How do birth control pills work? Tubal infertility - a death sentence or a disease that can be overcome? Brief anatomy and causes of tubal obstruction

Peristalsis(from Greek peristaltikos- grasping and compressive) - a wave-like contraction of the walls of the hollow tubular organs of the gastrointestinal tract or other systems (ureters, fallopian tubes, etc.), promoting the movement of their contents from the “entrance” of the organ to the “exit”.

Peristalsis of the esophagus

For the esophagus, peristalsis is the main type of motor activity. The speed of propagation of the peristaltic wave in the esophagus is approximately 3–5 cm per second.

There are primary and secondary peristalsis of the esophagus. Primary occurs immediately after the bolus passes the upper esophageal sphincter. Secondary is a reaction to bolus stretching of the esophageal wall.

The esophagus also contains so-called “cleansing” peristalsis, which is not associated with swallowing and is a reaction to irritation of the esophageal wall by food debris or refluxate that enters the esophagus from the stomach during gastroesophageal reflux.

Peristalsis of the stomach

Contractions of the stomach in the absence of food in the stomach are small and are mainly represented by a migrating motor complex, which includes periodically repeating peristaltic waves. After eating food, systolic contractions of the pyloric part occur in the stomach, the size of the cavity of the fundus and body of the stomach decreases, and peristaltic contractions occur. In the first hour after eating, peristalsis is low, the speed of propagation of the peristaltic wave is approximately 1 cm per second, the duration of each wave is approximately 1.5 seconds. Then these waves intensify, the amplitude and speed of their propagation in the antrum of the stomach increases, the pressure in the stomach increases, the pyloric sphincter opens and a portion of chyme moves into the intestine.

Intestinal peristalsis

The motor activity of the intestine is very diverse and peristalsis is only one type of intestinal contraction.

During the period stimulated by food, several types of peristaltic waves propagate in the small intestine, which differ in the speed of passage through the intestine. There are very slow, slow, fast and rapid peristaltic contractions. Majority peristaltic waves are formed in the duodenum, but there are also those that appear in the jejunum and ileum. At the same time, several peristaltic waves can move along the small intestine.

During the interdigestive period, migrating motor complexes, which also include peristaltic waves, spread in the small intestine.

In the large intestine, the speed of movement of digested food is slower than in other parts of the intestine. Peristalsis in the colon takes a smaller percentage of time than in the rest of the intestine.

Peristalsis of the colon and other intestines occurs, among other things, under the influence of the gastrocolic reflex after filling the stomach with food. Also, strong propulsive peristaltic contractions occur in the colon 3–4 times a day, pushing the contents of the intestine towards the anus.

Peristaltic contraction frequencies

The frequencies of peristaltic waves are determined by the frequencies of the so-called slow waves that arise in the smooth muscles of the walls of the hollow organs of the digestive tract and are set by special pacemakers - clusters of nerve cells, among which the dominant role is played by

The invention relates to medicine, gynecology, and can be used to evaluate the diagnosis of contractile activity of the fallopian tubes. After completion of salpingo-ovariolysis (salpingostomy), under the control of hysteroscopy, catheterization of the proximal portion of the isthmic section of the fallopian tube is performed, which is confirmed visually using a laparoscope. Then the tubal catheter is fixed to the patient’s ipsilateral inner thigh using an adhesive tape. Catheterization of the contralateral mouth of the fallopian tube is performed in a similar manner. An artificial hydroperitoneum is created using an isotonic sodium chloride solution stained with indigo carmine. The restoration of patency and contractile activity of the fallopian tube is assessed after 24 hours. A sign of normalization of fallopian tube function is the visualization of a colored saline solution in the lumen of the catheter. The method allows in the early postoperative period to predict the effectiveness of laparoscopy after salpingo-ovariolysis (salpingostomy) in the early postoperative period, to reduce the time interval between the operation and the onset of pregnancy.

The invention relates to medicine, namely to gynecology, and will be used to assess the patency and functional state of the fallopian tubes in the early postoperative period in order to predict subsequent conception.

Infertile marriage remains one of the pressing problems of modern medicine. The frequency of infertility in Russia is 10-15%, and in some regions it exceeds the 15% level defined by the WHO problem group as critical, affecting demographic indicators (Kulakov V.I., 1999). Among the causes of infertile marriage, one of the first places is occupied by disturbances in the anatomical and functional state of the fallopian tubes, accounting for 30-74% (Kulakov V.I., Ovsyannikova T.V., 1996, Healy D.L. et al., 1994). The main factor in dysfunction of the fallopian tubes is considered to be anatomical lesions, the causes of which are inflammatory changes in the pelvic organs (Westorm L.F. et al., 1992).

Lesions of the fallopian tubes are usually bilateral in nature, and therefore have a negative impact on reproductive function. Moreover, pathological changes often involve the entire length of the tube, which can cause mechanical obstruction or distort the rhythm of ciliary and contractile muscle activity. As a result of this dysfunction, the capture of the egg, the advancement of sperm and the transport of the embryo to the uterus are disrupted.

Currently, laparoscopy is recognized as the operation of choice for accurate diagnosis and reconstructive operations on the fallopian tubes (Kulakov V.I., Adamyan L.V., 2000).

For infertility caused by obstruction of the fallopian tubes, the following types of surgical interventions are performed: salpingolysis, salpingostomy (salpingoneostomy), fimbryoplasty, anastomosis, implantation and combined operations.

The criterion for the success of surgical treatment of patients with tubo-peritoneal infertility is the birth of a full-term child. Moreover, taking into account the average age of patients in this group, which is 29 years or more (Gasparov A.S. et al., 1999), it is desirable to achieve pregnancy as soon as possible after surgery.

The patency of the fallopian tubes is restored in a significant number of patients after reconstructive plastic surgery (Danilov A.Yu. et al., 2001), but pregnancy does not occur due to the fact that it is not possible to restore the normal function of the tubes (Selezneva N.D., 1998).

In this regard, in addition to surgical correction of fallopian tube pathology, it is important to assess their patency, the state of the endothelium during surgery, and especially function in the early postoperative period.

Currently, in order to assess the patency of the fallopian tube during laparoscopy, chromohidrotubation is performed using uterine cannulas of various modifications. The disadvantage of the method is the possibility of obtaining false positive results due to the passage of the coloring liquid through the opening in the uterus or fallopian tube and thereby simulating its patency, since in this case the dye is detected in the pouch of Douglas. False-negative results can be obtained as a result of technical malfunctions leading to distension of the uterine cavity with fluid, spasm or pathology of the orifice of the fallopian tube.

Rubin (1919) was the first to study the patency of the fallopian tubes using gas perturbation. Rubin's test consists of introducing carbon dioxide into the uterus at a rate of 60-90 ml/min for 2 minutes, measuring the pressure in the system and recording it on a kymogram. Under normal conditions, gas enters the abdominal cavity under pressure that does not exceed 100 mm Hg. Art., pressure between 100 and 200 mm Hg. Art. is pathological. The entry of carbon dioxide into the abdominal cavity is confirmed by x-ray evidence of the presence of gas under the diaphragm, complaints of pain under the shoulder blades, auscultatory evidence of the presence of a gas bubble in the abdominal cavity, or a sharp decrease in pressure visible on a kymogram.

The disadvantages of this method are: a high percentage of false-positive and false-negative results, which are associated with the tightness of the connection of the cannula to the cervix, spasm of the tubes and their rupture due to obstruction; the risk of gas embolism, the impossibility of using this method after laparoscopy in the early postoperative period due to the possible residue of the CO 2 environment in which this operation is performed.

Various devices have been proposed for pertubation. The most widely used apparatus is A.E. Mandelstam, the apparatus of the Krasnogvardeets plant and their modifications. When performing kymographic pertubation using the apparatus of the Krasnogvardeets plant, I.S. Rozovsky and P.P. Nikulin (1960) recommend taking into account such indicators as maximum pressure, the nature of the kymographic curve, and the minimum pressure in the system after stopping gas injection. Analysis of the results obtained allowed the authors to identify 6 types of kymographic curves characterizing the patency and peristalsis of the fallopian tubes.

This method has the same disadvantages as the Rubin test. Along with this, the method does not give a clear picture if one pipe is passable and the other is not.

There is a known method for determining the patency of the fallopian tubes in the early postoperative period using therapeutic and diagnostic hydrotubation (Grant A, 1971).

The disadvantages of this method are additional pain in the patient and the possibility of developing an inflammatory process in the early postoperative period, and the inability to assess the restoration of fallopian tube function. In addition, a correlation was subsequently identified between the frequency of this procedure and the likelihood of developing hydrosalpinx (Selezneva N.D., 1988).

J. Stangel (1986) proposed to determine the patency of the fallopian tubes and the sites of their blockage using cannulas (J. Sklar Manufacturing Company) of various lengths designed for retrograde perfusion.

The disadvantage of the method is that it can only be used during laparotomy and the impossibility, as with chromohidrotubation, of assessing the function of the fallopian tubes.

Pallady G.A. et al. (1989) proposed a method for diagnosing patency of the fallopian tubes using echohydrotubation, based on filling the uterine cavity with a gas-liquid medium with parallel ultrasound scanning. This technique was subsequently improved through the creation of special contrast agents, such as “Infuson” and others, and the technique was called hysterosalpingocontrast sonography (Boudghene F.P. et al., 2001). However, these methods have the disadvantages inherent in hydrotubation and chromohydrotubation.

Recently, in order to assess the patency and state of the internal anatomy of the fallopian tube, the falloposcopy method has been used (Kerin J. et al., 1990, Bauer O. et al., 1992). Falloposcopy is a transcervical endoscopic examination of the fallopian tubes, which allows the most accurate assessment of their patency, including during laparoscopy. The system for assessing the results of falloposcopy, including the degree of tube patency, pathological epithelial changes, abnormal vascular pattern, degree of adhesions, pathological intraluminal contents, is as follows: 1 (normal), 2 (moderate disease) and 3 (severe) . In this way, all 4 sections of the left and right fallopian tubes are assessed. A total score not exceeding 20 for each fallopian tube is considered normal, a score of 20-30 means a moderate disease, and more than 30 means a severe disease.

The disadvantage of this method is the impossibility of assessing the function of the fallopian tube.

There is a known method and apparatus for analyzing the functioning of the smooth muscle wall, proposed by V.D. Wilhelmus Adrianus (Holland, 1995). This method is based on determining the function of an organ containing muscle tissue and involves measuring the contractile activity of an element of the muscle wall: bladder, blood vessel, fallopian tube, intestine, uterus, etc. To do this, it is necessary to attach a marker to the specified element of the muscle wall with subsequent registration of contractions using a magnetic field or electromagnetic radiation in the high frequency range. The disadvantages of this method include the need to use a special device, lengthening of the operation time in cases of intraoperative use, and the inability to determine the patency of the fallopian tube.

There is a known method of selective transcervical catheterization of the proximal parts of the fallopian tubes (Adamyan L.V. et al., 2000) in order to assess their patency. To carry out catheterization of the fallopian tubes, a modified angiographic technique is used, which is carried out in an operating room equipped with X-ray surgical equipment.

The disadvantages of this method are its complexity and the inability to assess the function of the fallopian tubes.

The prototype of the invention is a method of intraperitoneal administration of a radioactive drug and the descending isoperistaltic flow of peritoneal fluid through the fallopian tubes is studied using radioisotope research (Volobuev A.I., 1986).

The essence of the method is that during puncture of the posterior vaginal vault, 0.9 MBq of a colloidal solution of radioactive gold in 5 ml of physiological solution is injected into the abdominal cavity. A tampon is inserted into the vagina, which is changed every 24 hours; the last tampon is removed 96 hours after the puncture. The swabs are then placed into the counter and the number of pulses is counted. The penetration of the radionuclide from the peritoneal fluid into the tube and then into the vagina is judged by the increase in recorded impulses in the tampon, which indicates the normal function of the oviducts.

The disadvantages of this method are: firstly, the lack of clear criteria for which of the fallopian tubes has retained function and is passable; secondly, the technical complexity of obtaining results (special equipment is required to interpret the data); thirdly, the radiation load on medical personnel and the patient.

These disadvantages are eliminated in the proposed invention. The objective of the invention is to increase the accuracy of the method and its information content.

The problem is solved by the fact that after salpingo-ovarylysis (salpingostomy) is performed during laparoscopy, transcervical catheterization of the interstitial sections of the right and left fallopian tubes is performed, and a solution stained with indigo carmine is injected using an aquapurator into the abdominal cavity. The function of the fallopian tube is considered not impaired if a colored solution is visualized in the lumen of the tubal catheter after 24 hours. Using this method, you can also judge which of the fallopian tubes has restored its function.

Analysis of scientific, medical and patent literature has made it possible to establish that only a few studies have been devoted to the study of fallopian tube patency in the early postoperative period, which boil down to the use of therapeutic and diagnostic hydrotubation and have the above-mentioned disadvantages inherent in this method.

It should be emphasized that normally the fallopian tube exhibits constant, complexly organized spontaneous activity; there is no state of complete rest. Even during pregnancy, when uterine contractility decreases, the fallopian tubes retain spontaneous activity, although reduced (Coutincho E.M. et al., 1975).

Two peaks of contractile activity of the fallopian tube are detected: one during menstruation at the lowest estrogen levels; the second during ovulation, at the highest estrogen levels (Coutincho E.M. et al., 1975).

Therefore, for the most objective assessment of the restoration of fallopian tube function, it is advisable to perform surgical intervention in the middle of the menstrual cycle, during one of the periods of their highest activity. In addition, the period of ovulation is characterized by a predominance of anabolic processes in the female body, which is the most favorable background for reconstructive operations (Garsia C.-R., 1980).

Our studies made it possible to establish a direct relationship between the restoration of normal function of the fallopian tube in the early postoperative period and the pregnancy rate within 1 year.

Assessing the restoration of the functional state of the fallopian tube after reconstructive operations on the pelvic organs in the early postoperative period can significantly increase the prognostic accuracy of conception, select patients for ovulation stimulation or IVF and PE programs.

Detailed description of the method and examples of its specific application

To implement the method, the following equipment is used: a standard set of laparoscopic equipment and instruments for gynecological operations, a hysterscope, a RIMBACH catheter system from KARL STORZ (Germany), 0.9% sodium chloride solution 200 ml, colored with indigo carmine.

The patient is in the lithotomy position. The anterior abdominal wall, perineum and vagina are disinfected with bactericidal solutions. The patient is covered with sheets, leaving the lower abdomen and perineum exposed. After a vaginal examination, an intrauterine cannula is installed, which has a channel for hydrotubation. A Veress needle is inserted through the navel and, after tests confirming its presence in the abdominal cavity, an automatic CO 2 insufflator is connected to create pneumoperitoneum. When the pressure reaches 15 mm Hg. the needle is removed and replaced with an 11-mm trocar, through which a laparoscope connected to a video system is inserted. To perform surgical laparoscopy, under visual control through the laparoscope, two additional 5-mm trocars are inserted 6-8 cm above the symphysis at the outer edges of the rectus abdominis muscles. At the beginning of laparoscopy, the pelvic cavity, its anatomical features are examined and the extent of the spread of the adhesive process is assessed. Using an intrauterine cannula, an uncolored isotonic solution is injected into the uterine cavity to diagnose tubal patency. Then salpingostomy (fimbrilysis) and or salpingo-ovariolysis are performed.

After completing the reconstructive plastic stage of tubal surgery, the intrauterine cannula is removed. Sequential dilatation of the cervical canal is performed using Hegar dilators, starting from No. 3 and leading to No. 8. A rigid 8-mm hysteroscope is inserted into the uterine cavity and the supply of isotonic sodium chloride solution begins.

After visualization of the orifice of the fallopian tube, the uterine cannula is brought to the latter. A tubal catheter is inserted through the uterine cannula and gradually advanced to the fimbrial region under the control of a laparoscope located in the abdominal cavity. In case of difficulty in moving the catheter along the fallopian tube, aquadissection of intratubal adhesions is performed using a syringe with an isotonic sodium chloride solution connected to the infusion hole. After excluding the presence of intratubal adhesions, the catheter is removed to the initial part of the isthmic region, which is confirmed visually using a laparoscope. Then the tubal catheter is fixed to the patient’s ipsilateral inner thigh using an adhesive tape. Catheterization of the contralateral mouth of the fallopian tube is performed in a similar manner.

At the end of the surgical intervention, the abdominal cavity is washed with an isotonic solution, and clots and fragments of adhesions are carefully removed. An artificial hydroperitoneum is created using isotonic sodium chloride solution, colored with indigo carmine, using the irrigation system included in the laparoscopic equipment set.

The restoration of contractile activity of the fallopian tube is assessed after 24 hours. A sign of normalization of fallopian tube function is the visualization of a colored saline solution in the lumen of the catheter.

We provide clinical examples confirming the effectiveness of the method.

Case history No. 3873/379 Date of operation 06/14/01

Patient N-kai I.N. 35 years

Diagnosis: Chronic bilateral salpingitis. Adhesive disease of the pelvic organs, stage 2. Fitz-Hyo-Curtis syndrome. Primary infertility.

Produced by: Laparoscopy. Salpingo-ovariolysis on both sides. Chromohydrotubation. Hysteroscopy. Fallopian tube catheterization. Artificial hydroperitoneum.

The restoration of contractile activity of the fallopian tube by the claimed method after 24 hours was assessed. No colored saline solution is observed in the catheter lumen.

The effectiveness of surgical treatment was assessed after 1 year - pregnancy did not occur.

Case history No. 4445/428 Date of operation 07/04/01

Patient I-va T.M. 29 years

Diagnosis: Chronic right-sided salpingitis, hydrosalpinx. Adhesive disease of the pelvic organs, stage 3. Condition after left-sided tubectomy (in 1997). Produced by: Laparoscopy. Viscerolysis. Salpingo-ovariolysis, salpingostomy on the right. Chromohydrotubation. Hysteroscopy. Fallopian tube catheterization. Artificial hydroperitoneum.

An assessment was made of the restoration of contractile activity of the fallopian tube using the proposed method. After 24 hours, a colored saline solution is visualized in the catheter lumen.

The effectiveness of surgical treatment was assessed after 1 year - pregnancy occurred.

Based on the materials of the proposed method for assessing the patency and functional state of the fallopian tubes in the early postoperative period, 86 patients who applied for laparoscopy for infertility at the Rostov Research Institute of Obstetrics and Pediatrics were examined. The inclusion criteria for the study group were as follows: the presence of moderate or severe adnexal adhesions, normospermia in the spouse, a positive postcoital test, duration of infertility over 2 years, absence of endometriosis and endocrine diseases.

The age of the examined patients ranged from 24 to 36 years, with an average of 29.42.2 years. Of these, 59% were diagnosed with primary infertility, and 41% were diagnosed with secondary infertility. The duration of infertility varied from 3 to 15 years, averaging 7.92.1 years.

During laparoscopy, all patients underwent salpingo-ovariolysis and/or salpingostomy, fimbryolysis using sets of instruments and equipment from STORZ. The extent of adhesions was assessed according to the American Fertility Society classification of adnexal adhesions. After the laparoscopic stage of the operation, the patients underwent catheterization of the fallopian tubes under hysteroscopy control and an artificial hydroperitoneum was created using an isotonic sodium chloride solution stained with indigo carmine.

In 67 (77.9%) patients, after 24 hours, the appearance of colored saline solution in the lumen of the catheter was noted, which we regarded as a sign indicating the restoration of contractile activity of the fallopian tube. In 19 (22.1%) patients, saline solution did not flow from the abdominal cavity into the lumen of the catheter despite the patency of the fallopian tubes, which was determined during laparoscopy during catheterization of the fallopian tubes and hydrotubation.

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

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

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

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

Vaginal swabs should be “clean”.

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

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

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

Dear visitors of the portal!
The “medical consultations” section is suspending its work.

The archive of medical consultations for 13 years contains a large number of prepared materials that you can use. Best regards, editors

Daria asks:

Hello! I would like to know. I had an ectopic pregnancy. After that, I was told to get tested for hidden infections. I had ureaplasma (it was identified), I did an HSG and they said that there was partial obstruction (they prescribed mud therapy), so I’m wondering if this will help me or not. Maybe it’s better to have an operation or they don’t do it for such a diagnosis???????

Answers Wild Nadezhda Ivanovna:

Surgical treatment should always come last. If there is a chance to be treated without surgery, then you need to put effort, desire, faith and hope into it. and believe me, it was not a fool who came up with the idea that children are born from love. But the treatment must be good and sufficient, in several stages. Do not forget that a lot depends on the functioning of the thyroid gland, and pregnancy will depend on the state of health, so you need to check the kidneys, throat and tonsils. If there are problems, get treatment and achieve remission. Don’t be offended, but you need to undergo good resorption therapy: now you can go to the physical room with vitamin therapy, then get examined, again resorption therapy. Then - Zatoka with its dirt, but within reasonable limits, or any sanatorium. Then again vitamin therapy: folic acid, herbal remedies. And try to get pregnant.

Anna asks:

Hello. I have obstruction of both fallopian tubes, I have just taken tests: 2 cultures, PCR, cytology. I’m waiting for the results. Then the doctor will prescribe treatment, then laparoscopy, after which, as the doctor said, the tubes may also be immobile. Please tell me, can I immediately remove the tubes and save for IVF? (crying)

Answers Khometa Taras Arsenovich:

Hello Anna! The options are exactly the ones you mentioned: either drugs and restoration of patency of the fallopian tubes or IVF. The choice in this case can only be made carefully. If you are young, have not yet raised funds for IVF, and have no history of hydrosalpinx, you can try drugs, but IVF is also possible. The result of LS depends very much on the condition of the fallopian tubes and also on the skill of the surgeon. If your age is more than 30 years, the period of infertility is more than 5 years, there are additionally other factors of infertility, especially male infertility - in this case, preference should definitely be given to IVF. We recommend removing tubes before IVF only in cases where we find long-standing or large-sized hydrosalpinxes, S uv., T.A. If you still have doubts, come to an appointment or contact us by email [email protected]

Inessa asks:

Hello! I went for an ultrasound, the doctor said the diagnosis was right-sided andexitis, polycytosis of the right ovary, I was told to take Regulon, I took it for a month and quit because my breasts were hurting, I was afraid that these were side effects, after stopping the drug my lower abdomen began to hurt, I went for a second ultrasound, the diagnosis was periovarial fibrosis of the right endometrium, echocardial. cervix ovary. (conclusion: the doctor’s handwriting is not legible, sorry for the mistakes) How can I tell,
Thank you

Answers Bystrov Leonid Alexandrovich:

Hello, Inessa! Prescribing treatment in absentia based on an illegible description is nonsense. If you would like a serious consultation, come to an appointment and we will sort it out. Maybe I'm wrong, but this is the result of the fact that you prescribed an ultrasound for yourself, and this is not true. If a doctor had done this, he would have given an explanation for all this, and if indicated, he would have prescribed treatment. You can make an appointment with me by phone. 497-33-67.

Oksana asks:

Hello! I am 25 years old. I had an echocardiogram and was diagnosed with obstruction of the fallopian tubes (fluid remained in the uterus). The endometrium was 6 mm on the 25th day of pregnancy, the ovarian membranes were thickened, there was no ovulation. I really want to have children. The gynecologist recommended hydrotubation. Is it effective? “Is my endometrium thin?” and what should I do with the ovarian lining (will the egg break through)?

Answers Khometa Taras Arsenovich:

Hello Oksana! If the pipes are impassable, it is rare to achieve restoration of their function. We do not use hydrotubation in our practice, because... a frequent complication is the formation of hydrosalpinxes and inflammation - then laparoscopy with removal of the tubes is indicated. In some cases, the tubes may be functionally impassable (for example, if you were in pain during the procedure, spasm of the tubes is possible) - in this case, you can try a course of light (!!!) anti-inflammatory therapy and once again check the patency using hysteroscopy (more informative) under general anesthesia. In case of reliable obstruction of the fallopian tubes, the only way to get pregnant is IVF. Until you figure out the tubes, there is no point in paying special attention to the condition of the endometrium. The husband must also do a spermogram.

Natasha asks:

Hello! My diagnosis is salpingo-ovariolysis, salpingostomy, fimbryoplasty on both sides. Chromosalpingoscopy. After 6-8 months you can do eco. Please tell me what needs to be done to prevent the pipes from becoming clogged during this time, except not to get colds, I don’t want to have surgery to remove the pipes again.

Answers Bystrov Leonid Alexandrovich:

Hello, Natasha! In general, after surgical treatment of tubal factor, the so-called rehabilitation therapy to prevent adhesions again (anti-inflammatory therapy, mud therapy, hardware hydrotubation, etc.), but this is necessary if you want to get pregnant on your own after surgery, and if we are talking about IVF, then this no longer matters, since tubal obstruction, indications for IVF.

Asks Tanyana Donetsk city:

5 years ago I had an operation for patency of the fallopian tubes. Pregnancy occurred 3 years later, but alas, it was ectopic. I was examined after the operation and treated, the doctor said that the left tube was well passable, but the pregnancy never occurred. I went to the hospital half a year later and they ordered an X-ray, it turned out that the left tube was not passable, they said I need to have an operation, but it’s not certain that it will help. I don’t know what to do, go for an operation or raise money for IVF.

Answers Strelko Galina Vladimirovna:

Dear Tatyana! The success of surgical treatment of tubal infertility depends on the condition of the tube before surgery, on the level of occlusion (near the uterus, in the middle part or in the ampullary section). With minor damage, localized mainly in the distal (closer to the ampullary) parts of the tube, the probability of pregnancy within a year after laparoscopy ranges from 30 to 60%. With pronounced changes in the wall of the tube, adhesions of the 3rd - 4th degree, the chances of success are significantly reduced and the likelihood of an ectopic pregnancy increases (about 10% after the 1st ectopic pregnancy).

If your fallopian tubes are blocked, you can apply for an IVF program at a budget cost or at one of the private clinics specializing in this area.

Larissa asks:

I’m 37 years old, I haven’t been pregnant, my husband and I want to do IVF, the left tube is impassable, the right one is in adhesions --- the doctors suggest removing two tubes before IVF. Please tell me, can we leave the right tube? Or remove both --- it’s already decent age

Answers Strelko Galina Vladimirovna:

Dear Larisa! Based on data from numerous randomized controlled trials, it was concluded that in patients with hydrosalpinx visible on ultrasound, the incidence of pregnancy and live birth is significantly lower (approximately 1.5 - 2 times) than in patients without hydrosalpinx visible on ultrasound, for whom IVF was performed due to tubal factor infertility. Therefore, patients in whom hydrosalpinx is visible on ultrasound during pre-IVF evaluation should be advised to remove the fallopian tubes or occlude the proximal segment(s) of the affected fallopian tube(s) before transferring the embryos into the uterine cavity. Patients with tubal pathology but no hydrosalpinx visible on ultrasound appear to receive no significant benefit from surgery over IVF.

Catherine asks:

Good afternoon
On 05/27/10, a laparoscopy of the fallopian tube and curettage of the uterus was performed. There are still no critical days, the stomach aches a little for 3 days and a dark and beige discharge has appeared. What could this be? Thank you

Answers Medical consultant of the website portal:

Hello, Ekaterina! The reasons for a delay in menstruation after laparoscopy and curettage of the walls of the uterine cavity can be very diverse - from pregnancy to serious trauma to the uterine mucosa, which causes amenorrhea (lack of menstruation). To determine the reason for the delay in menstruation, you need to take a pregnancy test, undergo a gynecological examination, colposcopy, ultrasound of the pelvic organs, take a smear test (microscopy, cytology), and, if indicated, a blood test for hormones and a consultation with an endocrinologist. You will learn more about the reasons for delayed periods from the popular scientific article Delayed periods. An accessible guide to action on our medical portal. Take care of your health!

Natalya asks:

Hello. I am 38 years old. I have 3 children from other marriages. Now I live with a man who is 25 years old. I had 3 abortions from him, the last 2 one after another. And now I haven’t been able to get pregnant from him for 2 years. I had tests and an ultrasound, everything was normal, the doctor said that I need to check the patency of the tubes. Is it necessary and does it hurt?

Answers Bystrov Leonid Alexandrovich:

Hello, Natalia! A woman who has such “life” experience and wants to get pregnant from her beloved husband asks about pain, this is strange. But that’s not the point - you don’t need to check the patency of the tubes and waste time, in my opinion, for you to really get a healthy child in the current situation is only IVF (artificial insemination), taking into account your age and the whole previous story that you wrote about.

Svetlana asks:

I had an appointment with a gynecologist and they told me that one tube was open? What does this mean and will it prevent me from getting pregnant?
Best regards, Svetlana.

Answers Bystrov Leonid Alexandrovich:

Hello Svetlana! If I understood you correctly (and you understood the doctor correctly), then only one tube is passable, but normally both fallopian tubes should be passable. It is not clear by what method this was determined in order to understand how true this is. Yes, this can be a problem for conception. But I would advise you on this matter to contact a reproduction center with reproductive specialists.

Maria asks:

Good afternoon My doctor sent me for surgery to remove a cyst from my left ovary. After the operation, I find out that it was not a cyst, but bilateral hydrosalpingitis. The left pipe was removed and the right one was cleaned. The doctor said that you can try to get pregnant for a year, if not, then go for IVF
It will be a year in October, but my husband and I are already committed to IVF. The question is: is it necessary or not to remove the second pipe? Ultrasound now shows that there is no fluid in the right pipe and there is no need to remove it. Could this somehow affect the outcome of IVF?
I really want to keep her, because I heard that after the birth of children as a result of IVF, there are cases of spontaneous pregnancy.
Thanks in advance for your answer!

Answers Palyga Igor Evgenievich:

Hello Maria! If there were adhesions in the right fallopian tube, then restoring patency in most cases does not produce results. The only way for you to get pregnant is really IVF. If I were the operating doctor in case of bilateral hydrosalpins, I would also immediately remove the right tube, but there is still no use from it. Quite often there are cases where on ultrasound before the start of stimulation no enlargement of the tube is observed, but during treatment hydrosalpins appears again. In this case, embryos cannot be transferred, because the result of the program will be negative, i.e. implantation fails. In principle, you can go to the program with a pipe. If hydrosalpins occurs during stimulation, the resulting material will be frozen, you will be sent for surgical removal of the tube, and then a cryoprotocol will be performed.

Svetlana asks:

Hello. I am 28, I was not pregnant. I recently had an X-ray of the fallopian tubes, the right one is patent, and the left one is partially, there are adhesions. I was prescribed physical procedures (ampicillin, novocaine and hydrocartisone) hydroturbation. How effective is this or are there other methods that are more effective? effective?

Answers Palyga Igor Evgenievich:

Going to the gym will help like a poultice for a dead person. You can try to combat adhesions with medication if they are fresh (up to a maximum of 6 months), otherwise there will be no effect. Hydrotubation is currently an outdated, ineffective treatment method. During laparoscopy, the adhesions are dissected, i.e. the visual patency of the pipe is restored, but it is difficult to say to what extent the functioning of the villi is restored. If the right tube is completely patent, you can conduct folliculometry and ovulation monitoring and, when the dominant follicle on the right matures in a favorable period (ovulation period), immediately plan a pregnancy. Or another option is to go for laparoscopy and then in the first 6 months. After that, try to get pregnant. If this fails, then go for IVF. I wish you success!

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

Brief anatomy and causes of tubal obstruction

Brief anatomy and mechanism of fertilization

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

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

The walls of the fallopian tube consist of three membranes:

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

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

A general understanding of the structure of the organ allows us to better understand the causal mechanisms and how to treat obstruction of the fallopian tubes, as well as the importance of preventing inflammatory diseases of the uterus and its appendages for the implementation of the mechanism of fertilization.

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

Causes of obstruction

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

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

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

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

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

Symptoms and diagnosis

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

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

Also possible:

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

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

Diagnostics

Basic diagnostic methods:

1. Hysterosalpingography.
2. Sonohysterosalpigoscopy.
3. Therapeutic and diagnostic laparoscopy.

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

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

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

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

Treatment of fallopian tube obstruction and pregnancy

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

In case of anatomical disorders, laparoscopic surgery is used to dissect the detected adhesions around the fallopian tubes or perform plastic surgery of the latter in order to restore their patency, which previously could only be done by laparotomy (incision of the anterior abdominal wall and peritoneum) access.

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

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

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