Female infertility caused by tubal obstruction. Female infertility of tubal origin

Pathology fallopian tubes- one of the common (35-74%) causes of infertility. Main reasons causing disturbance patency of one or both fallopian tubes, especially in combination with adhesions, include sexually transmitted diseases (STDs), complicated abortions, spontaneous miscarriages, childbirth, numerous therapeutic and diagnostic hydroturbations, surgical interventions on the pelvic organs.

Despite the successes achieved in the treatment of inflammatory diseases of the female genital organs, they specific gravity significant among the causes of infertility in women. There was no trend towards a decrease in the incidence of fallopian tube obstruction.

Most often, operations for tubo-peritoneal infertility are performed to separate adhesions and restore patency of the fallopian tubes (salpingostomy, salpingoneostomy).

Limits of technical operability should be defined for each operation, but there are several conditions in which surgical treatment contraindicated.
1. Tuberculosis of the fallopian tubes.
2. Pronounced sclerotic process in the pipes.
3. Short tubes with absence of ampulla or fimbriae as a result of previous surgery.
4. The length of the tube is less than 4 cm after a previous operation.
5. Common adhesive process as a consequence of recurrent inflammatory disease of the pelvic organs.
6. Additional incurable factors of infertility. Additional examination includes the entire research algorithm for infertile marriage. Attention is focused on excluding STDs and analyzing the results of bacteriological analysis.

GHA is recognized as the leading method for diagnosing tubal infertility. As a rule, the operation is performed in phase I menstrual cycle(7-12th day).

Operative technique

The operation is performed under general intravenous or endotracheal anesthesia (the latter is preferable).

Accesses

A hollow uterine probe is inserted into the uterine cavity. Using this instrument, the uterus can be moved in the frontal and sagittal planes during examination and surgery. In addition, a dye is injected through a uterine probe to perform chromosalpingoscopy.

The operation is performed using three trocars: paraumbilical (10 mm) and additional ones inserted into both iliac regions(5mm). At the time of trocar insertion, the patient is in horizontal position, then it is changed to the Trendelenburg position.

Salpingolysis- freeing the tube from adhesions, which involves cutting the adhesions between the tube and the ovary, between the appendages and the side wall of the pelvis, between the appendages and the intestines, and the omentum.
1. The adhesions are pulled by creating traction and countertraction. To do this, the position of the uterus is changed using an intrauterine probe, capturing the adhesions themselves with a manipulator or changing the position of the tubes and ovaries. Excision of adhesions is performed with scissors with or without EC.
2. Chromosalpingoscopy is performed: 10-15 ml of methylene blue or indigo carmine solution is injected through the cannula of the uterine probe.

Fimbryoplasty or fimbryolysis is performed when there is partial or complete occlusion of the fimbrial section of the tube, preserved fimbriae and the possibility of their identification. The operation is also performed for phimosis of the fimbriae and their eversion.

Fimbryolysis for phimosis of the distal fallopian tube

1. Chromosalpingoscopy.

2. The adhesions are cut using an L-shaped electrode, trying to lift them above the fimbriae. In case of a pronounced adhesive process or gluing of fimbriae, the dissector branches are inserted through a small hole into the lumen of the tube, then they are smoothly moved apart, separating the adhesions. Bleeding areas are carefully coagulated.

Salpingostomy, or salpingoneostomy, is indicated when the tube is completely occluded and fimbriae cannot be identified (for example, with hydrosalpinx).

Salpingostomy. Cross-shaped opening of the ampullary part of the fallopian tube

Such changes are caused by endosalpingitis, leading to damage to the epithelium of the tube and a complete loss of folding of the mucous membrane and cilia. The prognosis for this disease and after salpingoneostomy is unfavorable.

Salpingoneostomy. Creation of a new opening in the ampulla of the fallopian tube

1. Chromohisterosalpingoscopy is performed.
2. Find a scar at the free end of the hydrosalpinx.
3. Using an L-shaped electrode, a section of tissue is dissected in the center, then radial incisions are made.
4. Using irrigation, areas of bleeding are found and coagulated.
5. After hemostasis, superficial coagulation of the peritoneal cover of the tube is performed at a distance of 2-3 mm from the edge of the incision, as this allows the mucous membrane of the fallopian tube to be slightly turned outward.

Postoperative management

1. Non-narcotic analgesics.
2. Antibiotic therapy.
3. Exercise therapy, magnetic therapy.
4. Bed rest canceled after the patient awakens.
5. Oral nutrition is allowed on the first day without restrictions.
6. Urination and stool are restored independently.
7. The duration of hospitalization is 5-7 days.

Complications

1. Damage to neighboring organs (intestines, bladder) is possible if the operating technique and rules for using HF electricity are violated. 2. General complications laparoscopy. Operations for external endometriosis

In the structure of infertility, the frequency of endometriosis is about 50%.

Most often, endometrioid lesions are located on the wide sacrouterine ligaments, in the retrouterine space and on the ovaries. The rarest localization is the anterior uterine space, tubes and round ligaments of the uterus.

A comparative study of infertility treatment methods for endometriosis showed that the use of only endoscopic coagulation of lesions or removal of ovarian cysts leads to pregnancy in 30-35% of cases.

Somewhat more good results(35-40%) can be obtained using drug therapy.

It is possible to increase the efficiency of restoration of menstrual reproductive function to 45-52% and prevent relapses of the disease by using two stages of treatment - laparoscopic and medicinal. Hormonal correction We produce for common forms of endometriosis or after non-radical surgery.

In case of radical operations for endometriosis, we recommend resolution of pregnancy without prescribing hormonal treatment.

G.M. Savelyeva

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).

Read in this article

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 required quantity nutrients.

At normal functioning reproductive organs Conception occurs in a distant 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 affected only one of the pipes, then the chances of successful conception are reduced by half. 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 difficult to treat rehabilitation therapy. Adhesions may reappear, especially after surgical treatment. In many cases, auxiliary reproductive techniques: 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.

Reasons causing development each form is different. They can occur individually or in combination.

What causes the development of fallopian tube pathologies?

Tubal infertility is detected in complete absence or obstruction of paths. 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 accumulation near the fallopian tubes significant amount biologically active substances. 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. Excessive adrenaline rushes sometimes occur during prolonged periods of time. nervous tension, 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 cause inflammatory diseases organs reproductive system, external endometriosis, 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, preventing normal development reproductive processes. The capture of the egg and its movement are impaired.

Peritoneal infertility can also be caused by postoperative complications(appearance of rotting processes in the abdominal cavity), chronic infections genitals (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 nervous system. Main reasons:

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

Conservative methods of treating infertility

If there are infections in the genital tract, it is prescribed complex therapy aimed at eliminating the causative agent of the inflammatory process.
Additionally, drugs are used to increase the body’s self-defense. Chronic inflammation appendages lead 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, hydrocortisone. 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 the whole complex measures for the treatment of PTB.

A woman is asked to attend electrophoresis daily using enzymes, biostimulants, magnesium salts, iodine, and calcium. An alternative may be organ ultraphonophoresis pelvic area. 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 vascular system small pelvis.

Gynecological irrigation and massage can be used for treatment. In the first case, it will be assigned mineral water, filled with hydrogen sulfide, radon, nitrogen, etc. Can also be used mud tampons 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 during the treatment of TPH gives best results, rather 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 high probability the appearance of adhesions 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 full recovery. Protect from various kinds sexually transmitted infections can barrier contraceptives(condoms).

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!

Tubal factor and tubo-peritoneal infertility. Treatment methods and IVF

Tubal factor is a fairly common cause of female infertility and accounts for 35-40% in the structure of all female infertility. within six months (at the age of over 35 years or 12 months at the age of up to 35 years) with regular sexual intercourse without the use of contraceptives, and other factors of infertility are excluded, then it is necessary to examine the fallopian tubes.

Peritoneal factor
The structure of the fallopian tubes
What causes tubal factor infertility?
Hydrosalpinx
Treatment and IVF for pipe factor

Infertility of tubal-peritoneal origin is a combination of pathology of the fallopian tubes (or their absence) and adhesions in the pelvis. Often these two pathologies are combined, as they develop against the background of various inflammatory processes in the pelvis.

Pipe factor

Two concepts are often substituted for each other: “pipe factor” and “”. Patency of the fallopian tubes does not exclude the presence of tubal factor infertility. The tube may be passable, but it is severely inflamed and peristalsis is impaired.

Peritoneal factor

Peritoneal factor is the presence of adhesions - strands of connective tissue between adjacent organs (uterus, tubes, ovary, intestines, bladder).

Causes of tubal-peritoneal factor infertility:

Infections: chlamydia or gonorrhea come first. Infections kill the epithelial cells and villi inside the fallopian tube. A woman may not even suspect that she is infected, because in most cases the infection occurs without symptoms or signs.
Intrauterine manipulation: medical abortions, diagnostic curettage uterine cavity, hydrotubation of fallopian tubes.
Tuberculous salpingitis is detected in 1-2% of patients with tubal infertility.

The structure of the fallopian tubes

Normal fallopian tubes located on both sides of the uterine angles. They pick up an egg that is released every month from an ovarian follicle. It is in the tube that the egg is formed by the sperm.

The main function of the tube for pregnancy is to transport the fertilized egg into the uterine cavity, where it occurs. This occurs due to the peristaltic translational movements of the muscle layer and the wave-like movement of the ciliated epithelium.

What is tubal factor infertility

Tubal infertility refers to a specific group pathological changes in the fallopian tubes:

obstruction of one or two fallopian tubes;
their absence;
adhesions in the lumen of the tubes, narrowing of the lumen;
the presence of inflammatory exudate - liquid (hydrosalpinx) in the pipes;
deformation, torsion, change in shape and length;
dysfunction of the ciliated epithelium of the mucosa;
disruption of the muscular layer of the tube, as a result of which peristalsis and advancement of the oocyte are disrupted.

The role of hydrosalpinx in tubal infertility

Often independent pregnancy inflammation of the fallopian tube with the accumulation of inflammatory fluid in the lumen interferes. The organ is stretched, deformed, and a closed cavity is formed. Hydrosalpinx is diagnosed in 10-30% infertile couples. This disease prevents the onset natural pregnancy and pregnancy after, not only because of a mechanical obstacle, but because of a focus of chronic inflammation.

Causes of hydrosalpinx:

past infections;
salpingitis – inflammation of the fallopian tubes;
tubal surgery;
endometriosis;
adhesive process in the pelvis.

IVF for tubal factor infertility the first time

The fluid resulting from hydrosalpinx is toxic to the embryo. Therefore, even if one of the tubes is passable and its functions are preserved, in most cases the embryo during natural pregnancy and IVF is doomed to death. In addition, the exudate gradually enters the uterine cavity in small portions and can wash away the fertilized egg and disrupt -.

Treatment options for hydrosalpinx:

radical surgical treatment– removal of the affected pipe;
removal of fluid and restoration of patency and anti-inflammatory therapy;
aspiration of exudate from the fallopian tube.

IN modern practice Evidence has long been obtained in favor of removing foci of infection. Studies confirm that after removal of pathological fallopian tubes, the chances of pregnancy in IVF protocols increase (in women under 35 years old up to 49%).

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 of the fallopian tubes. However, there are quite a few cases where, after treatment of tubal infertility, women have a chance to become a mother.

What is hidden behind the diagnosis of “Infertility”?

Female infertility is the impossibility of a woman childbearing age 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.

Infertility tubal origin 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.

With a diagnosis of “incomplete obstruction,” the possibility of getting pregnant still exists, but for women with such diagnoses, gynecologists usually prescribe special drugs to stimulate ovulation.

What are the causes of the disease?

There are known cases when obstruction of the fallopian tubes is caused by congenital pathologies development of the uterus, tubes and appendages. In addition, there are many reasons that can provoke tubal infertility in 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 disorders hormonal levels or metabolic process 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 violations can be no less dangerous and can become. 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 disturbed 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 diagnosis should be carried out only in the complete absence of inflammation 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 healing effect Thus, it turns out that the woman receives double benefits.

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 ways diagnostics

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 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.

Cannot be carried out this diagnosis and 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, it is currently used in medicine sufficient quantity methods to detect obstruction of the fallopian tubes and diagnose tubal infertility. But it is worth remembering that it is better to consult with 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 difficult forms, 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 usual life, the health risk 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 the menstrual cycle, then ovulation stimulation is carried out. The maturation of the egg is carefully monitored in order to extract it in time.

The most important stage is the stage of fertilization of the egg and the development of embryos. If everything went well at this stage, the embryo is placed in the uterus, where the baby continues to grow and develop. The woman is prescribed certain drugs which help support the body.

To summarize all of the above, I would like to especially note that one of the most important factors during the treatment of tubal infertility is psychological factor. Only positive attitude and your confidence will help you cope with the problem. Follow the doctor's instructions and be sure to believe in the success of the treatment!

Replies

The fallopian tubes perform the most important function in the process of conceiving a child. It is in the cavity of the tubes that the sperm must meet the egg, which leaves the ovary.

If there are any anatomical and functional disorders in the tubes, fertilization is difficult, since male and female cells do not have the opportunity to meet. As a result, the woman receives a diagnosis of infertility, or more precisely, tubal infertility. If conception is prevented by adhesions in the pelvic organs, this is peritoneal infertility. Very often these two types appear in combination. Tubal-peritoneal infertility accounts for about 30% of cases of all types of female infertility.

Causes and origins

Female infertility of tubal origin can manifest itself in the form of various disorders of the fallopian tubes. Namely:

functional disorders: impairment contractile activity pipes without visible anatomical changes;
organic lesions: visually noticeable signs in the form of torsions, ligations, adhesions of pipes, compression from pathological formations.

Infertility of tubo-peritoneal origin can occur for the following reasons:

disturbances in the production of female hormones;
deviations in central regulation against the background of chronic psychological stress;
chronic inflammatory processes in the female genital organs due to infections, endometriosis, resulting in localized accumulation of biologically active substances;
previous pelvic inflammatory diseases;
certain surgical interventions on the genitals, intestines;
diagnostic or medical procedures in the pelvic area;
various complications after childbirth and abortion.

Diagnostics

A couple is considered infertile if they have sexual intercourse at least once a week for a year and do not become pregnant. Having checked a man for fertility and found no problems on this side, doctors take care of the woman’s health.

When diagnosing infertility, our specialists take into account everything modern developments in this area. First of all, it is worth eliminating endocrine causes this problem. If after using the correctly selected one in our center hormone therapy conception does not occur, it makes sense to suspect a tubo-peritoneal factor of infertility.

The most reliable research method in this case is diagnostic laparoscopy.

If its results confirm that the patient has tubal infertility, an adequate, most effective and safe treatment is selected.

Treatment

The choice of treatment required for tuboperitoneal infertility is usually between surgical laparoscopy and IVF. In the first case surgical method supplemented in postoperative period carrying out restorative therapy and stimulating ovulation.

Laparoscopic operations for tubal infertility are aimed at restoring the patency of the fallopian tubes. In this case, a woman should have no contraindications to this species treatment.

Contraindications to laparoscopic reconstructive plastic interventions are:

the patient's age is more than 35 years;
long-term infertility, more than 10 years;
extensive endometriosis;
acute inflammation in the pelvic area;
pronounced adhesive process;
tuberculosis of the genital organs;
previous similar operations.

When diagnosed with tubal infertility, treatment with laparoscopic intervention aims to free the tubes from the adhesions that compress them. The entrance to the fallopian tube is restored, and if this is not possible, a new opening is created in the closed section.

If diagnosed with tuboperitoneal infertility, treatment surgically carried out to separate adhesions and their coagulation. At the same time, our specialists will detect and eliminate existing other problems during the operation. surgical pathologies. These include fibroids different types, endometrioid heterotopias, retention formations in the ovaries.

After laparoscopy surgery, to increase the effect of treatment, clinics must perform restorative physiotherapy. This will activate metabolic processes and prevents the formation of new adhesions. This treatment is carried out for a month; during this time and for another 1-2 months after, contraception is recommended. If pregnancy does not occur in the next six months, they switch to using ovulation inducers. The total period of surgical and subsequent treatment in this case is 2 years. If no effect is observed, doctors advise using in vitro fertilization.

If it is impossible to cure peritoneal-tubal infertility in one way or another, IVF becomes the only way the birth of a child. Our center specialists recommend auxiliary reproductive technologies when there is definitely no possibility of natural conception and there is no prospect of any reconstructive plastic surgery. Namely:

in the absence of fallopian tubes;
for deep anatomical pathologies;
after ineffective surgery.

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