Tubal-peritoneal infertility: explanation, causes, treatment

In the vast majority of young healthy married couples, conception occurs within 6-12 months of sexual activity without contraception. However, about 10-15% of families are faced with the fact that pregnancy does not occur.

The incidence of infertility in marriage has remained at a stable level over the past 20-30 years. At the same time, there is a decrease in the birth rate and fertility, which is due to social factors (later age of marriage and pregnancy planning). Today, more and more women are postponing childbearing until after 37-40 years of age.

Infertility can be caused by male or female factors or a combination of both. Among the causes of female infertility are the following:

• ovarian dysfunction (impaired maturation of a mature oocyte);
• cervical factor (violation of the properties of cervical mucus, which ensures the penetration of sperm into the uterine cavity);
• pathology of the uterine cavity (various conditions that prevent implantation and development of the embryo);
• tubal factor (impaired patency of the fallopian tubes).

Tubal infertility

What factors can cause tubal obstruction?

Tubal factor, caused by obstruction of the fallopian tubes, is detected in 30-35% of cases, being the main cause of infertility. What are the main reasons for the development of this pathology?

Causes of fallopian tube obstruction

• Infectious and inflammatory diseases of the pelvic organs (uterus, ovaries and fallopian tubes). The causes may be chlamydia, gonorrhea and other sexually transmitted diseases.
• Operations performed in the abdominal or pelvic cavity. For example, a condition after surgical treatment of an ectopic pregnancy or appendicitis complicated by peritonitis - inflammation of the abdominal cavity.
• Endometriosis of the fallopian tubes.
• Tuberculosis of the pelvic organs.
• Genetically determined anomalies in the development of the fallopian tubes with a violation of their motor function.
• Formations (primarily tumors) in the lumen of the tubes or compressing the tubes from the outside and disrupting their function.

Causes of tubo-peritoneal infertility

As we have already found out, tubo-peritoneal infertility is inherently a combined pathology. Tubal infertility excludes the possibility of conception due to functional or anatomical disorders that cause the problem of patency of the fallopian tubes.

Peritoneal or peritoneal infertility excludes the possibility of fertilization due to the presence of fusion in the pelvis.

Let us outline the following reasons for which the functioning of the fallopian tubes is disrupted:

• inflammatory diseases of the genital organs (for example, the presence of acute or chronic inflammatory diseases of the organs, such as adnexitis and salpingoophoritis (here we are talking about inflammation of the appendages), salpingitis (inflammation of the fallopian tubes), oophoritis (inflammation of the ovaries), etc.);
• the presence of genital infections (herpes, ureaplasma, chlamydia, mycoplasma, gonorrhea or trichomoniasis);
• violations of the structure of the fallopian tube;
• trauma or inflammatory process that developed during abortion or childbirth;
• surgical intervention in the internal genital organs, for example, removal of fibroids, cysts, etc.;
• an excess of stress hormones due to their increased secretion due to the patient being in a state of constant (chronic) stress;
• deficiency of female hormones, excess production of male hormones.

The peritoneal form of infertility is diagnosed when adhesions form on the appendages. The reason for their appearance is the transfer of operations, as well as infectious diseases in which the pelvic organs are affected.

In fairly common cases, endometriosis causes adhesions, especially if the uterine mucosa grows on the peritoneum. Let us highlight the signs and factors that may indicate tubal factor infertility:

• pain during sexual intercourse;
• the patient’s history (that is, in her medical history) of adnexitis in acute or chronic form;
• detection of fluid in the appendages, which is determined during ultrasound diagnostics;
• undergoing operations in the pelvic organs;
• ectopic pregnancy;
• pain in the lower abdomen, reminiscent of contractions, noted on the side where the adhesion is located, or on both sides;
• abortion.

Inserting an intrauterine contraceptive device also significantly increases the risk of adhesions and damage to the fallopian tubes.

Thus, actions carried out when installing uterine devices can be carried out without taking into account the presence of contraindications in the case of a particular patient. Negligence regarding the need for antiseptic treatment during the procedure also contributes to the worsening of the picture.

The relevance of the diagnosis of tubo-peritoneal infertility can also be assumed in patients with endocrine disorders who have not conceived a year after completing the course of therapy.

In general, we can add that the listed reasons and factors are indirect in nature, therefore, it is essentially not possible to determine the cause that provoked infertility based only on external signs.

Symptoms of tubal obstruction

Infertility is the most common sign of obstruction, since fertilization is impossible with it: normally, the egg and sperm are found in the fallopian tube. And if conception does occur, then the fertilized egg cannot enter the uterine cavity through the tube for further development. Other signs of obstruction may include: - Episodes of ectopic pregnancy during your lifetime. - Pain or discomfort in the lower abdomen. - Pain during sexual intercourse, which is felt deep in the pelvic area. - Pain when urinating. - Spotting between periods or after sex. - Copious vaginal discharge, especially yellowish or greenish in color.

Menstruation with fallopian tube obstruction

Menstruation with this pathology can be painful and irregular.

Sometimes, apart from the inability to get pregnant, a woman does not worry about anything and there are no obvious symptoms. The menstrual cycle is disrupted only during severe inflammatory processes.

Symptoms

You can suspect tubo-peritoneal infertility if:

• the woman has had one or more operations on the lower abdomen or genitals, where incisions were made in the abdominal wall;
• the patient has had one or more abortions;
• tubal patency studies were performed;
• have heavy menstruation;
• periodic pain in the lower abdomen;
• there is pain during sexual intercourse;
• painful periods;
• ultrasound at least once determined the presence of fluid in the uterine appendages;
• a diagnosis of adnexitis (salpingoophoritis) has been made at least once or a diagnosis of “Chronic adnexitis” has been made.

Infertility itself does not manifest itself with any special symptoms, other than the inability to get pregnant with frequent unprotected sexual intercourse.

Diagnosis of fallopian tube obstruction

The doctor begins to diagnose diseases of the fallopian tubes with a survey. The specialist examines the life history, asks whether operations were performed in the pelvic area, whether there were inflammations of the pelvic organs during life. The gynecologist also finds out whether the woman has ever had pulmonary or intestinal tuberculosis, or whether she has endometriosis. Then the discharge from the genital organs is examined (to determine infections), blood is taken for a general analysis (with a count of leukocytes) and markers of inflammation (C-reactive protein) are determined.

Ultrasound

Instrumental studies usually include ultrasound examination of the pelvic organs. It is usually done using a transvaginal (inserted into the vagina) probe. If ultrasound data is insufficient, an MRI is performed. These methods can detect inflammatory infiltrates and thickenings in the area of ​​the uterine appendages, changes in the contour of the tubes, and fluid in the pelvis.

If tuberculosis is suspected, an x-ray of the pelvic organs is required. The method allows you to see calcifications in the ovaries, tubes, lymph nodes, and displacement of the uterus due to adhesions.

Hysterosalpingography (HSG)

The study is carried out to accurately assess the patency of the tubes and verify the diagnosis. To do this, a radiopaque contrast agent is injected into the uterus through a thin catheter. The contrast fills the organ cavity and penetrates the fallopian tubes. After this, X-rays are taken, which show whether there are defects in the filling of the pipe cavities, i.e. their blockage. Carrying out HSG is associated with the risk of complications: - allergy to contrast - inflammation of the uterine mucosa - inflammation of the fallopian tubes - disruption of the integrity of the uterine wall.

Surgery (laparoscopy)

Diagnostic laparoscopy is performed if the previous examination was ineffective. During this low-impact operation, an optical system is inserted through small incisions in the abdomen. The manipulation allows not only to examine the area of ​​the fallopian tubes, but also, if necessary, to take tissue samples for research. Laparoscopy can detect endometriosis, changes in the length and tortuosity of the tubes, adhesions and disturbances in the motor activity of the tubes. In addition to diagnostics, during this surgical intervention, therapeutic manipulations are also performed, for example, dissection of adhesions.

Diagnostics

It is sometimes difficult for specialists to determine the exact cause of the development of tuboperitoneal infertility, because the disease is difficult to identify. To accurately determine the diagnosis, the doctor must take into account information about all of the above causes of the disease and make sure of one or more reasons leading to the lack of conception. It is impossible to detect tubal infertility based on ultrasound or gynecological examination. Therefore, it is necessary to do a hysterosalpingography: an x-ray of the fallopian tubes and uterus with the introduction of a special drug. If necessary, laparoscopy is performed.

Complete and partial obstruction of the fallopian tubes

Pregnancy with complete obstruction of the fallopian tubes is impossible.

Partial obstruction may be due to damage to only one tube. This occurs if the tube was removed due to an ectopic pregnancy or other operations in the pelvic cavity, or a developmental anomaly was discovered - congenital absence of the tube. Pregnancy in this case is likely if several conditions are met:

1. have at least one functioning ovary
2. the only pipe is healthy
3. There are monthly ovulatory cycles.

Causes of tubal infertility

The disease is detected during the complete absence or disruption of patency of the pathways. In addition, this can be caused by malfunctions in the functioning of the relevant organs, due to which the fallopian tubes lose their ability to contract (increased or decreased tone).

This pathology is caused by the following reasons:

• genital infections transmitted during sexual intercourse;
• surgical intervention in the pelvis, abdominal cavity, fallopian tubes;
• external endometriosis, provokes accumulation of a large number of active elements near the fallopian tubes;
• consequences of inflammation or trauma in the postpartum period;
• hormonal disorders.

The functional pathological process is characterized by disturbances in the functioning of the muscular layer of the tubes: hypo-, hypertonicity, disruptions in the central nervous system. Main provoking factors:

• constant stress;
• emotional turmoil;
• disruption of hormone production;
• inflammatory processes in the organs of the genitourinary system;
• operations.

Infertility is often caused by the presence of infections and inflammation in the uterus, tubes, and ovaries. In this regard, treatment should be started immediately.

Treatment of fallopian tube obstruction

First, drug therapy is carried out. For inflammatory processes provoked by an infectious agent - including chlamydia, gonococci, Haemophilus influenzae, streptococci, Escherichia coli - antibiotics are prescribed in tablets or injections. Usually these are: - metronidazole - clindamycin - ceftriaxone - doxycycline - ofloxacin.

To accurately select the drug, culture the discharge from the cervix and determine the sensitivity of microorganisms to antibacterial drugs of different groups. A combination of antimicrobial agents is possible depending on the pathogen. The drugs are taken for a long time, for up to 14 days. It is important to complete the full course of treatment, even if the condition improves after a few days of treatment. If a woman has been diagnosed with gonorrhea or chlamydia, her sexual partner should also receive treatment.

Drug treatment (longidaza)

Therapy with longidase (hyaluronidase) or chymotrypsin is carried out together with antibiotics, daily, once a day, in a course of 7-10 injections. The effect stimulates the resorption of adhesions and reduces inflammation. There have been no large clinical studies of the drug.

Treatment with folk remedies

This type of therapy has no evidence base and is not used in official medicine. Hog uterus (Orthília secúnda) was previously widely used in folk medicine, mainly in Siberia. It was believed that boron uterus has anti-inflammatory, antimicrobial, and diuretic effects. Until now, for tubal infertility, an alcoholic infusion is used (50 g of herbal raw materials are infused in 500 ml of vodka) or a water infusion (1 teaspoon of crushed plant is brewed with 1 glass of boiling water, then kept in a water bath for about 15 minutes).

The alcohol solution is used three times a day, before meals, 30-40 drops in a small amount of water, for 6 months according to the scheme: 1 week of intake and three weeks of rest. During menstruation, boron uterus should not be taken.

It must be remembered that during treatment with herbs, including boron uterus, allergic reactions may develop. Before taking herbal infusions, you need to consult a doctor to determine indications and contraindications.

Diagnosis of TPB

Only a doctor can determine the main signs of infertility, as well as draw appropriate conclusions about the situation with a particular patient, and all this is done based on the results of a comprehensive examination. Consideration of the tubo-peritoneal factor of infertility through its diagnosis comes down to the following actions:

• analysis of the patient’s complaints (for example, the presence of pain, the nature of its manifestation, whether there are problems associated with conception, identification of symptoms that determine childlessness for the treatment of infertility in the future);
• study of anamnesis (history of diseases suffered by the patient, in particular genital infections, gynecological diseases, surgical interventions in the genital area, number of pregnancies, including miscarriages, abortions);
• study of the characteristics of the menstrual cycle (age of onset of menstruation, duration and regularity of menstruation, date of last menstruation);
• conducting a comprehensive gynecological examination (including a two-manual vaginal examination, which allows us to determine the developmental features of the genital organs, their size, the general condition of the uterine ligaments and ovaries, the degree of their mobility, the presence/absence of pain);
• bacteriological culture - taking biomaterial from the vagina for subsequent research, which consists of placing it in a special environment and makes it possible to obtain information regarding the pathogen that provoked the inflammatory process, and also determines sensitivity to antibiotics;

• PCR diagnostics (this diagnostic method allows us to identify the presence of inflammatory pathogens in the patient’s genitourinary organs and sexually transmitted infections through the use of the polymerase chain reaction technique);
• diagnostics of hormone levels (testosterone, prolactin, FSH and LH)
• phalloscopy (use of fiber optics to examine the cavity of the appendages);
• hysterosalpingography using ultrasound or an X-ray machine, during the study the condition of the fallopian tubes is determined for their patency through the use of contrast, which makes it possible to diagnose tubal infertility;
• kymographic pertrubation (appendages are examined for their motor activity, for which carbon dioxide or air is introduced into them);
• hydrosalpingoscopy (ultrasound examination in which the appendages are filled with water, acting as contrast);
• laparoscopy (a diagnostic method of inserting a tube with a camera into the abdominal cavity, which includes the possibility of dissecting adhesions and eliminating endometriotic lesions).
• to identify the presence of sexually transmitted infections in the patient, a smear is taken, the results of which will be obtained during subsequent microscopy;

When diagnosing the condition of the fallopian tubes, depending on the location and nature of the severity of adhesions, a specific degree is assigned to them, which determines the spread of the adhesive process:

• I degree - minimal, avascular, planar adhesions, the tubes are characterized by patency, the folding of their mucosa is preserved;
• II degree - the thinness of the adhesions is noted, they do not have vessels or they are poorly vascularized, the ovary does not have adhesions on more than 50% of its surface, occlusion in the distal part of the fallopian tube is also allowed, the folding of their mucosa and the fimbrial part are preserved;

• III degree - characterized by the density of vascularized adhesions, more than 50% of the surface of the ovary is affected, occlusion is noted in the distal section, the folding of the endosalpinx is destroyed;
• IV degree - characterized by the density of vascularized adhesions, the abundance of adhesions does not allow one to examine the surface of the ovary affected by them, the fallopian tube has the appearance of a hydrosalpinx (or sactosalpinx), the folding of the tube mucosa is destroyed.

ECO

In vitro fertilization is performed if pregnancy does not occur during drug treatment. For this procedure, an egg is taken from a woman and sperm from a man, then fertilization is carried out in a laboratory. After 3-5 days, the embryo is placed in the woman’s uterus for further gestation. This method of assisted reproductive technologies is considered the most effective. It is used for complete obstruction of the fallopian tubes or for serious violations of the cellular composition and chemical properties of sperm in men.

VRT

There are times when all the necessary measures to restore the patency of the pipes do not bring the desired result. In such cases, doctors recommend the IVF method - artificial insemination. The sperm and egg are fertilized in vitro, and the resulting embryo is placed directly into the uterus for implantation. With this method, the fallopian tubes are not involved in the fertilization process. Many resort to this method to achieve their cherished goal - having a child. There is no need to worry that without the participation of the fallopian tubes in fertilization, you will not be able to carry a child. Many fertility specialists advise removing inflamed and damaged tubes before the procedure to increase the chance of success and avoid the risk of ectopic pregnancy. In modern medicine, reproductive technology is well developed. The most important thing is to contact a specialist in a timely manner and strictly follow all his instructions and recommendations. This will bring you closer to your cherished dream, and you will soon hear the long-awaited word “mother”.

Video: Tubal-peritoneal infertility

Therapy

Conservative treatment

This method consists of taking the necessary medications and is aimed at relieving the inflammatory process. He is on a course of antibiotic injections and Longidase injections. After achieving the effect, the patient is prescribed anti-adhesion absorbable drugs, and physiotherapy procedures (electrophoresis) are prescribed to resolve thin films in the fallopian tubes. Doctors also use products that improve local blood circulation.

Once tubal obstruction is diagnosed, treatment is aimed at restoring the possibility of conception.

The conservative method can be effective if the period of occurrence of the adhesive process does not exceed six months.

Surgery

Obstruction of the fallopian tubes can be surgically removed using laparoscopy or laparotomy. Both operations require general anesthesia. Laparoscopy is a microsurgical procedure. Punctures are made in the required places, through one of which a tiny chamber is inserted inside. Thanks to the use of such equipment, an image of the abdominal cavity, instruments inserted into additional incisions on the abdomen (and pipe openings) and the doctor’s manipulations are transmitted to the screen. The surgeon cuts through the adhesions, but if the films are in the center of the oviduct, he cannot reach the required area. In this case, the fallopian tubes are cut in two places, then the blocked part of the organ is removed, and the healthy ends are sewn together.

Laparotomy entails greater trauma. During this process, the surgeon makes a horizontal/vertical incision in the lower abdomen, then finds and dissects the formed adhesions.

Treatment with folk remedies

Treatment with folk remedies can help only in the early stages, but turning to it as an addition to the main therapy is justified. The effect of using traditional medicine methods for such a diagnosis is small. You should first discuss the use of each such remedy with a specialist.

Basically, folk methods have a general therapeutic focus - these are infusions, tinctures, decoctions. But among them there are also local agents. For example, flax seeds are used to resolve adhesions. A compress is prepared from this raw material. A couple of tablespoons of seeds are poured into a piece of gauze, the edges of which are tied. The flax packaged in this way is dipped into boiling water and kept on fire for 3 minutes. The compress is allowed to cool (but not completely) in the same container. Then the warm gauze is squeezed out and placed on the lower abdomen. The area of ​​the body with the applied compress is covered with cellophane and wrapped in a towel. In this form they fall asleep. The course of treatment consists of 8 procedures.

Hog queen

Borovaya uterus can have an anti-inflammatory, absorbable effect. This plant is successfully used to eliminate various problems in the female body, including for the purpose of resolving adhesions.

Decoctions and tinctures are prepared from boron uterus, and it is also used for douching. Candles and oil extracts are made from this herb.

To prepare the tincture, 5 tablespoons of the raw material are poured with half a liter of vodka. The infusion period for the product is 2 weeks. The mixture should be shaken periodically. Measure 40 drops an hour before breakfast, lunch, dinner.

To prepare an infusion of boron uterus, crush 2 tablespoons of the leaves of the plant and add 500 ml of boiling water. Cover the container with a lid, wrap it up, and set aside for 20 minutes. The finished infusion is filtered. Single dosage – half a glass; daily number of doses – 4. Take food half an hour after the procedure.

Other medicines

The therapeutic effect of using an infusion/tincture of boron uterus can be supplemented with milk thistle. A spoon of this herb needs to be filled with 200 ml of boiling water. The infusion time for the product is half an hour. Drink in small sips an hour before your morning and evening meals, warming up the cooled infusion in a steam bath.

The fallopian tubes can also be cleaned with cinquefoil. Prepare a tincture from it by pouring the raw material (1 spoon) with vodka (300 ml). The period for bringing it to condition is 3 weeks. Before each dose, add 50 ml of water. Take a spoonful of tincture. The daily number of doses is 3. The duration of the course is a month.

St. John's wort can be used to treat obstruction of the fallopian tubes. Grind the dried herb, pour 1 spoon of raw material into 250 ml of boiled water. Place the product on low heat; boiling time – 20 minutes. Single dosage – a quarter glass. The daily number of receptions is 3.

Treatment

Treatment of functional tubal infertility is carried out with medications: anti-inflammatory drugs, antispasmodics, adaptogens. Psychotherapeutic methods, gynecological massage, hydrotherapy, ultrasound, and balneotherapy are also used.

If the problem of unsuccessful conception caused damage to the tube, and it consisted of acute or currently worsened bacterial inflammation of the appendages, antibacterial drugs are prescribed.

When the cause is chronic inflammation, therapy is carried out using not only antibiotics, but also drugs that enhance immunity. Physiotherapy methods aimed at resolving swelling and fluid accumulation are also used.

Treatment of endometriosis is carried out with a course of hormonal drugs, after which laparoscopic removal of foci of abnormally located endometrium is usually carried out.

Treatment of peritoneal infertility is carried out surgically: 2 incisions are made on the anterior abdominal wall, through 1, sterile air is first pumped into the abdominal cavity, then a device with a camera is inserted there. The second incision is used to introduce micro-instruments into it, which will cut the adhesions and cauterize them.

If the patency of the fallopian tubes is impaired due to any of the reasons, surgical treatment is also necessary. The method is selected depending on the situation. So, the following can be done:

• salpingolysis – dissection of adhesions;
• fimbryoplasty – restoration of only the entrance to the fallopian tube;
• salpingostomy - creation of a new hole in the closed section;
• salpingo-salpingoanastomosis - removal of part of the pipe with their subsequent reconnection after restoration of patency of the resected area;
• implantation of appendages into the uterus if there is no patency in the tubal interstitium.

After any of the operations, a course of several hydrotubations (“expansion” of the fallopian tubes with liquid) may be necessary. If after the operation pregnancy does not occur within six months or a year, it makes sense to start preparing for IVF, since the more time passes, the less likely it is.

Treatment with folk remedies for this pathology is ineffective.

Tubal infertility

- a variant of female infertility caused by functional or organic obstruction of the fallopian tubes. There are no specific symptoms. Like other forms of infertility, it manifests itself as the inability to become pregnant after having regular sexual relations for 6-12 months. When making a diagnosis, hysterosalpingography, ultrasound hysterosalpingoscopy, laparoscopy, and laboratory tests to identify STIs are used. Treatment of tubo-peritoneal infertility includes medication and physiotherapy, hydrotubation, transcatheter recanalization, reconstructive plastic surgery, IVF.

Classification

Peritoneal infertility (tubal) is a factor in the lack of fertilization in a third of patients who have frequent intimate life without the use of contraception with subsequent infection with sexually transmitted infections. There is the following classification of pathology:

• functional, the ability to contract the fallopian tube is impaired;
• infertility of an organic type, in such a situation, the patency of the pipes will be impaired from the outside (adhesions, growths), from the inside - due to inflammation.

Peritoneal infertility in all cases is formed due to the formation of adhesions in the pelvic organs, which will be a response to inflammation. In addition, the pathological process happens:

• primary, a woman cannot become pregnant initially;
• secondary, the patient had pregnancies before, but after that the possibility of natural fertilization disappeared.

Infertility can also be divided into:

• relative: there is a possibility of natural fertilization;
• absolute: inability to get pregnant in the traditional way.

Obstruction of the fallopian tubes affects women, regardless of age. The incorrect structure of the tubes, the presence of a mechanical barrier in them or the uterus makes fertilization impossible.

Types of infertility

When a woman of childbearing age wants, but cannot, become pregnant, they speak of infertility. This diagnosis is made after 1 year of unsuccessful attempts, and for people over 35 after 1.5 years.

There are 2 options: the woman could not get pregnant and the second option was that she could not carry it to term (history of pregnancy).

The note

Absolute infertility occurs when there are irreversible disorders of the reproductive system, while relative infertility is treatable. Tubal infertility refers to relative infertility.