Why do pipes stop working?
The fallopian tube is a thin organ with a complex structure. Its inner surface is covered with folds and cilia, which create a fluid flow and move the egg towards the sperm, and then the embryo into the uterine cavity.
Inflammation damages this delicate lining. The cilia die, the folds stick together, and the wall thickens. Even if the lumen is preserved, the transport function may be lost - and this is why “passable” tubes do not always mean the possibility of pregnancy.
- Previous pelvic inflammatory diseases, especially chlamydial diseases, are the main cause
- Sexually transmitted infections, including asymptomatic ones
- Endometriosis with adhesions
- Surgeries on the abdominal and pelvic organs
- Appendectomy, especially complicated
- History of ectopic pregnancy and tubal surgery
- Abortion and complicated childbirth
- Tuberculosis of the genital organs
- Congenital tubal anomalies
- Adhesive process of any origin
Symptoms
As a rule, there are none. Tubal obstruction does not hurt and does not manifest itself in any way - the only sign is the absence of pregnancy.
- Lack of pregnancy with regular sexual activity without contraception
- Past ectopic pregnancy
- Chronic pelvic pain due to adhesions
- Pain during intercourse
- Indications in the anamnesis of previous inflammations and operations
- The menstrual cycle usually remains regular - ovulation continues
Patency testing methods
- Hysterosalpingography (HSG) is an X-ray method with the introduction of contrast into the uterine cavity; shows well the shape of the cavity and the patency of the pipes
- Hydrosonography (echo-HSG) is an ultrasound option with the introduction of saline or special contrast; without radiation exposure
- Hydropertubation and pertubation - introduction of liquid or gas into the uterine cavity with assessment of patency
- Diagnostic laparoscopy with chromohydrotubation - injection of dye and observation of its exit from the tubes; most accurate method
- Ultrasound of the pelvic organs - reveals hydrosalpinx
- Screening for infections, including chlamydia
- Assessment of the ovarian reserve and spermogram of the partner is a mandatory part of the examination of the couple
A significant advantage of laparoscopy is that it is both diagnostic and therapeutic: detected adhesions can be immediately separated. But this is an operation, so they usually start with less invasive methods.
Treatment: surgery or IVF
This is the main question, and the answer to it depends on the degree of damage to the tubes, the woman’s age, the state of the ovarian reserve and the partner’s spermogram.
- Laparoscopic salpingo-ovariolysis - separation of adhesions around the tubes and ovaries; effective in the adhesion process with a intact pipe wall
- Salpingostomy - the formation of a new hole in the tube if it is obstructed in the final section
- Fimbryoplasty - restoration of the fimbriae of the tube
- Restoring patency during laparotomy
- Introduction of anti-adhesive barriers during surgery
- IVF is the method of choice for severe tubal damage, bilateral proximal obstruction, hydrosalpinx and in women over 35 years of age
- Removal of hydrosalpinx before IVF is a mandatory step that increases the likelihood of implantation
What is taken into account when choosing tactics
- Возраст женщины — после 35 лет время становится решающим фактором
- Овариальный резерв по АМГ и количеству антральных фолликулов
- Степень и локализация поражения труб
- Наличие гидросальпинкса
- Спермограмма партнёра — при мужском факторе операция на трубах теряет смысл
- Длительность бесплодия
- Наличие эндометриоза и других сопутствующих факторов
- Предыдущие операции на органах малого таза
Prevention
- Using a condom with new partners
- Regular examination for chlamydia - it most often damages the pipes and is asymptomatic
- Immediate and complete treatment of inflammatory diseases of the pelvic organs
- Refusal of abortion through reliable contraception
- Screening for infections before intrauterine interventions
- Timely treatment of endometriosis
- Do not delay examination if you are not pregnant: one year before age 35 and six months after age 35
Where to get examined in Tashkent
We need methods for assessing tubal patency, ultrasound, and the ability to perform laparoscopy with immediate separation of adhesions.
In Tashkent, such examination and surgical treatment are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic; IVF programs are implemented jointly with reproductive specialists.
The examination of the couple should proceed in parallel: a spermogram of the partner is performed quickly and simply, and its result can completely change the tactics. It is irrational to start checking the pipes without knowing the sperm parameters. Clinic contacts are below.
