Female infertility, the causes, treatment and diagnosis of which is worried by thousands of gynecologists, is a big social problem at the present time, because it not only reduces demographic indicators, but also leads to mental problems in women, affecting their quality of life and health generally.
Childless couples are becoming more and more, these indicators are already reaching 20% in some countries, which is a critical point, and tubal-pertoneal infertility accounts for more than 35% of all recorded cases. And this is not surprising, since the fallopian tubes are a very sensitive part of the reproductive system and suffer greatly from the inflammatory process.
Causes
Peritoneal infertility occurs as a result of adhesions in the pelvic cavity, and tubal infertility in the case of adhesions in the fallopian tubes. The combination of these two conditions is referred to as tubal-peritoneal infertility.
Normally, the egg is fertilized in the abdominal cavity, and then moves into the uterus due to the reduction of the villi lining the tubes from the inside. The ovum cannot move independently. Damaged villi or the presence of adhesions interferes with the progress of the sperm to the egg and fertilization.
Adhesive process in the small pelvis develops due to inflammation caused by an infection that penetrates the body during intercourse (chlamydia, gonorrhea, etc.) or with the appearance of appendicitis. Tubal peritoneal infertility may result from abortion or surgery in the abdomen and ovaries.
Much attention is paid today to the study of herpes infection, as a factor leading to infertility.
From scientific works it is known that more than 40% of women who have found tubal-peritoneal infertility suffer from endometriosis, polycystic ovaries or have a benign tumor of the reproductive system.
Phenomena such as kinking or narrowing of the tubes can also prevent pregnancy.
Diagnostics
Diagnosis and treatment of tubal infertility should be thorough and phased.
First of all, such examination methods as hormonal, immunological, cytogenetic, as well as analysis for sexually transmitted diseases are carried out. All this is aimed at eliminating tubal infertility.
Then hysterosalpingography is performed to assess the patency of the pipes. The method is based on an X-ray examination, in which a contrast agent is injected into the uterine cavity. In the picture you can see that the solution did not get into the fallopian tubes, which means they are not passable. However, the probability of an incorrect result in such a study is about 20%.
A similar method is sonohysterosalpingoscopy, performed using ultrasound. It is considered sparing due to the lack of exposure from x-rays, but less reliable due to the low resolution of the ultrasound apparatus.
Reliable method laparoscopy can be considered, during which the abdominal cavity, ovaries, fallopian tubes and uterus are visualized. This procedure is considered a mini-operation, therefore, it is performed under general anesthesia. In addition, it can be considered therapeutic, since the adhesions found during the examination are dissected using special equipment.
Treatment
Tubal peritoneal infertility is treated primarily by surgery. Today, laparoscopy is used, during which small incisions of the abdominal wall are made, whereas laparotomy (dissection of the peritoneum), which itself is the cause of adhesions, was used before.
With partial obstruction of the tubes and good condition of the villi, laparoscopy gives a positive result in 50-60% of cases. In advanced cases, even the repeated conduct of this operation, patency does not restore.
The second stage of treatment can be considered as antibacterial, immunocorrective and infusion therapy, as well as the use of non-pharmacological treatment methods (physiotherapy, plasmapheresis, ozone therapy, herbal medicine) aimed at preventing the formation of new adhesions.
Then, a control hysterosalpingography is given to confirm that the fallopian tubes are free.
If patency is not restored or pregnancy is absent 1 year after careful treatment, in vitro fertilization is prescribed .