparoscopy.

Ultrasound diagnosis of fallopian tube obstruction uninformative. It allows you to determine only the displacement of the uterus, anomalies of its development and some types of congenital pathology tubes, the presence of myomatous nodes and other tumors, the size and position of the ovaries.

Hysterosalpingography (HSG) is the introduction of a contrast solution into the uterine cavity, which passes into the fallopian tubes and from there into abdominal cavity, which is recorded by several consecutive x-ray images. Using GHA, the presence of pathology in the uterine cavity and the absence or presence of obstacles in the lumen of the tubes are determined. The disadvantage of the method is a significant percentage of false negative and false positive results (20%).

Sonohysterosalpingography (SHHS) the technique is identical to the previous procedure, but is performed using an ultrasound machine, and an isotonic sodium chloride solution is used as a contrast. SHSG is a more gentle diagnostic method than GSG, since the pelvic organs are not exposed to x-ray irradiation. But the information content of the results is much lower, due to the lower resolution of the ultrasound machine compared to X-rays.

Laparoscopy provides an opportunity to examine the abdominal cavity and the condition of the peritoneum, the surface of the uterus and its appendages in an enlarged form. Laparoscopy for tubal obstruction is more informative if it is performed simultaneously with chromohydrotubation - the introduction of a methylene blue solution into the cervix, which also enters the tubes through the uterine cavity, from where it flows into the abdominal cavity, which indicates the absence of an obstruction in them.

Treatment of fallopian tube obstruction and pregnancy

For functional obstruction, the effectiveness of treatment depends on the degree hormonal disorders and the possibilities of their correction. In some cases, adequate anti-inflammatory treatment is necessary, and sometimes therapy for a woman’s psychosomatic condition is sufficient.

In case of anatomical disorders, through laparoscopic surgery, the detected adhesions around the fallopian tubes are dissected or plastic surgery is performed on the latter in order to restore their patency, which previously could only be done laparotomically (incision of the anterior abdominal wall and peritoneum) access.

However, spontaneous pregnancy after repeated laparoscopic operations on the fallopian tubes occurs in less than 5% of cases. This is explained by the repeated development of the adhesive process.

In the case of minor damage to the tubes during operations requiring the dissection of a small number of adhesions, pregnancy occurs in more than half of the patients; when the patency of the ampullary section of the tube is restored, in 15-29%. Significant damage to the fimbriae greatly reduces the possibility of natural pregnancy.

Treatment with surgical methods It is effective only in cases of partial obstruction of the fallopian tubes, since restoring the normal lumen in them does not allow restoring the functioning of the ciliated epithelium of the mucous membrane. The possibility of a normal pregnancy occurring in these cases is very small, but the likelihood of an ectopic pregnancy increases significantly. The optimal solution to the problem in these cases is in vitro fertilization.

Kymopertubation (kymographic pertubation) is a modern method for studying both the patency of the fallopian tubes and their functional capacity.

To carry out cypertubation, a number of conditions must be met:

This study is best carried out in phase 1 of the menstrual cycle (before ovulation);

there should be no acute inflammatory process in the genitals at the time of the study;

Vaginal swabs should be “clean”.

If you can examine the patency of the fallopian tubes in other ways - (ultrasound and x-ray), as well as with

Kymopertubation can be performed using a special computer device. Gas is injected into the uterine cavity at a rate of 25 cubic cm per minute, which must pass through the fallopian tubes and exit into the abdominal cavity. When gas enters the abdominal cavity from the uterine cavity, a characteristic tubal noise is determined with a stethoscope. A subjective sign of gas entering the abdominal cavity is the phrenicus symptom - pain in the right supraclavicular region caused by gas irritation of the endings of the phrenic nerve (the women studied noted pain in the shoulders). If the patency of the fallopian tubes is blocked, pain occurs in the lower abdomen.
The whole procedure takes about 5 minutes. Then computer data processing is carried out - the machine calculates the frequency and amplitude of contractions of the fallopian tubes, the speed at which the gas entered the uterine cavity, etc. After this, a result is given that indicates whether the fallopian tubes are passable and how much their functional activity is preserved.

It should be noted that after kympertubation, if everything is in order with the fallopian tubes, pregnancy can be planned already in this menstrual cycle. If the patency or peristalsis of the fallopian tubes is impaired, additional examination and appropriate treatment are necessary.

The use of hormonal contraceptives has become firmly established modern women. But at the same time, some of them still believe that this method of protection against unwanted pregnancy can be harmful to health. In order to appreciate the superiority of hormonal contraception over other methods, you need to understand how birth control pills work.

There are several main points that prevent conception. These include:

Ovulation is the release of a mature egg from the ovary into the fallopian tube, where, under favorable circumstances, it encounters a sperm. The drugs suppress the maturation of the egg, so ovulation cannot occur when taking the pills normally.

Thickening of mucus in the cervical canal

Sperm must travel from the vagina into the uterine cavity, and from there into the fallopian tubes. When taking birth control pills, the mucus in the cervix becomes very thick, which prevents male reproductive cells from penetrating into the uterus.

Therefore, even if a woman forgot to take the pill and spontaneous ovulation occurred, the likelihood of pregnancy is still extremely low.

Decreased peristalsis of the fallopian tubes

Without this component, a fertilized egg cannot enter the uterus. Also, poor peristalsis reduces the likelihood of sperm penetrating the egg.

The fallopian tubes are a conductor between the ovary and the uterus, and if this conductor does not work, then pregnancy is impossible.

Effect on the endometrium

Normally, a fertilized egg should enter the uterus and attach to the endometrium. During the first half of the menstrual cycle, the endometrium is restored after menstruation. In the second half, it actively proliferates so that the egg can implant successfully.

But under the influence of contraceptives, the endometrium is restored very weakly, and if conception suddenly occurs (which is extremely rare), the egg will still not be able to attach to the inner lining of the uterus.

The effectiveness of hormonal contraceptives in their correct use is almost 100%.

There are combined oral contraceptives, which include estrogen and progestin components in varying dosages.

There are also progestin preparations - mini-pills that contain only gestagens. Their effect on a woman’s body varies somewhat, but in essence, their effect comes down to preventing ovulation.

Many women do not understand the difference between menstruation and the menstrual-like bleeding that occurs when taking the pill.

True menstruation is the result of successive physiological changes in a woman's reproductive tract. It is a sign that conception did not occur in this cycle.

The monthly bleeding that occurs when taking hormonal birth control occurs as a result of a sharp drop in hormone levels in a woman’s body. This is why you need a 7-day break. Usually on the third day after withdrawal, menstrual-like discharge begins.

Some women feel that the pills can cause deep damage to their reproductive system. But on the contrary, the absence of ovulation, cyclical changes in the uterus or mammary glands has positive influence on the condition of these organs.

In fact, monthly cyclical fluctuations of one's own hormones are aimed at causing pregnancy. If this does not happen, then during menstruation the woman’s body experiences stress.

The use of contraceptives allows you to eliminate hormonal surges by using synthetic hormones in the appropriate dosage.

Infertility is not as rare a problem as it might seem. More than 5% of the world's population faces difficulties conceiving a child. There can be many reasons: pathologies of the uterus, poor sperm characteristics, antibodies. Tubal infertility is the lack of conception due to pathology of the fallopian tubes. Accounts for 25-30% of all cases of infertility. Tubal factor is diagnosed both with and with.

There is also tubo-peritoneal infertility, when the blockage is not located in the fallopian tube, but on the border with the ovary. If obstruction is not treated in a timely manner, infertility, ectopic pregnancy and symptoms of chronic pelvic pain are diagnosed.

Female infertility is a condition when a woman of childbearing age is unable to reproduce. There are two degrees of infertility: 1st degree (primary), when conception has never occurred, and 2nd degree (secondary), when the patient already has children.

There are absolute and relative infertility. Absolute infertility is often associated with irreversible developmental defects that impair the function of the genital organs. Relative infertility has a cause that can be eliminated and restore reproductive function. Tubal infertility is classified as the second type.

Importance of Fallopian Tubes

The fallopian or fallopian tubes are a paired organ that is responsible for moving the egg after fertilization to the uterus. Blockage of the tube lumen with adhesions or fluid prevents the free movement of the egg. Displacement of the fallopian tubes by adhesions also leads to infertility.

The fallopian tubes are adjacent to the ovaries as a cylindrical funnel-shaped canal. The egg moves along it. In healthy female body the fallopian tubes are lined with microvilli fimbriae. Their role is to promote the mature egg to the sperm.

Natural fertilization occurs in another part of the fallopian tube. The egg moves back into the uterus due to contractions of the tube. It takes 3-5 days for the cell to travel through the tubes and into the uterus, where it attaches to the lining of the uterus.

Tubal obstruction

Natural conception occurs in the fallopian tubes. Any pathology of this area of the genital organs can cause infertility. The most common cause is obstruction of the fallopian tubes. This phenomenon is diagnosed when adhesions form or fluid accumulates. The obstruction stops the egg and it simply cannot merge with the sperm.

There may be complete or partial obstruction. With partial, one pipe may be free or all will not be completely blocked. With this diagnosis, there is a chance to conceive a child naturally, but it is very small. As long as there is at least one healthy section of the tube, there is still a chance of getting pregnant, but the probability will depend on the size of the hole. Complete failure is often due to the accumulation of liquid in the pipes ().

It happens that only one scar is formed, but it covers precisely the edge of the fallopian tube, which also complicates the process of conception. The phenomenon is also called partial obstruction. Such pathologies increase the risk of ectopic pregnancy.

Most often, the obstruction is eliminated surgically. To improve the effect, the patient is prescribed drugs to stimulate ovulation.

Causes of tubal infertility

Obstruction of the fallopian tubes can be congenital or acquired. It happens that girls are born with an abnormal structure of the uterus and fallopian tubes. Acquired obstruction can occur against the background of endocrine disruption, severe inflammation or illness.

Obstruction is most often the result of inflammation or infection. The inflammatory process can be associated with specific and nonspecific flora. In particular, inflammation in the fallopian tubes is caused by chlamydia, gonococci and mycoplasma. Without timely treatment, adhesions will form around the tubes, ovaries and in the pelvis.

Often infectious complications diagnosed after childbirth, abortion, curettage or surgery on the pelvic organs or intestines. Often, adhesions appear due to complications after removal of the appendix.

The cause of inflammation can be endometriosis (overgrowth of endometrial cells). Many sexually transmitted infections cause acute inflammatory processes in the genitals and pelvis (herpes, gonorrhea).

It is not necessary that the inflammation “adjacent” to the fallopian tubes. Diseases of the upper respiratory tract capable of causing chronic At risk are women with inflammatory processes in the intestines.

Large uterine fibroids ( benign tumor) against the background of endometriosis can provoke blockage of the fallopian tubes.

There is an opinion that hormonal imbalances and metabolic problems also affect the patency of the tubes and the possibility of conception. In particular, an increase in the level of male sex hormones and an incorrect ratio of progesterone and estrogen.

Tubal-peritoneal infertility occurs due to adhesions in the peritoneal cavity. Adhesions are dangerous because they can displace organs: the uterus, fallopian tubes and ovaries in the wrong position do not work properly. It is also noteworthy that even small adhesions can cut off the fallopian tubes from the ovary.

Often such infertility is diagnosed after surgery on the genitals and peritoneum. Chronic inflammation - Right way to dysfunction of the reproductive system.

It happens that the pipes are passable, but certain sections are narrowed or do not function correctly. The phenomenon will not be accompanied by pronounced symptoms, so many people ignore it. However, these minor problems can send the embryo outside the uterus.

It is often too late and the obstruction is discovered along with an ectopic pregnancy. A woman may not be aware of the deviation for a long time and will try to conceive a child. And since the pipes are passable, this is quite possible, but, unfortunately, risky.

It can also cause tubal infertility. Constant stress and unstable psycho-emotional state negatively affect the body as a whole. Excess stress hormones aggravate any abnormal processes.

Symptoms and diagnosis of tubal infertility

Tubal infertility usually develops without symptoms. Sometimes a woman may feel short-term pain in the lower abdomen. The only sure sign will be the absence of pregnancy. The diagnosis of infertility is made only after a year of unsuccessful attempts. If partners are over 35 years old, doctors give one and a half years. Lack of pregnancy is a serious reason to go to the clinic. The inability to conceive a child is not dangerous in itself, but the disease is more dangerous which caused infertility.

A reproductologist deals with the problem of infertility. To find out the reason, it is necessary to take tests for both women and men. This is due to the fact that male infertility is hardly less common than female infertility. Diagnosing tubal infertility is quite difficult, so this problem should only be addressed to an experienced doctor.

Diagnostics

If there is a suspicion of obstruction of the fallopian tubes, a series of studies are prescribed to confirm the diagnosis. It is worth remembering that you cannot undergo examination if there is an inflammatory process or acute infection.

First of all, the doctor examines the medical history and complaints. When diagnosing infertility, an important role is played by gynecological history (STIs, pregnancies, abortions, surgeries, etc.) and the menstrual cycle calendar. A gynecological examination is required.

Additional tests:

study of gynecological smear;
bacteriological examination;
polymerase chain reaction method.

Hysterosalpingography

The most effective are (), (surgical examination of the fallopian tubes and nearby organs), echohysterosalpingoscopy (ultrasound with saline solution). Sometimes blood is also tested for anti-chlamydial antibodies, but they do not always indicate the presence of an obstruction.

Hysterosalpingography allows you to calculate the obstructed tube and the area of accumulation of adhesions. Before the procedure, a special liquid is injected into the uterus, which makes it possible to take pictures. The first one is done immediately, then another one after ten minutes and the last one after a day. Experienced doctor will be able to make or refute a diagnosis based on such images.

However, the method is not safe. If inflammation develops in the genitals at the time of the test, the test may worsen it, even leading to rupture of the fallopian tubes. Hysterosalpingography is recommended only as a last resort. This is also due to the fact that infertile women can only have x-rays twice a year.

Kymographic hydrotubation

Doctors willingly use CHT as a diagnostic method. Kymographic hydrotubation allows you to determine the amount free space in the fallopian tubes: they are purged, the volume of introduced air is determined and the patency of the tubes is calculated. The device allows you to record pressure fluctuations in the tubes and uterus in the form of a curve, from which the doctor can determine the degree of patency. The CTG method is not only diagnostic, but also therapeutic.

Bicontrast gynecography allows diagnosing adhesions around the ovaries and fallopian tubes. The study is useful in that it makes it possible to assess the intensity. The results will be more accurate if you conduct the test in the second half of the cycle.

Contraindications for BG:

inflammation of the genital organs;
uterine bleeding;
heart disease;
tuberculosis;
hypertension.

Laparoscopy allows you to examine inflamed tissue. The study provides a complete picture in preparation for surgical restoration of patency.

All methods for diagnosing obstruction of the fallopian tubes can be dangerous, so each patient should first consult with a gynecologist. All tests give results, but not everyone is suitable in a certain situation.

Treatment of tubal infertility

This infertility is considered one of the most difficult. It may give in conservative treatment or require surgery.

The conservative method consists of prescribing anti-inflammatory drugs, physical procedures, hydroturbation and perturbation. Hydroturation involves injecting liquid medications directly into the uterus. Perturbation is the treatment of the fallopian tubes with air currents. The procedure is risky and therefore requires medical supervision. Blowing out the fallopian tubes can cause them to rupture.

If infertility has developed due to endocrine disorders, hormonal correction is added to the course of treatment. This is a prerequisite for surgery. Hormonal imbalances can make any treatment ineffective and will only worsen the spread of adhesions.

The conservative method of treating tubal infertility is used less and less. It is often aimed at eliminating infections and inflammation before diagnosis and surgical intervention. Physiotherapy is recommended as a “clean-up” from the effects of inflammation: restore reactions in tissues, soften and even remove adhesions.

Surgery

Surgical intervention is required for patients with complete or partial obstruction, torsion or compaction. More often they resort to laparoscopy. The operation is performed through a small hole, when all adhesions are separated and tubal plastic surgery is performed to further restore patency. The tubes are returned to their correct position in relation to the pelvic organs. Laparoscopy is considered the best method treatment of tubal infertility. Its advantage is fast recovery, minimal risk and low chance of relapse. To prevent re-formation of adhesions, surgeons use anti-adhesion barriers.

Contraindications for surgery:

depressed or anxious state of the patient;
intensive formation of adhesions;
age from 30 years (sometimes).

In cases of severe stress, the patient is prescribed sedatives and other drugs that can improve mood and mental condition women.

Surgery may not be effective, especially when the anatomy of the tubes has changed too much. And there really are many such cases. It happens that after removal of adhesions, the pipes cannot recover: there is no peristalsis, microvilli do not function. In this case, the fallopian tubes are considered dead.

In case of failure, doctors advise IVF, because this method allows you to fertilize the egg artificially and completely bypass the fallopian tubes when placing the embryo in the uterus.

Prevention of tubal infertility

To avoid problems with reproductive function due to pathologies of the fallopian tubes, all inflammations should be treated in a timely manner, regardless of their location. This is especially true for the genitals and appendicitis. It is important to undergo complete rehabilitation after surgery.

Prevention of infections is carried out through the use of contraceptives. Otherwise, you need to exclude any potentially dangerous sexual relations. Every day a woman must observe the rules of personal hygiene. Any symptom or discomfort should be investigated. Consultation with a gynecologist is required 2 times a year.

It is necessary to monitor not only the physical condition, but also respond to psychological disruptions. Strong feelings, stress, chronic fatigue and anxiety can harm the body no worse than tangible infections. A woman needs to control her emotions and fight her fears.

IVF for tubal infertility

The optimal waiting period for conception after tubal restoration is 2 years. For such patients it is recommended alternative methods, which provide modern reproductive technologies. Tubal infertility automatically becomes an indication for IVF.

In vitro fertilization requires careful monitoring of all phases of the menstrual cycle. The patient is prescribed drugs that stimulate ovulation. The maturation of the egg is monitored, and the finished one is removed.

The stage of direct fertilization occurs “in vitro”. Favorable conditions are created and only the best sperm are selected. If the situation is successful, the embryo is placed in the uterus without affecting the fallopian tubes. If the embryo implants, the fetus will develop normally. For prevention purposes, additional strengthening drugs are prescribed.

Conclusion

Regardless of the diagnosis or outcome, you need to be mentally determined to win. In matters of infertility, the psychological factor plays a crucial role, because a woman’s body, especially during the period of egg maturation, when hormones are raging, reacts sharply to emotions and experiences.

Fallopian tube pathologies are one of the most common causes of infertility. However, modern diagnostic methods make it possible to thoroughly study the problem, and treatment regimens have been successfully used in practice for many years.

Infertility is much easier to prevent than to cure. Prevention is a guarantee of health, because tubal infertility is only a complication of another disease. And often this disease can be treated very quickly. The main thing is to seek help in a timely manner.