Operations in the treatment of female infertility. Female infertility of tubal origin

Content:

Complete or partial obstruction of the tubes leads to a pathology called tubal infertility. Another type of infertility associated with obstruction is known as peritoneal. In this case, an obstacle in the form of adhesions is located between the ovary and the tube. In the presence of both pathologies at once, tubo-peritoneal infertility is diagnosed, when adhesions in the ovary are combined with obstruction inside the fallopian tubes.

Causes of tubo-peritoneal infertility

Splices formed from connective tissues change not only the anatomical, but also the functional state of the internal genital organs. Because of this, the mechanisms of ovulation, perception and transportation of the egg are disrupted. A chronic pain syndrome develops, dysmenorrhea and dyspareunia occur, and the functions of the intestines and urinary system are disrupted. One of these pathologies is a complete or partial obstruction of the patency of the tubes, the formation of adhesions in the ovaries, which ultimately leads to tubo-peritoneal infertility.

Main causes of pathology:

Forms of tubo-peritoneal infertility

The main forms of tubo-peritoneal infertility are the following types of this pathology:

Tubal infertility associated with anatomical or functional obstruction of the fallopian tubes, or their complete absence.
Peritoneal infertility caused by the formation of adhesions in the ovarian area.
Functional pathology of the fallopian tubes, in which dysfunction of muscle tissue manifests itself in the form of hypertonicity or hypotonicity. At the same time, there are no mechanical damages.
The main form is tubal infertility, which manifests itself in the form of dysfunction of the tubes or their organic damage. With functional disorders, the contractile activity of the fallopian tubes is disrupted. Organic lesions are characterized by the presence of obstruction, adhesions and other anomalies. The development of the peritoneal form occurs under the influence of inflammation of the genital organs, the consequences of operations on the genitals, abdominal cavity and pelvic organs.

Symptoms of tubo-peritoneal infertility

The main symptom of this pathology is the inability to become pregnant for a long time. This symptom fully applies to other types of infertility. A distinctive feature of this form is the presence of a history of tubal or ectopic pregnancies. In some cases, pain is felt in the lower abdomen and the regularity of the menstrual cycle is disrupted.

Diagnostics

Diagnosis of tubal-peritoneal infertility begins with collecting anamnesis in order to accurately determine the causes of the pathology. Risk factors such as previous abortions and surgical operations, the presence of gynecological diseases and sexually transmitted diseases, ectopic pregnancies and diagnostic curettages are identified. The features and nature of the menstrual cycle are carefully clarified.

The next stage of diagnosis is a classic gynecological examination. With the help of palpation of the uterus, ovaries and other reproductive organs, their anatomical features are established, which may not make it possible to get pregnant. Negative sensations during a vaginal examination indicate possible inflammation and damage to the genital organs.

An analysis is prescribed by microscopic examination of a smear. The biological material presented for study makes it possible to detect infectious agents. In addition, the bacteriological culture method is used, when vaginal discharge is placed in a special environment favorable to harmful microorganisms. Then, as the colonies grow, their characteristics are studied.

Using classical ultrasound, visual examination of the fallopian tubes is not possible. Therefore, adhesions and other pathologies are detected using hydrosonography. For this purpose, a special sterile solution is poured into the uterine cavity. It moves inside the fallopian tubes and allows you to clearly see the obstructed areas. This method is considered the most effective and safe, allowing you to completely eliminate X-ray radiation during the examination.

X-rays are still used in hysterosalpingography, when the fallopian tubes are examined for obstruction and the presence of adhesions. A visual assessment of the reproductive organs can be obtained by performing diagnostic laparoscopy. A thin endoscope is inserted into the abdominal cavity, displaying the obtained data on a monitor screen.

Treatment of tubo-peritoneal infertility

Methods of conservative drug therapy are not effective enough in treating the disease; they eliminate only etiotropic factors - infectious pathogens, inflammation and other similar processes.

The most rational way to eliminate adhesions, which shows good results, is surgical intervention. Surgical procedures can be performed in several ways:

Method of therapeutic laparoscopy. In this case, during the dissection of adhesions, direct visual control is carried out using an optical device inserted through small holes into the abdominal cavity. To directly restore patency, classical surgery is used, as well as electrical or laser destruction.
With the help of fibrimolysis, the funnels of the tubes are surgically restored.
Salpingostomy is used in the case of a complete absence of a hole in the pipes with the aim of creating it artificially.

As a complement to surgical intervention, physiotherapeutic methods are used, using medicinal electrophoresis, gynecological massage and irrigation, ultraphonophoresis of the pelvic organs, and electrical stimulation of the uterus.

If the listed methods are ineffective, the use of assisted reproductive technologies, including in vitro fertilization, is recommended.

Prevention

Preventive measures have not only medical, but also socio-economic importance. In order to prevent tubo-peritoneal infertility, it is necessary to prevent and promptly treat diseases that provoke the occurrence and development of this pathology. This work should be carried out not only by gynecologists, but also by venereologists, psycho-neuropathologists and other necessary specialists.

A variant of female infertility caused by functional or organic obstruction of the fallopian tubes. There are no specific symptoms. Like other forms of infertility, it manifests itself as the inability to become pregnant after having regular sexual relations for 6-12 months. When making a diagnosis, hysterosalpingography, ultrasound hysterosalpingoscopy, laparoscopy, and laboratory tests to identify STIs are used. Treatment of tubo-peritoneal infertility includes medication and physiotherapy, hydrotubation, transcatheter recanalization, reconstructive plastic surgery, IVF.

Classification

Clinical classification of tubal infertility is carried out taking into account the localization of the pathological process, the presence or absence of anatomical changes. Specialists in the field of gynecology and reproductive medicine distinguish:

Actually tubal infertility. A woman cannot become pregnant due to functional or organic disorders in the fallopian tubes. In this case, the obstruction may be proximal with the presence of obstructions in the uterine part or isthmus of the tube and distal with impaired capture of the egg during ovulation.
Peritoneal infertility. The egg cannot enter the funnel of the tube due to inflammatory or other processes in the pelvic organs. Often, peritoneal infertility is accompanied by morphological or functional changes in the tubes.

Symptoms of tubal infertility

There are no specific symptoms characteristic of this variant of reproductive dysfunction. As with other forms of infertility, the patient notes the absence of pregnancy for 6-12 months, although she has regular sex life and is not protected. The pain syndrome is not expressed or is of low intensity - periodically there are pains in the lower abdomen and (less often) in the lower back, which arise or intensify during menstruation and sexual intercourse. Menstrual function is usually preserved. Some women report heavy discharge during menstruation.

Complications

The most serious complication of tubal infertility that occurs against the background of functional or partial organic obstruction of the fallopian tubes is ectopic pregnancy. If a fertilized egg cannot enter the uterus, it can be implanted into the wall of the tube, ovarian tissue or abdominal organs. Spontaneous termination of an ectopic pregnancy is accompanied by massive bleeding, severe pain, a critical drop in blood pressure and other disorders that pose a serious danger to a woman’s life.

Diagnostics

When identifying tubal infertility, it is important to take into account anamnestic information about past cervicitis, endometritis, salpingitis, adnexitis, abdominal trauma, surgery on the intestines and pelvic organs, abortion, complicated childbirth, invasive diagnostic and therapeutic procedures. The survey plan includes methods such as:

Examination by a gynecologist. Bimanual examination may reveal slightly enlarged, hardened and painful appendages. Sometimes the mobility of the uterus is limited, its position is changed, and the vaginal vaults are shortened.
Hysterosalpingography. When contrasting, changes in shape (local narrowing, expansion) and patency of the tubes are determined, up to complete disruption, in which the contrast agent does not enter the abdominal cavity.
Ultrasound hysterosalpingoscopy (EchoGSS, USGSS). Allows you to detect obstruction of the fallopian tubes and signs of adhesions in the pelvis.
Fertiloscopy and laparoscopy with chromopertubation. Visually detects adhesions and foci of endometriosis, provides an objective assessment of the patency of the fallopian tubes by monitoring the flow of dye injected into the cervical canal into the abdominal cavity.
Transcervical falloposcopy. Endoscopic examination of the epithelium and lumen of the tubes allows the most accurate assessment of their condition.
Kimopertubation. The motor activity of the appendages when carbon dioxide or air enters them is impaired.
Laboratory diagnosis of STIs. Since in some cases the cause of tuboperitoneal infertility is infectious processes, in order to prescribe etiotropic treatment it is important to identify the pathogen and assess its sensitivity to antibacterial drugs.

Tubal-peritoneal infertility must be differentiated from infertility caused by ovarian dysfunction, pathology of the uterine cavity, the action of the cervical factor and reasons from the patient’s husband. A reproductologist and a gynecologist-endocrinologist are involved in differential diagnosis.

Treatment of tubal infertility

To eliminate the causes of tubal obstruction, conservative and surgical treatment methods are used. Drug therapy includes:

Antibacterial drugs. Etiopathogenetic treatment is aimed at eliminating the STI pathogen that caused the inflammatory process.
Immunotherapy. Allows you to correct immunological disorders that lead to a protracted and chronic course of salpingitis and adnexitis.
Absorbable therapy. Local and general use of enzyme preparations, biostimulants, and glucocorticosteroids is indicated for the resorption of adhesions and synechiae that occur after infectious and aseptic inflammation.
Hormone therapy. It is used for disorders that have developed against the background of an imbalance in the female hormonal system.
Sedatives. Effective for correcting functional disorders.

In the complex treatment of tubal-peritoneal infertility, physiotherapeutic techniques are widely used: electrophoresis, transvaginal ultraphonophoresis, electrical stimulation of the fallopian tubes and uterus, gynecological irrigation, mud applications, EHF therapy, vibration and gynecological massage. To restore impaired tube patency, minimally invasive interventions are also used - transcatheter recanalization, hydrotubation, pertubation.

A more effective way to solve the problem of tubal infertility is to use surgical approaches. Surgical treatment is indicated for patients under the age of 35 years with a history of infertility of no more than 10 years in the absence of acute and subacute inflammation, tuberculous lesions of the genital organs, severe endometriosis and adhesions. To restore tubal patency, reconstructive and plastic laparoscopic interventions are used, such as:

Salpingolysis. During the operation, the tube is freed from the surrounding adhesions.
Salpingostomy. With massive adhesions and adhesions in the funnel area, the formation of a new hole is effective.
Fimbryolysis and fimbryoplasty. The operation is aimed at releasing the fimbriae of the fallopian tube from adhesions or plasticizing its funnel.
Salpingo-salpingoanastomosis. After excision of the affected area, the remaining parts of the pipe are connected to each other.
Tube transplant. If the interstitial part of the tube is obstructed, it is recommended to move it to another part of the uterus.

Often such interventions are supplemented with a course of postoperative hydrotubation. In addition to tubal plastic surgery, during laparoscopy it is possible to coagulate and separate adhesions, remove accompanying neoplasms that can interfere with conception and pregnancy - ovarian retention cysts, intramural and subserous uterine fibroids, foci of endometriosis. If there are contraindications and surgical treatment is ineffective, IVF is recommended for patients with tubal infertility.

Prognosis and prevention

The prognosis of TBI depends on the type of disorders and the degree of their severity. After reconstructive plastic surgery, pregnancy occurs in 20-50% of cases, with the largest number of conceptions noted in the first year after surgery; subsequently, the likelihood of gestation decreases significantly. When using IVF, the effectiveness ranges from 35 to 40%. The main methods of preventing tubal infertility are timely detection and treatment of inflammatory processes, endocrine disorders, comprehensive rehabilitation after pelvic surgery, adequate obstetric care, refusal of abortions and unjustified invasive therapeutic and diagnostic procedures.

Tubal and tubo-peritoneal factors of infertility belong to the same ICD-10 code and are synonymous concepts that subsequently lead to infertility in a woman. Distinctive features are the pathogenesis of impaired conception.

Pipe factor infertility is a partial or complete obstruction of the fallopian tubes resulting from inflammatory processes or diseases associated with the genital organs. In this case, obstruction is most often caused by the accumulation of fluid.
The movement of the egg through the tube slows down, as a result of which fertilization either does not occur, or the fertilized egg does not reach the uterine cavity and is attached in the tube or, much less commonly, in the abdominal cavity to the intestinal walls, omentum and other anatomical structures.
Peritoneal factor occurs as a result of the formation of adhesions in the pelvis, as a result of which the egg cannot penetrate the fallopian tube and meet the sperm for fertilization. The causes of this pathology can be inflammation or surgery.

Both types of disorders lead to the development of infertility.

Types of fallopian tube obstruction

The fallopian tubes are an integral part in conceiving a child. If any tubal pathologies occur, a woman may be diagnosed with infertility. It can be caused by the following diseases:

Reference! Tubal obstruction usually does not have obvious symptoms, so you should think about the possibility of such a disease after surgery in the abdominal area or a sexually transmitted infection.

What could cause the pathology?

Infertility of this origin cannot appear on its own; it is caused by various pathological processes in a woman’s body. Experts identify the following factors that can cause tubal infertility:

Before making a diagnosis of tubal infertility, a specialist must find out the presence of these factors in order to ensure the correctness of the targeted diagnosis and further treatment.

Symptoms

Usually this pathology does not cause symptoms; a woman finds out about the presence of the disease when she cannot get pregnant or when an ectopic pregnancy occurs. There is unilateral and bilateral obstruction, as well as complete and partial. In each case, pathology can manifest itself in different ways:

Unilateral obstruction less likely, but still gives a woman the opportunity to become pregnant, provided that the second tube is completely passable.
Bilateral obstruction, is manifested by the main symptom of the inability to get pregnant for a long period of time. Pathology is detected through diagnosis.
Complete or partial obstruction, also does not provide the opportunity for the egg to meet the sperm, which does not allow fertilization. In cases of partial obstruction, an ectopic pregnancy may occur, which may lead to removal of the tubes.

Given the absence of obvious symptoms, it is necessary to be attentive to all factors that can cause this type of infertility. And if you suspect this pathology, consult a gynecologist.

Diagnostics

When contacting a specialist with complaints about the inability to become pregnant, the woman is examined as follows:

Another important detail in making a correct diagnosis is obtaining detailed information about the menstrual cycle, which includes their frequency and duration. The doctor will pay special attention to previous diseases of the genital organs, infections and surgical interventions, which could provoke the blockage process.

Important! The appointment of diagnostics and subsequent treatment should be carried out exclusively by a gynecologist.

Treatment

Today, specialists use a wide range of techniques to get rid of the problem of tubal infertility, and also make it possible to get pregnant. The following methods are currently used to treat this disease:

Surgical: This method is especially effective in the presence of adhesions. Treatment is performed by dissecting adhesions using laparoscopy. This procedure involves inserting a tube into the abdominal cavity through which instruments are passed to remove adhesions. Now carrying out such an operation makes it possible to resume entry into the fallopian tubes or create holes in them.
ECO: This procedure is an alternative way to achieve pregnancy. It is usually prescribed to women who have been trying to get pregnant for more than two years and none of the other methods gives positive results. The procedure itself involves tracking the menstrual cycle, stimulating ovulation and retrieving eggs. They are then fertilized with sperm and placed in the uterus, where the embryo continues to grow.

When treating this type of infertility, special attention should be paid to the psychological state of the woman, excluding all kinds of stressful situations.

Forecast

When diagnosing female infertility of tubo-peritoneal origin, prognoses can be very different. An important factor is what caused such changes in the woman’s body. Therefore, the first thing doctors do is eliminate the causes, which include inflammation and infections. The prognosis for pregnancy after treatment of tubal infertility is as follows.

As is known, the cause of tubal infertility is anatomical disturbances in the patency of the tubes. And peritoneal or peritoneal infertility occurs if there are adhesions in the pelvic area.

These two types of infertility often occur in one patient, so they are combined under the same name “tubal-peritoneal infertility.”

Forms of infertility

Peritoneal infertility.
Tubal infertility.
Functional pathology of the fallopian tubes.

When it comes to peritoneal infertility, doctors mean the appearance of adhesions in the ovarian area. This type of infertility is a consequence of inflammation of the pelvic organs, or external endometriosis.

Tubal infertility occurs when the fallopian tubes are either obstructed or absent altogether. But as for the reasons for its occurrence, everything is much more complicated:

all kinds of operations of the female reproductive system;
sexually transmitted infections;
injuries and disorders after abortion;
endometriosis.

If there is a functional pathology of the fallopian tubes, then the doctor, as a rule, determines the presence of a violation of the muscular layer of the tubes: their increased or decreased tone, or simply an imbalance.

The causes of this pathology may be:

poor blood clotting;
emotional breakdowns and nervous breakdowns;
imbalance of sex hormones.

Diagnosis of tubal infertility

The gynecologist will urgently require your medical history: whether there have been any surgeries, STDs, etc.
Pain in the lower abdomen, extremely painful menstruation may already indicate that there is an obstruction of the cervix.
There are two instrumental methods that establish tubal infertility. These are laparoscopy and hysterosalpingography.

Laparoscopy

Laparoscopy is a surgical procedure in which a woman is hospitalized for several days.
Twenty-four hours before surgery, the patient is prohibited from eating and drinking. And after a sedative injection, or so-called premedication, she is taken to the operating room. And under general anesthesia, the doctor makes three small incisions. The doctor inserts a lighting device into one of them, and with the help of the other two, the doctor examines the right and left fallopian tubes.

In this case, the doctor can see whether the fallopian tubes are passable. If yes, then the diagnosis is completed, but if not, then certain manipulations are carried out to restore patency.

Hysterosalpinography

This examination is carried out by introducing a certain substance into the patient’s body, after which she is subjected to x-ray and ultrasound examination, which will show the patency of the tubes.
During an x-ray, a contrast agent is injected, thanks to which the doctor sees the patency in the uterine tubes.
During an ultrasound examination, fluid is injected into the genitals, and the monitor shows whether the fallopian tubes can pass fluid.

Treatment of tubal infertility

Infertility is treated either through surgery, such as laparoscopy, salpinography, or microsurgical interventions, or with medications, when immunomodulators and adaptogens are prescribed.

Contraindications to surgical intervention:

if infertility has been occurring for more than ten years;
the woman’s age is over forty;
endometriosis of the third and fourth degrees;
adhesions and tuberculosis of the female genital organs.

And finally, do not self-medicate, but feel free to contact specialists in this field who will help you cope with this disease and enjoy a healthy life. Infertility is no longer a death sentence in our time!

About 60% of women diagnosed with infertility have problems with obstruction or the structure of the fallopian tubes, as well as the appearance of adhesions in the ovarian area. Each of the above pathologies can independently affect the reproductive system. In some cases, the factors are interrelated and arise simultaneously. Therefore, almost 30% of women are diagnosed with tuboperitoneal infertility (TPI).

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Proper functioning of the reproductive system

The surface of a woman's fallopian tubes is covered with thin villi. Their main function is to promote the mature egg to the sperm. The end of the tube adjacent to the ovary has a cylindrical shape. It is into this “funnel” that the egg must fall. After fertilization, it moves through the tubes to the uterus, receiving the right amount of nutrients.

With normal functioning of the reproductive organs, conception occurs in a remote section of the tube. Its movement to the uterus is facilitated by villi and contractile movements. The process of moving a fertilized cell takes up to 5 days, after which it is implanted in the uterus.

TPB: concept, complications, consequences

TPB is a combination of tubal and peritoneal infertility. Conception does not occur due to a violation of the patency of the fallopian tubes or their structure with a parallel adhesive process occurring in the ovarian area.

If the pathology affects only one of the tubes, then the chances of successful conception are halved. If both pathways are damaged, infertility occurs. The fertilized egg will not be able to travel through the tubes and will not enter the uterus.

Such infertility in women is common, but is poorly amenable to restorative therapy. Adhesions may reappear, especially after surgical treatment. In many cases, assisted reproductive techniques are offered: intrauterine insemination, ICSI, IVF.

Tubal-peritoneal infertility can cause complications in the form of chronic pain in the pelvic area or ectopic pregnancy. In the latter case, the fertilized egg is implanted outside the uterus. The result can be bleeding and death.

Main forms and causes of infertility

Tubal-peritoneal infertility has several forms:

pipe;
peritoneal;
functional disorders of the fallopian tubes.

The reasons causing the development of each form are different. They can occur individually or in combination.

What causes the development of fallopian tube pathologies?

Tubal infertility is detected in the complete absence or obstruction of the tract. It can also be caused by dysfunction. The fallopian tubes lose their ability to contract (hypo-, incoordination).

Tubal infertility can be caused by the following reasons:

Genital infections that are sexually transmitted. Thus, chlamydia provokes an inflammatory process. Destruction of the villi develops, and the mobility of the pathways decreases. As a result, normal capture and movement of the egg becomes impossible. Gonorrhea causes adhesive processes, the appearance of adhesions. Mycoplasma can temporarily settle on cells, then attach to the sperm. This reduces his mobility.
Surgical interventions regarding the pelvic organs, abdominal cavity (tubal ligation, myomectomy, ovarian resection).
External causes the accumulation of a significant amount of biologically active substances near the fallopian tubes. The disease leads to the growth of the lining of the uterus beyond its boundaries. Under the influence of regular cyclic changes, fluid-filled foci are formed from it. New growths appear in the form of a cyst.
Inflammatory or traumatic complications after childbirth.
Hormonal disorders may be associated with insufficient production of female and/or excessive secretion of male biologically active substances. Sometimes excessive releases of adrenaline occur during prolonged nervous tension and excitement.

Reasons for the formation of adhesions

Peritoneal infertility is a condition caused by the appearance of adhesions in the ovarian area. The appearance of adhesive processes can be caused by inflammatory diseases of the reproductive system, external endometriosis, and surgical interventions.

The fallopian tubes undergo changes. Foci of adhesions alternate with lymphocytic accumulations, pathologies of capillaries, veins, arteriosclerosis appear, changes in nerve tissue are observed, the lumens of the tubes are deformed, and cysts can form. External endometriosis creates unfavorable conditions for the embryo, interfering with the normal course of reproductive processes. The capture of the egg and its movement are impaired.

Peritoneal infertility can also be caused by postoperative complications (the appearance of rotting processes in the abdominal cavity), chronic infections of the genital organs (especially chlamydia).

Causes of fallopian tube dysfunction

Functional pathology is characterized by malfunctions in the muscular layer of the tubes: increased/decreased tone, imbalance with the nervous system. Main reasons:

chronic stress condition;
psycho-emotional instability;
imbalance in the secretion of male and female hormones;
inflammation of the reproductive system;
surgical interventions.

Conservative methods of treating infertility

If there are infections in the genital tract, complex therapy is prescribed, aimed at eliminating the causative agent of the inflammatory process.
Additionally, drugs are used to increase the body’s self-defense. Chronic inflammation of the appendages leads to immunological disorders, so restoration of the system is necessary to fully eliminate infections.
Absorbable therapy involves the use of enzymes, biostimulants, and glucocorticoids. Hydrotubation with antibacterial drugs and hydrocortisone is sometimes used. This technique, unfortunately, is not effective enough and causes a number of complications: exacerbation of inflammation, disruption of the ability of the tubes to move the egg, etc.
Physiotherapy may involve a whole range of measures to treat LBP.

A woman is asked to attend electrophoresis daily using enzymes, biostimulants, magnesium salts, iodine, and calcium. An alternative may be ultraphonophoresis of the pelvic organs. A solution of vitamin E (2-10%), potassium iodide based on glycerin (1%), ichthyol, terralitin, lidase, hyaluronidase, naphthalene, heparoid and other ointments is used.

Electrical stimulation of the uterus and appendages is used as physiotherapy. It is used daily starting from day 7 of the cycle. If surgical treatment was performed, EHF is prescribed after a month. This procedure must be completed three times a day with breaks of 2 hours. Therapy is aimed at improving the condition of the pelvic vascular system.

Gynecological irrigation and massage can be used for treatment. In the first case, mineral water filled with hydrogen sulfide, radon, nitrogen, etc. will be prescribed. Mud tampons can also be used in the vagina. To improve metabolic processes in tissues, vaginal hydromassage is prescribed. It enhances diffusion and blood flow, prevents the formation of adhesions and leads to rupture of existing ones. Such procedures can be obtained in specialized clinics and sanatoriums.

Surgical treatment and contraindications to its use

Surgical intervention in the treatment of TPH gives better results than conservative therapy. It includes: laparoscopy, selective salpingography (artificial creation of an opening in the tracts when they are completely closed), microsurgical operations.

Laparoscopy

The advantage of using such treatment is the ability to diagnose tubal obstruction, identify the causes and simultaneously eliminate it. The type of operation will depend on the nature of the identified pathologies:

freeing tracks from splices;
restoration of the entrance to the “funnel” of the fallopian tube;
creation of a new passage in a completely closed area;
separation or removal of adhesions.

Laparoscopy may be accompanied by removal of other pathologies found. In the postoperative period, restorative therapy and stimulation of ovulation are prescribed.

Microsurgical operations

Microsurgical intervention allows:

free the pipe villi from splicing;
eliminate kinks, curvatures, external adhesions;
remove part of the damaged pipe and connect the remaining ends.

The insufficient effectiveness of microsurgical operations is associated with a high probability of adhesions appearing after their completion, which again makes the tubes impassable.

When the prescribed treatment does not produce results, which makes tubal infertility absolute, IVF may be recommended. These are cells with subsequent implantation of the resulting embryo into the uterus. IVF is also used in the case of complete absence of paths. Women who have absolutely no possibility of natural conception get a chance to give birth to a baby.

Contraindications to surgical interventions

As with any intervention or taking medications, there are contraindications in this case:

the woman’s age is over 35 years;
the duration of the period of infertility is more than 10 years;
active inflammatory processes;
tuberculosis of the reproductive system;
presence from the genital tract;
malformations in the development of the uterus;
recent surgeries on the reproductive organs;
neoplasms inside the uterus.

Despite all the restrictions, you should not stop at contacting one specialist. It is better to undergo several examinations and get advice from different doctors. In addition, do not forget that there is also. If the partner is also not doing well with the reproductive system, then there is simply no point in stimulation. It is necessary to be treated simultaneously in case of detection of infectious diseases.

Measures to prevent the development of PTB

Tubal-peritoneal factor of infertility is a very common phenomenon, but it is possible to prevent its development. It is important to promptly eliminate all infectious and inflammatory diseases of the reproductive system. Therapy should be continued until complete recovery. Barrier contraceptives (condoms) can protect against various types of sexually transmitted infections.

It is imperative to adhere to the rules of personal hygiene and avoid casual sexual intercourse. Pregnancy planning helps exclude abortions. Every woman needs to visit a gynecologist at least once every six months. And the main thing is to believe that everything will work out! And the long-awaited stork will soon arrive, you just need to try a little more!