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

Fallopian tube pathology is one of the most frequent (35-74%) causes of infertility. The main causes that cause impaired 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 progress made in the treatment of inflammatory diseases of the female genital organs, their proportion among the causes of infertility in women is significant. There was no trend towards a decrease in the frequency of obstruction of the fallopian tubes.

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

For each operation, the limits of technical operability should be determined, but there are several conditions in which surgical treatment is contraindicated.
1. Tuberculosis of the fallopian tubes.
2. Pronounced sclerotic process in the tubes.
3. Short tubes with no ampulla or fimbria as a result of previous surgery.
4. The length of the tube is less than 4 cm after a previous operation.
5. Widespread adhesive process as a consequence of recurrent inflammatory disease of the pelvic organs.
6. Additional incurable factors of infertility. An additional examination includes the entire algorithm of studies in infertile marriages. Attention is focused on the exclusion of STDs and the analysis of the results of bacteriological analysis.

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

Operational technique

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

Access

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

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

Salpingolysis- release of the tube from adhesions, which involves the dissection of adhesions between the tube and the ovary, between the appendages and the side wall of the small pelvis, between the appendages and the intestines, the omentum.
1. Spikes are tightened by creating traction and counter-traction. To do this, change the position of the uterus using an intrauterine probe, capturing the adhesions themselves with a manipulator or changing the position of the tubes and ovaries. Adhesions are excised 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.

Fimbrioplasty or fimbriolysis is performed with partial or complete occlusion of the fimbriae of the tube, preserved fimbriae and the possibility of their identification. The operation is also performed with phimosis of the fimbriae and their eversion.

Fimbriolysis in phimosis of the distal fallopian tube

1. Chromosalpingoscopy.

2. Adhesions are dissected using an L-shaped electrode, trying to lift them above the pili. With a pronounced adhesive process or gluing of the fimbria through a small hole into the lumen of the tube, the branches of the dissector are introduced, 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 the fimbria cannot be identified (for example, with hydrosalpinx).

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

Such changes are caused by endosalpingitis, leading to damage to the epithelium of the tube and the 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 hole in the ampulla of the fallopian tube

1. Produce hromogisterosalpingoscopy.
2. Find a scar at the free end of the hydro-salpinx.
3. Using an L-shaped electrode, cut a piece of tissue in the center, then make radial cuts.
4. With the help of irrigation, bleeding areas are found, they are 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, magnetotherapy.
4. Bed rest is canceled after the patient wakes up.
5. Oral nutrition is allowed on the first day without restrictions.
6. Urination and stool are restored on their own.
7. Duration of hospitalization is 5-7 days.

Complications

1. Damage to adjacent organs (intestine, bladder) is possible if the operation technique and the rules for using HF electricity are violated. 2. General complications of laparoscopy. Surgery for external endometriosis

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

Most often, endometrioid lesions are located on the wide sacro-uterine ligaments, in the retrouterine space and on the ovaries. The most rare 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.

Slightly better results (35-40%) can be obtained with the use of drug therapy.

It is possible to increase the efficiency of restoration of menstrual-reproductive function up to 45-52% and prevent recurrence of the disease when using two stages of treatment - laparoscopic and medical. We perform hormonal correction in case of common forms of endometriosis or after non-radical surgery.

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

G.M. Savelyeva

About 60% of women diagnosed with infertility have problems with obstruction or the very structure of the fallopian tubes, as well as the appearance of adhesions in the ovaries. Each of these pathologies can independently affect the reproductive system. In some cases, the factors are interrelated and occur simultaneously. Therefore, almost 30% of women are diagnosed with tubal-peritoneal infertility (TPB).

Read in this article

Proper functioning of the reproductive system

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

With the 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 an adhesive process occurring in parallel in the region of the ovaries.

If the pathology has touched only one of the tubes, then the chances of a successful conception are halved. If both pathways are damaged, infertility occurs. A fertilized egg will not be able to move through the tubes and will not enter the uterus.

Such infertility in women is common, but 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 lead to complications such as chronic pelvic pain or ectopic pregnancy. In the latter case, the fertilized egg attaches itself outside the uterus. The result can be bleeding and death.

The main forms and causes of infertility

Tubal-peritoneal infertility has several forms:

pipe;
peritoneal;
functional disorders of the fallopian tubes.

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

What causes the development of pathologies of the fallopian tubes?

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

Tubal infertility can be caused by the following reasons:

Genital infections that are sexually transmitted. So, chlamydia provokes an inflammatory process. The destruction of the villi develops, the mobility of the pathways decreases. As a result, the normal capture and movement of the egg becomes impossible. Gonorrhea causes adhesive processes, the appearance of adhesions. Mycoplasma can temporarily settle on the cells, then attach to the spermatozoon. 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 limits. Under the influence of regular cyclic changes, foci filled with liquid are formed from it. Neoplasms appear in the form of cysts.
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 there are excessive releases of adrenaline with prolonged nervous tension, excitement.

Reasons for the formation of adhesions

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

Fallopian tubes undergo changes. Foci of adhesions alternate with lymphocytic accumulations, pathologies of capillaries, veins, arteriosclerosis appear, changes in nervous tissues are observed, tube lumens are deformed, cysts can form. External endometriosis creates unfavorable conditions for the embryo, preventing the normal course of reproductive processes. The capture of the egg, its movement is disturbed.

Postoperative complications (the appearance of decay processes in the abdominal cavity), chronic infections of the genital organs (especially chlamydia) can also cause peritoneal infertility.

Causes of dysfunction of the fallopian tubes

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 organs of the reproductive system;
surgical interventions.

Conservative treatments for infertility

In the presence of 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 self-defense of the body. Chronic inflammation of the appendages leads to immunological disorders, so the restoration of the system is necessary for the full elimination of infections.
Resolving therapy involves the use of enzymes, biostimulants, glucocorticoids. Sometimes hydrotubation with antibacterial drugs, hydrocortisone is used. This technique, unfortunately, is not effective enough and causes a number of complications: exacerbation of inflammation, impaired ability of the tubes to move the egg, etc.
Physiotherapy can involve a whole range of measures for the treatment of TPB.

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

As physiotherapy, electrical stimulation of the uterus and appendages is used. It is used daily starting from the 7th day of the cycle. If surgical treatment was performed, EHF is prescribed in a month. This procedure must be done three times a day with breaks of 2 hours. Therapy is aimed at improving the condition of the vascular system of the small pelvis.

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 swabs in the vagina can also be used. To improve metabolic processes in tissues, vaginal hydromassage is prescribed. It enhances diffusion, 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 TPB gives better results than conservative therapy. It includes: laparoscopy, selective salpingography (artificial creation of a hole in the pathways when they are completely overgrown), microsurgical operations.

Laparoscopy

The advantage of using such treatment is the possibility of diagnosing obstruction of the fallopian tubes, identifying the causes with its simultaneous elimination. The type of operation will depend on the nature of the identified pathologies:

freeing paths from splices;
restoration of the entrance to the "funnel" of the fallopian tube;
creation of a new passage in the area of complete infection;
separation or removal of adhesions.

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

Microsurgical operations

Microsurgical intervention allows:

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

Insufficient efficiency of microsurgical operations is associated with a high probability of adhesions after their completion, which again makes the tubes impassable.

When the prescribed treatment fails, 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 a 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 when taking drugs, there are contraindications in this case:

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

Despite all the limitations, 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 and . 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 and in the case of detection of diseases of an infectious nature.

Measures to prevent the development of TPB

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

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

Tubal factor and tubal-peritoneal infertility. Methods of treatment and IVF

The tubal factor is a fairly common cause of female infertility and occupies 35-40% in the structure of all female infertility. within six months (at the age of more than 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, 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 tubal factor

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

Pipe factor

Often two concepts are substituted for each other: "pipe factor" and "". The patency of the fallopian tubes does not exclude the presence of a tubal infertility factor. The tube may be passable, but it is very inflamed, peristalsis is disturbed.

Peritoneal factor

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

Causes of tubal-peritoneal infertility factor:

Infections: In the first place are chlamydia or gonorrhea. Infections kill 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 and signs.
Intrauterine manipulations: medical abortions, diagnostic curettage of the uterine cavity, hydrotubation of the fallopian tubes.
Tuberculous salpingitis is detected in 1-2% of patients with tubal infertility.

The structure of the fallopian tubes

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

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

What is tubal factor infertility

Tubal infertility refers to a certain group of 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 in the pipes of inflammatory exudate - fluid (hydrosalpinx);
deformation, torsion, change in shape and length;
dysfunction of the ciliated epithelium of the mucosa;
violation of the muscular layer of the tube, as a result of which the peristalsis and promotion of the oocyte are disturbed.

The role of hydrosalpinx in tubal infertility

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

Causes of hydrosalpinx:

transferred infections;
salpingitis - inflammation of the fallopian tubes;
surgical operations on the pipes;
endometriosis;
adhesive process in the small pelvis.

IVF for tubal infertility from the first try

The fluid resulting from the 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 during 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 tube;
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 the removal of foci of infection. Studies confirm that after the removal of pathological fallopian tubes, the chances of pregnancy in IVF protocols increase (up to 49% in women under 35 years of age).

Not always the desire to get pregnant is carried out without any problems. The diagnosis of "tubal infertility" is about 30% of women who cannot conceive a child. This complication, as a rule, appears as a result of obstruction of the fallopian tubes. However, many cases are known when, after treatment of tubal infertility, women have a chance to become a mother.

What lies behind the diagnosis of "Infertility"?

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

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

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

Infertility of tubal genesis occurs due to the appearance of adhesions or fluid in the fallopian tubes, which do not allow the mature egg to pass into the uterus and interfere with the meeting with the spermatozoon, and, accordingly, the conception itself.

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

With the diagnosis of "incomplete obstruction", the possibility of becoming pregnant still exists, however, gynecologists, as a rule, prescribe special drugs to stimulate ovulation for women with such diagnoses.

What are the causes of the disease?

There are cases when 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 sexual infections, the presence of fibroids, surgical interventions, abortions, the formation of adhesions in the pelvic organs. Endometriosis is another of the most common causes of tubal infertility.

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

In cases where the fallopian tubes are completely passable, but in some of their sections there are narrowings with impaired functionality, or if the tubes are partially impassable, you should not ignore this, such violations can be no less dangerous and can become. More about ectopic pregnancy

Often a woman may not be aware that she suffers from obstruction of the fallopian tubes, in principle there are no signs of the disease, it can only be detected through diagnostics. It is worth worrying if you are periodically disturbed by pulling pains in the lower abdomen - this may be a symptom of obstruction of the tubes and, therefore, a symptom of tubal infertility.

How is obstruction diagnosed?

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

The most accessible and accurate method is considered diagnostics of KGT (kymographic hydrotubation). The fallopian tubes are purged using a special apparatus that has an air reservoir, which makes it possible to determine the volume of air introduced.

The kymograph allows you to note the change in pressure in the tubes and uterus, based on the curve obtained, 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 is also a therapeutic method that provides a therapeutic effect, so it turns out that the woman receives a double benefit.

The next research method that we will consider is − hysterosalpingography . Diagnostics using this method allows you to find out which of the pipes 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 image is taken immediately, the next after 10 minutes, and the final after 24 hours from the moment the substance was injected. 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, it is worth consulting with a gynecologist and learning about alternative diagnostic methods.

It is also worth considering that women with diagnosed infertility are not recommended to be exposed to x-rays more often than 2 times a year.

Female infertility of tubal origin can be diagnosed using bicontrast gynecography , which allows you to identify adhesions that are 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 can not be carried out with inflammation of the genital organs or uterine bleeding. This method quite accurately allows you to determine the functions that pipes are capable of performing, and is also indispensable for determining the breadth of the adhesive process.

Another method for detecting pathologies is laparoscopy . During this study, tissues that are involved in the inflammatory process are studied. This diagnostic method is widely used in preparing women for an operation to restore tubal patency.

So, as can be seen from the foregoing, 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 with your gynecologist in advance about the diagnostic method, which will help you choose the most suitable option for your particular case.

Can tubal factor infertility be treated?

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 present with suspected infertility are examined for 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 in the fight against infection, but it is recommended to eliminate the effects of inflammation with the help of physiotherapy, which is able to restore nervous reactions in tissues, softens and even removes adhesions.

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

The most effective treatment for tubal infertility is operative laparoscopy , this method is used to cut the adhesions that caused the obstruction of the tube. The method has much more advantages than abdominal operations: after the intervention, the woman quickly recovers and returns to her usual life, the risk to health is minimal, and there are practically no recurrences of adhesive disease.

Note that operative laparoscopy may be useless in some cases.

Quite often there are situations when, after the treatment and restoration of the patency of the tubes, 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 the treatment of tubal infertility the desired pregnancy did not occur?

Alternative methods of getting pregnant

If two years or more have passed after treatment, and pregnancy has not occurred, then it is worth contacting specialists and choosing another way to solve the problem. Tubal infertility is an indication for IVF.

This procedure begins with tracking the menstrual cycle, then ovulation is stimulated. Careful monitoring of the maturation of the egg is carried out 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. A woman is prescribed certain drugs that help support the body.

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

Answers

The fallopian tubes perform an important function in the process of conceiving a child. It is in the cavity of the tubes that the sperm must meet with the egg that comes out of the ovary.

If there are any anatomical and functional disorders in the tubes, fertilization is difficult, since the male and female cells do not have the opportunity to meet. As a result, the woman receives a diagnosis - infertility, more precisely, tubal infertility. If conception is prevented by adhesive processes in the pelvic organs, this is already peritoneal infertility. Very often, these two types appear in combination. The share of 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: violation of the contractile activity of the tubes without visible anatomical changes;
organic lesions: visually noticeable signs in the form of torsion, ligation, tube adhesions, compression from pathological formations.

Infertility of tubal-peritoneal genesis can appear for the following reasons:

violations of 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 a localized accumulation of biologically active substances;
transferred inflammatory diseases of the small pelvis;
certain surgical interventions on the genitals, intestines;
diagnostic or therapeutic procedures in the pelvic area;
various complications after childbirth and abortion.

Diagnostics

A couple is considered infertile if they do not become pregnant during sexual intercourse at least once a week for a year. Having checked a man for fertility and found no violations on this side, doctors are engaged in the health of a woman.

When diagnosing infertility, our specialists take into account all modern developments in this field. First of all, it is necessary to exclude the endocrine causes of this problem. If conception does not occur after the use of hormone therapy that has been properly selected in our center, it makes sense to suspect a tubal-peritoneal factor of infertility.

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

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

Treatment

The choice of types of treatment that tubo-peritoneal infertility needs usually occurs between operative laparoscopy and IVF. In the first case, the surgical method is supplemented in the postoperative period with restorative therapy and ovulation stimulation.

Laparoscopic surgery for tubal infertility is aimed at restoring the patency of the fallopian tubes. At the same time, a woman should not have contraindications to this type of treatment.

Contraindications to laparoscopic reconstructive-plastic interventions are:

the age of the patient is more than 35 years;
prolonged infertility, more than 10 years;
extensive endometriosis;
acute inflammation in the pelvic area;
pronounced adhesive process;
genital tuberculosis;
previous similar transactions.

With the diagnosis of tubal infertility, treatment with the help of laparoscopic intervention aims to free the tubes from adhesions that squeeze them. The entrance to the fallopian tube is restored, and if this is not possible, a new hole is created in the overgrown section.

With a diagnosis of tubal-peritoneal infertility, surgical treatment is carried out to separate adhesions and coagulate them. At the same time, our specialists will detect and eliminate other surgical pathologies during the operation. These include fibroids of various types, endometrioid heterotopias, retention formations in the ovaries.

After the operation of laparoscopy, to increase the effect of treatment in clinics, restorative physiotherapy is mandatory. This activates metabolic processes and prevents the formation of new adhesions. Such treatment is carried out for a month, at this time and another 1-2 months after contraception is recommended. If pregnancy does not occur in the next six months, they switch to the use of ovulation inducers. The total period of surgical and subsequent treatment in this case is 2 years. If there is no effect, 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 to give birth to a child. The specialists of our center recommend assisted 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;
with deep anatomical pathologies;
after unsuccessful surgery.

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