Female infertility today is one of the most urgent and serious problems of modern medicine. You can often hear a similar story from patients: “I am 30 years old, I met the man of my dreams, we want a baby, but it doesn’t work out. Doctor, help! In Ukraine, about 50% of women of reproductive age are not married, 50% of them are infertile. Female infertility is a problem that destroys families and lives. However, there are several ways to solve this problem, and the first step towards solving it should be to find the root cause of reproductive dysfunction. The series of our articles on female infertility aims to help both the doctor and the patient understand this issue.
The most common form of infertility is tubal-peritoneal
Tubal-peritoneal infertility is one of the most common forms of female infertility, accounting for about 40% of all such reproductive disorders. Tubal-peritoneal infertility develops against the background of the development of obstruction of the fallopian tubes. Ovulation occurs, but due to the presence of mechanical barriers, the egg does not enter the cavity of the fallopian tubes and uterus, and fertilization does not occur. Most often, this condition develops after suffering infectious diseases of the female genital organs. The clinical picture of the infection is not necessarily always pronounced, however, the longer the infectious agent is in the body of a woman, the more favorable conditions are created for the formation of an adhesive process in the pelvic cavity, which leads to the development of obstruction of the fallopian tubes.
The main causes of tubal-peritoneal infertility
The most pronounced adhesive process in the abdominal cavity and fallopian tubes after suffering gonorrhea. This infection has a fairly pronounced clinical picture and requires immediate treatment. In addition, the inflammatory process is necessarily accompanied by hemodynamic disturbances in the walls of the fallopian tubes, which causes atrophy of the ciliated epithelium, the normal functioning of which is necessary for the advancement of the egg through the lumen of the fallopian tube. Thus, even if the patency of the fallopian tubes is preserved, the infectious process can cause infertility. Abortions performed in the past also provoke the development of tubal-peritoneal infertility, which is associated with trauma to the walls of the uterus and possible obliteration of the mouths of the fallopian tubes. Operations on the pelvic organs also provoke the development of adhesive processes. In addition, tumors of the uterus and ovaries can compress the fallopian tubes and serve as a mechanical obstacle to the normal advancement of the egg.
Instrumental methods for diagnosing obstruction of the fallopian tubes
To diagnose obstruction of the fallopian tubes, instrumental research methods are used to visualize the pathological picture. Widely used metrosalpingography - radiopaque examination of the fallopian tubes. It is necessary to conduct a study in the second phase of the menstrual cycle, since progesterone, produced in the luteal phase, stimulates the relaxation of the fallopian tubes, which allows you to better examine their condition. For contrast, water-soluble contrast agents such as urographin or triombrast are used. Electroroentgenography gives an even more accurate image, however, it is not used as often, due to the need to use special equipment. The most informative method in the diagnosis of obstruction of the fallopian tubes is the surgical method of research - laparoscopy. By means of laparoscopy, it is possible not only to determine the localization of the adhesive process or other mechanical obstacle as accurately as possible, but also to perform medical manipulations immediately after the diagnosis.
Treatment of tubal-peritoneal infertility begins with conservative methods of therapy. If the inflammatory process is confirmed, the woman is prescribed a course of antibiotic therapy in order to eliminate the infectious agent. In addition, drugs that improve microcirculation, biostimulants and adaptogens are prescribed. It often happens that after the elimination of the infection and the normalization of the hemodynamic properties of the fallopian tubes, pregnancy occurs. If this does not happen, and the adhesive process interferes with the passage of the egg, surgical intervention is performed. Depending on the localization of the adhesive process, fimbrio- and salpingolysis, salpingostomy, transplantation of the tube into the uterus, salpingo-salpingoanastomosis are performed. It should be noted that surgery should be laparoscopic, since even microsurgical laparotomy significantly increases the risk of re-development of the adhesive process. In the event that even surgical methods of therapy do not lead to pregnancy, the couple is recommended to undergo in vitro fertilization.
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