Is it possible to get pregnant without IVF with ligated tubes? We increase the passability of the car: advice from professionals How to restore the passability of the fallopian tube

Certain diseases and surgeries often cause adhesions to form in or around the fallopian tubes. And this condition is one of the causes of infertility. In order to assess the patency of the fallopian tubes, various methods are used. Some of them are carried out only for diagnostic purposes, while other procedures not only help to identify changes, but also, if possible, eliminate them.

Why is the fallopian tube obstructed?

When the egg matures, it enters the fallopian tube. If she meets a sperm there, then the process of fertilization occurs. The embryo is then transferred to the uterine cavity. In cases where the patency of the pipes is changed, this becomes impossible.

There are several reasons that contribute to obstruction of the fallopian tubes. This condition may occur due to:

Post-existing inflammation. For example, it can develop after diseases that are sexually transmitted. Also, infectious inflammation is a common complication of interrupted pregnancy. Tubal obstruction in many patients occurs due to chlamydia. The latter disease is asymptomatic, and the woman does not realize that she has such an infection;
- Surgeries on the abdominal organs, especially in the presence of complications.

Against the background of inflammation and after surgery, adhesions (connective tissue films) can form that close the lumen of the fallopian tube completely or only partially. Sometimes, due to adhesions, the tubes are compressed from the outside or are displaced along with the ovaries. If adhesions form between the ovary and the tube, then the egg will not even be able to penetrate the latter.

How to check the patency of the fallopian tubes

The study of fallopian tube patency is carried out using different methods. Each of them has both its advantages and disadvantages.

Based on the examination results, the specialist selects further treatment. Your doctor may prescribe one or more of the following diagnostic procedures:

Hysterosalpingography;
- Ultrasound of the fallopian tubes;
- Laparoscopy.

Hysterosalpingography

This is a check of the patency of the fallopian tubes using an x-ray method. Hysterosalpingography is performed only when there is no active inflammatory process. The study is performed in the follicular phase of the cycle, before ovulation. The procedure does not require general anesthesia and is performed on an outpatient basis.

A catheter is inserted into the uterus through the cervical canal, through which a contrast agent enters the organ cavity. X-rays are then taken at the beginning and end of the study. The first of them helps to assess the shape of the uterine cavity and the clarity of its contours, as well as determine the presence of pathological changes in the tubes and their patency. The second image allows you to evaluate not only the shape of the tubes, but also how the contrast agent spreads in the pelvic cavity, if it enters there.

This method is less accurate than laparoscopy. Although this procedure is unpleasant, it is well tolerated and there are no complications after it. After the procedure, you must use protection during one menstrual cycle.

Ultrasound of fallopian tube patency

During this procedure, the woman is not exposed to x-rays, and the examination is easily tolerated. After the ultrasound, contraception is not required. The main disadvantage of the method is the lower accuracy of the result obtained (compared to hysterosalpingography).

Tubal patency is usually determined by this method before ovulation. A catheter is inserted into the uterine cavity through the cervix. Under the control of an ultrasound probe inserted into the vagina, saline is infused through the catheter and it is assessed whether fluid is flowing into the abdominal cavity through the fallopian tubes. If this does not happen, then it is likely that the latter are impassable. The saline solution may also not enter the pelvic cavity due to severe spasm of the fallopian tubes.

Laparoscopy

This is a surgical method in which the doctor can examine the fallopian tubes with minimal damage to the skin. During laparoscopy, it is possible not only to detect the presence of obstruction, but also to eliminate its cause.

The procedure is carried out in a hospital setting. Small incisions are made on the anterior abdominal wall, through which an optical system with micro-illuminators and a manipulator (a device with which a specialist moves the internal organs to better view them) are inserted. To improve visibility, the abdominal cavity is filled with carbon dioxide.

To assess the patency of the fallopian tubes, a solution of methylene blue is injected into the uterine cavity through the cervix. Using a video camera, they evaluate whether this substance passes through the pipes in real time.

The recovery period after such surgery is short. A woman usually stays in hospital for no more than two or three days. The risk of adhesions formation after laparoscopy is minimal, and the accuracy of this method is higher than that of hysterosalpingography and ultrasound.

How is tubal obstruction treated?

Conservative treatment is effective only in cases when it is carried out within six months after the inflammation. It consists of the use of anti-inflammatory drugs and physiotherapeutic procedures.

Surgery through laparoscopy is the main method of treating obstruction. Adhesions in the pelvic cavity are dissected, the fimbriae are freed from adhesions, and the patency of the fallopian tubes is restored if possible.

If the pipes are completely obstructed along their entire length, it will no longer be possible to restore their normal function. Therefore, if they are greatly changed and stretched, they are removed.

To choose a method for determining the patency of the fallopian tubes, you should consult your doctor. But such a study must be completed in case of infertility, after an ectopic pregnancy or inflammation of the organs in the pelvis. Source -

Women, as a rule, learn about the existence of fallopian tubes in two cases - when they cannot get pregnant and when an ectopic pregnancy occurs.

The fallopian tubes are of utmost importance in pregnancy. This is where the sperm meets the egg.

The fallopian tube captures the egg released from the ovary with its free end and pushes it inside the tube. There, the egg waits for the sperm and after fertilization, the embryo is pushed out by the tube into the uterine cavity, where it should attach to the uterine mucosa.

Thus, the fallopian tube must not only be patent, but must also be capable of transporting a fertilized egg into the uterine cavity.

The two most common causes of tubal damage are:

• inflammatory process (most often chlamydia)
• previous surgical intervention, mainly on the pelvic organs (including removal of appendicitis)

Checking the patency of the fallopian tubes is carried out in the following ways:

• GHA or MSG (hystero- or metro-salpingography)
• Hydrosonography
• Laparoscopy
• Fertiloscopy

The most commonly used is HSG. This is actually an x-ray of the fallopian tubes. In order to take this picture, a woman lies down on a special table in the X-ray room, a special tube is inserted into the cervical canal, through which a contrast agent is injected into the uterus. The contrast agent fills the uterine cavity and from there it must enter the tubes, and from them flow into the abdominal cavity.

This is a rather unpleasant procedure, but in most cases it allows you to most accurately and without surgery assess the patency of the fallopian tubes. In this case, not only the patency of the pipe is assessed (passable or not), but you can see how the pipe has been changed - it can be expanded, highly tortuous, have constrictions, etc. Of course, the better the picture of the pipes, the more information it can bring.

Sometimes an image of the tubes also has a therapeutic effect (there are cases of pregnancy occurring after an HSG). This is due to the fact that during the procedure, a contrast agent is injected into the uterus under slight pressure, and if there were thin internal adhesions in the fallopian tubes, they break and the tubes become passable.

Until recently (in some clinics this is still used to this day), there was a technique for restoring the patency of the fallopian tubes, which was called “hydrotubation”. The essence of the method was that every day, for an average of 10 days, a woman with an obstructed tube was injected into the uterus in the same way as described above, containing various medications. With the help of these medications and the pressure created by the syringe piston, the patency of the pipes was restored - in fact, by blowing them out. This technique was practically abandoned, as alternative treatment methods appeared, and the technique was extremely painful (many women screamed out loud).

Hydrosonography

Essentially the same as HSG, but in this case the image is obtained using an ultrasound machine. In terms of its information content, this method is significantly inferior to GHA, but is better tolerated by the patient.

Laparoscopy

Surgical method for assessing fallopian tube patency. As a rule, it is not used in isolation for this purpose only. During laparoscopy, a blue solution is injected into the uterus, which is clearly visible in the abdominal cavity. This inspection of the pipes is usually carried out after surgery to separate adhesions that were obstructing the patency of the pipes.

Fertiloscopy

Examination of the fallopian tubes and pelvic organs through the posterior vaginal fornix - this technique is similar to laparoscopy, only the instruments are inserted not through the anterior abdominal wall, but through the vagina. This method is combined with hysteroscopy. Small operations can be performed using this method.

Thus, the most optimal method for checking the patency of the fallopian tubes is GHA.

Treatment

There are 4 methods for restoring the patency of the fallopian tubes.

• Laparoscopy
• Fertiloscopy
• Recanalization of fallopian tubes
• Hydrotubation

Of all the listed methods for restoring the patency of the fallopian tubes, I did not describe recanalization.

Recanalization of fallopian tubes

Using this method, it is possible to restore the patency of the fallopian tubes in their initial sections. Under the control of an X-ray machine, a thin conductor is inserted into the uterine cavity, along which a catheter with a balloon is advanced. The guidewire is gradually inserted into the mouth of the tube, followed by the catheter. The balloon inflates, expanding the lumen of the pipe. The guidewire with the catheter is advanced further until the tube becomes passable. This does not always work out, since if the pipe is tightly tightened with the outer bridge, then it will not be possible to cope with it from the inside.

Important!

• Whatever method is used to restore the patency of the fallopian tubes, the effect, as a rule, does not last long, and the likelihood of a relapse of the condition is very high.
• Restoring the patency of the tube does not mean that the fallopian tube is functionally active; in other words, if the tube allows fluid to pass freely, this does not mean that it will be able to transport a fertilized egg into the uterine cavity.

Of course, there are cases where a normal pregnancy developed with very altered tubes or even with only one tube and one preserved ovary located on opposite sides. These are the exceptions that prove the rule.

How to decide what to do with the pipes?

The question is whether it is worthwhile to restore the fallopian tubes or choose the method of artificial insemination.

Age matters a lot. If you are young and, apart from the problem with the fallopian tubes, you do not expect any other disorders that would prevent pregnancy, you can try to restore the patency of the tubes and try to get pregnant for a year. If it doesn’t work out, don’t waste your time and immediately turn to the IVF method. It happens that after the birth of the first child through IVF, subsequent pregnancy occurs naturally. This is due to the fact that during pregnancy the uterus increases in size and independent separation of adhesions and restoration of patency of the fallopian tubes can occur.

After 35 years, with prolonged infertility and obstruction of the fallopian tubes, you should first of all give preference to IVF. Over time, the quality of the eggs deteriorates and the risk of genetic disorders in the fetus increases. Therefore, it is not advisable to waste time trying to restore the patency of the pipes - time is wasted, and this works against you. You also have a great chance after the birth of your first child to solve the problem with the fallopian tubes.

It is important to remember that after tubal patency is restored, the risk of ectopic pregnancy increases.

Of course, it is difficult to decide on your own which tactic to choose, but it seems to me that having an idea of ​​the problem, it will be easier for you to discuss it with your doctor and jointly make the right decision.

Surely, most women have heard about such a medical phenomenon as “problems with the passage of an egg through the fallopian tubes.” But not everyone understands what exactly is the danger of this phenomenon and how it is treated.

The fallopian tubes play an important role in the female body. Their most important function is that they serve as a “transport” channel through which a fertilized egg can enter.

The fallopian tubes look like two 10 cm long extensions that connect the uterus and ovaries. They are located, respectively, on the left and right sides of the uterus.

The internal diameter of the fallopian tubes can range from 0.1 mm to 1 cm. And this is quite enough for the normal movement of the fertilized egg to the place of its development (meaning the uterine cavity).

What is meant by patency and obstruction of the uterine processes

Every day, we hear advertising information that medical clinics help women cure blocked fallopian tubes, and we look through articles in magazines about problems with fallopian tubes.

It is from this information that we understand that tubal obstruction is associated with

Obstruction of the fallopian tubes does not cause any complications or problems for women’s health.

That is why it is detected only when a woman is planning a pregnancy.

Problems with the patency of the uterine tubes can affect the desired pregnancy in the following ways:

• Create problems for successful conception
• Be the reason

According to statistics, 25% of couples experiencing problems with conception attribute their failures to obstruction of the uterine tubes.

Symptoms and causes affecting the development of fallopian tube obstruction

Since a diameter of 0.1 mm is sufficient for the passage of an egg inside the fallopian tube, problems with advancement may arise if the canal is completely blocked.

The causative factors of pathologies of patency of the uterine processes include the following circumstances:

What circumstances influence the formation of obstruction?

1. Salpingitis– damage to the fallopian tubes by inflammatory infections. In this case, the walls of the pipes can simply stick together and block the channel for the movement of the fertilized egg.

2. External compression of the uterine processes. Adhesions in the pelvic area can put pressure on the tubes, blocking their natural patency. Adhesions are formed as a result of surgical operations in the pelvic or abdominal area.

3. According to individual indications, women may generally have fallopian tubes removed. Accordingly, the passage of the egg is impossible.

4. Ectopic pregnancy.

5. . fallopian tubes Tuberculosis.

6. Congenital pathologies

The most likely reason is – transmission of inflammatory infections of the fallopian tubes :

• Single dose – carries a 12% chance of developing obstruction of the uterine canals
• Double – 35%
• Three times – 75%.

As for the symptoms of obstruction, this is just one manifestation - prolonged unsuccessful attempts to conceive. Sometimes this symptom may be accompanied by pain in the abdominal area.

How to diagnose fallopian tubes for patency

The process of diagnosing fallopian tubes for free progression is quite complex and requires several types of research. In addition, experts always warn that the results may be inaccurate and subject to estimation errors.

Hysterosalpingography.

This test is an x-ray of the uterus and tubes. The radiologist injects a contrast agent into the uterine cavity. After that, X-rays are taken in several projections.

The results are assessed by how the contrast liquid spreads in the image. If fluid has flowed from the uterus through the tubes into the abdominal cavity, then the fallopian tubes are patent.

If the movement of liquid has frozen in the pipe channels, the pipes are considered impassable.

Disadvantages of this study:

• High data inaccuracy
• The procedure is painful.

Laparoscopy.

is that it requires a mandatory hospital stay, because The patient will be given anesthesia.

During the procedure, three incisions are made into which laparoscope (device with a video camera) and other auxiliary tools. A video camera allows you to assess the condition of the uterus and fallopian tubes.

Advantages of the method:

• Increased accuracy compared to x-ray examination.
• Possibility of combining treatment with research. If adhesions and tissue proliferation are detected, they can be eliminated during the examination.

Transvaginal hydrolaparoscopy.

The procedure is considered a subtype of laparoscopy. It is also carried out using a video camera, but only one incision is made in the vaginal area.

The study does not require hospitalization and can be performed on an outpatient basis.

With this examination, the risk of possible complications is much lower.

Hydrosonography ().

A special ultrasound, which also involves the use of contrast fluid. Regular saline solution can be used as a contrast agent.

The method is based on determining how fluid flows from the pipes into the abdominal cavity.

In terms of data reliability, the method is practically equivalent to hysterosalpingography, but causes less pain.

Additional research.

In addition to the listed options, the gynecologist will definitely prescribe an analysis for cytological smear and bacteriological smear.

Is it possible to cure fallopian tube pathologies?

Gynecologists note that even with a preliminary diagnosis of problems with patency of the fallopian tubes on both sides, the likelihood of becoming pregnant remains, since the results of even laparoscopy are not 100% accurate.

The mistake of many women is that they perceive the diagnosis of obstruction as a diagnosis of complete infertility and stop using contraception.

Very often, slight compression of the fallopian tubes still leaves a channel for the passage of the egg. It’s just that other factors are superimposed on the unsuccessful ones.

Before prescribing treatment, the gynecologist must exclude other possible factors that prevent conception from occurring. Namely:

1. Conducting tests on a woman to determine the regularity of ovulation.
2. Identification of other possible pathologies of the uterus.
3. Conducting a semen analysis of a man to determine the number and motility of sperm.

And only after this, if all tests are normal, should we proceed to treatment of fallopian tube obstruction.

Removal of blocked areas of the fallopian tubes is only possible through surgery. This may be laparoscopy or laparotomy.

During the operation, the area with the adherent walls is removed, and the patent sections of the fallopian tubes are sutured.

What is the prognosis for conception after surgery?

After surgical intervention, the patency of the fallopian tubes is restored by 80%.

Therefore, and also increases. Doctors note that the age factor plays a role in the likelihood of conception.

In women who have their fallopian tubes restored, only 14% can become pregnant naturally.

However, this does not mean infertility. Modern IVF technologies make it possible to achieve the desired pregnancy after 39 years of age with high success.

Be careful! Tubal reconstruction increases the risk of ectopic pregnancy. Therefore, upon pregnancy, it is necessary to perform an ultrasound to determine whether the embryo has implanted correctly.

Tubal obstruction in both the isthmic (located closer to the uterus) and the ampullary section (located closer to the ovary) can be eliminated by surgical laparoscopy - a surgical operation that allows you to see the internal organs of the abdominal cavity. Many gynecological operations were previously performed by major abdominal surgery (laparotomy). Currently, almost all of these operations can be performed laparoscopically. After surgical laparoscopy, patients recover much faster and the likelihood of complications is much lower. In addition, laparotomy is associated with a high risk of subsequent formation of adhesions in the abdominal cavity.

During laparoscopy, the surgeon can remove adhesions and restore patency of the tube using microsurgical techniques. Microsurgery is a delicate surgical technique using optical magnification that is usually used to repair small organs such as blood vessels or fallopian tubes.

Since the likelihood of pregnancy after repeated laparoscopic operations is quite low, it is very important that the first operation is performed with particular care by a highly qualified and experienced surgeon. Although in our country there are cases of multiple operations on pipes, their necessity is highly questionable. In the United States, repeated laparoscopic operations to restore tubal patency are extremely rarely prescribed due to their low effectiveness. A statistical analysis of the results of repeated laparoscopic tubal operations was carried out and it was shown that they lead to spontaneous pregnancy in less than 5% of cases.

The effectiveness of the operation depends primarily on the degree of damage to the pipes. There may be no result, since adhesions often reappear after some time, despite all the efforts of the surgeon. If the damage to the tubes is minor, and the surgeon only needs to remove adhesions around the tubes, pregnancy after surgery occurs in 50-60% of cases. If the fimbriae (finger-like fimbriae at the end of the tube) are significantly damaged, the pregnancy rate is much lower. Restoration of patency in the ampullary region leads to pregnancy in 15-30% of cases, depending on the degree of damage (according to the American Society for Reproductive Medicine - ASRM).

Surgical treatment methods are effective for partial obstruction of the tubes, but for complete obstruction they have virtually no effect. Even after restoring the mechanical patency of the tubes, it is not possible to restore the normal functioning of the ciliated epithelium lining the fallopian tubes. In such cases, as a rule, the patient does not even try to restore the patency of the tubes using laparoscopy, since the likelihood of pregnancy occurring naturally after such an operation is negligible, while the likelihood of pregnancy, on the contrary, increases sharply. In this case it turns out to be much more effective extracorporeal fertilization.

Women with damaged tubes, whether they have been repaired or not, have an increased risk of having an ectopic pregnancy. A tubal pregnancy can rupture the fallopian tube and cause severe bleeding in the pelvis, becoming life-threatening if not treated promptly. Therefore, a woman who has undergone tubal surgery should consult a doctor at the first suspicion of pregnancy in order to determine the location of the fertilized egg and eliminate the possibility of an ectopic pregnancy.

Tubal infertility is relatively easily overcome using the method, since in this case the eggs are removed directly from the ovaries, completely bypassing the fallopian tubes, and the embryos obtained in the laboratory are transferred directly into the uterine cavity. IVF is preferable to surgery for severe tubal damage or when previous surgery has failed.

In healthy women, the fallopian tubes carry mature eggs from the ovaries to the uterus. In order for a woman to become pregnant, at least one of these tubes must remain open. When obstructions occur, sperm and eggs cannot enter the fallopian tubes, where fertilization usually occurs. Blocked fallopian tubes are a problem in up to 40% of infertile women, so it is vital to identify the problem and begin effective treatment.

Method 1 of 3: Diagnosis of Fallopian Tube Obstruction

Method 2 of 3: Understanding the Causes of Blocked Tubals

Method 3 of 3: Treatment of obstructed tubes

• Know that even if nothing works to clear your blocked fallopian tubes or get you pregnant, you still have other options. Consider adoption or surrogacy if becoming a mother is so important to you.
• Keep in mind that if you only have one fallopian tube blocked, you may be able to get pregnant without any treatment at all. Whether treatment should be carried out or not depends on the reasons for the blockage and the health of your and your partner's genital organs. Talk to your doctor about other options.
• Infertility can be an extremely painful and unpleasant diagnosis, so it is very important to control your emotions. Make an appointment with a therapist or join a support group if you're feeling overwhelmed, and try to maintain healthy routines: a nutritious diet, regular exercise, and more healthy sleep.