Obstruction of the fallopian tubes, what to do
Whether a woman can become pregnant is directly influenced by the patency of her fallopian tubes: whether it is complete or partial. It also matters whether one or both pipes show signs of obstruction.
Complete obstruction of the tubes makes it impossible for the egg to enter the uterus, since the lumen is closed. In such a situation, a woman will not be able to conceive a child naturally. However, modern reproductive technologies can come to her aid, namely IVF.
If a woman has incomplete patency of the fallopian tubes, this means that the lumen of the epididymis is only partially closed. The egg cell has the ability to penetrate the uterus, which means that a woman can conceive a child on her own. However, the chances of successful fertilization in such patients are much lower than in healthy representatives of the beautiful half of humanity.
Also, natural conception can occur when only one fallopian tube is impassable, and the second is partially passable or completely healthy. Nevertheless, the problem of tubal infertility remains relevant in modern society. Primary infertility is diagnosed in both very young girls and young women at the age of 30. Moreover, they often did not have abortions, did not undergo surgical interventions, and do not have any serious diseases in their anamnesis.
Statistics indicate that about 15% of families face infertility. And in 20-25% of cases, it is the obstruction of the fallopian tubes that becomes his fault.
- Symptoms of obstruction of the fallopian tubes
- Causes of obstruction of the fallopian tubes
- How is the fallopian tubes checked for patency?
- Complications and consequences of obstruction of the fallopian tubes
- Pain in the fallopian tubes: what to do?
- Methods for restoring patency of the fallopian tubes
- Complete obstruction of the fallopian tubes: what to do?
- IVF for obstruction of the fallopian tubes
Symptoms of obstruction of the fallopian tubes
Obstruction of the fallopian tubes does not give vivid symptoms. Therefore, a woman may not be aware of her problem for a long time. Her state of health is not disturbed, menstruation occurs on time, no disruptions in their cyclicity are observed. Therefore, in the woman's opinion, there are no obvious reasons for concern about her own health.
A sign that may indicate obstruction of the appendages is the absence of pregnancy for a long time - a whole year of regular intimate life without protection. Moreover, in order to draw attention to this symptom, a woman should strive to become pregnant and not have hormonal or endocrine pathologies.
Depending on the cause that triggered the development of obstruction, the clinical picture may vary somewhat.
When adhesions caused the blockage of the tubes against the background of inflammation of the pelvic organs, periodically a woman may be bothered by pains in the lower abdomen of a aching nature.
If the obstruction of the tubes is a consequence of surgical intervention in the abdominal cavity (surgery for appendicitis, removal of the ovary, abortion, etc.), then the pain will be pulling in nature. Sometimes they become quite intense and disrupt the quality of life.
A symptom that indicates a blockage in the tubes may be severe pain that occurs during the next menstrual cycle.
Often, even an ultrasound scan and examination on a gynecological chair does not allow identifying the existing problem.
Sometimes, against the background of obstruction of the fallopian tubes, a woman may experience pain during intercourse, with deep penetration or sharp jolts, when the vagina is greatly stretched.
If the obstruction of the tubes is due to chronic inflammation in the pelvic organs, then abnormal vaginal discharge that appears against the background of periodic pain is not excluded.
So, the main symptoms that can indirectly indicate obstruction of the fallopian tubes are as follows:
- Pain during menstrual bleeding.
- Unpleasant sensations during intimacy.
- Occurring from time to time, pulling or aching pains with localization in the lower abdomen.
- Pathological vaginal discharge.
Causes of obstruction of the fallopian tubes
Two basic causes of obstruction of the fallopian tubes can be distinguished - these are functional disorders and organic pathologies of the appendages.
Disorders of a functional nature include disorders in the normal contractility of the tubes, their hypo- or hypertonicity, adynamia of cilia and villi, discoordination of their movements. In this case, the structure of the appendages and their histology remain unchanged.
Factors that contribute to the formation of functional disorders:
- Hormonal imbalance. At the same time, the female sex hormones circulate in the body much less than necessary.
- Malfunctions of the nervous system due to stressful situations.
- A high level of biologically active substances in the blood and tissues against the background of inflammation of the uterus, ovaries or tubes. These substances include interleukins, prostaglandins, thromboxane A2, etc.
Organic lesions include adhesions formed in the abdominal cavity, torsion of appendages, their compression by various tumors, and underdevelopment of organs.
Factors that can provoke the development of organic lesions:
- Inflammatory diseases of the pelvic organs, including venereal diseases.
- The presence of a chronic infection, for example, mycoplasmosis, chlamydia, ureaplasmosis, cytomegalovirus, etc.
- Surgical operations on the uterus and appendages, or on other organs located in the abdominal cavity.
- Diagnostic or therapeutic procedures that were accompanied by invasive intervention in the organs of the reproductive system.
- Postponed abortions.
- Complications of childbirth or abortion.
So, the obstruction of the fallopian tubes can be due to a number of different reasons that have a functional or organic nature.
What microorganisms are capable of provoking obstruction of the fallopian tubes?
Almost any pathogenic microorganisms are capable of causing inflammation of the genitals, which in the future can lead to the development of obstruction of the fallopian tubes. Among the coccal flora, adnexitis is most often provoked by staphylococci, streptococci and enterococci. Although fungi, viruses and protozoa can also cause inflammation of the fallopian tubes.
The risk that a woman, after suffering inflammation of the appendages, will develop obstruction of the fallopian tubes, is reduced to the following figures:
- In 12% of women, obstruction develops after a single episode of inflammation.
- In 35% of women - after 2 cases of inflammation.
- In 75% of women, after 3 episodes.
How is the fallopian tubes checked for patency?
There are several diagnostic methods that allow you to establish obstruction of the fallopian tubes, among them:
Ultrasound of the pelvic organs. With the help of a conventional ultrasound examination, the doctor will be able to determine the structure of the female genital organs, identify their inflammation, the presence of adhesions, tumors, hydrosalpinx. (More: ultrasound for patency of the fallopian tubes).
USGSG (echohysterosalpingography, hydrosonography). This procedure is carried out in almost the same way as any other ultrasound examination: a gel is applied to the abdominal cavity and examined with a scanner. However, before the procedure, sterile saline is injected into the cervix using a thin catheter, the movement of which is displayed on the monitor. If a woman has partial obstruction of the fallopian tubes, then this method is not very informative, and also less accurate in comparison with the HSG.
Hysterosalpingography (HSG, metrosalpingography)- This is a study of the uterus and appendages using a contrast agent, after the introduction of which pictures are taken on an X-ray machine. If the fallopian tubes are obstructed, diagnosis should be carried out in the second half of the menstrual cycle. The effectiveness of the method is 98%. The procedure is performed on an outpatient basis, or in hospitals of gynecological departments. 2 days before it is necessary to give up intimacy. A week before the diagnosis, you can not douche, enter vaginal drugs, except for those prescribed by the doctor. A contrast agent (cardiotrast, urotrast, verografin, triombrast) is fed into the uterus through a special tube, intravaginally. The doctor then takes a series of images to assess the condition of the uterus and fallopian tubes. For 3 months after the procedure, a woman should be protected to avoid pregnancy. Hysterosalpingography is the leading method for diagnosing tubal obstruction. A significant drawback of the study is that it makes it possible to establish the presence of an obstacle in the pipes, but its nature cannot be clarified. (More: GHA tubal X-ray: pros and cons).
Perturbation or "blowing" of the fallopian tubes. During this study, gas is injected into the uterine cavity under pressure. It can be air, carbon dioxide, oxygen. The procedure is practically painless for the patient and does not take more than 5 minutes. When the gas fills the fallopian tubes, they begin to contract, and this process is recorded by special equipment. The results are displayed in graphical form. The doctor makes a conclusion about the patency of the tubes on the basis of the data obtained, and also evaluates some indirect signs: a characteristic noise in the abdominal cavity, pain in the clavicle in the patient.
Laparoscopy with chromohydrotubation. This method belongs to minimally invasive surgical techniques. In order to detect only obstruction of the fallopian tubes, laparoscopy is used extremely rarely, most often the method is used for therapeutic purposes. The study allows not only to identify the obstruction of the fallopian tubes, but also to eliminate the existing violations. The procedure is performed under general anesthesia in a hospital setting. Two incisions are made in the abdominal cavity through which the instrumentation is inserted. The term "chromotubation" means that a sterile solution is injected into the uterine cavity, which, if the fallopian tubes are obstructed, will not spread through them. After laparoscopy, the woman will remain in the hospital for several days under the supervision of doctors. (More: Laparoscopy of the fallopian tubes: indications and contraindications).
Fertiloscopy (transvaginal hydrolaparoscopy). This procedure is less traumatic compared to laparoscopy, since the access to the tubes is not through the abdominal cavity, but through the vagina, on the back wall of which a small incision is made. The study can be performed in an outpatient setting under local anesthesia. Saline is injected into the pelvic area through an incision to lower and straighten the fallopian tubes. The patency check is carried out using a contrast agent.
To determine which diagnostic method is a priority in a particular case, a medical consultation is necessary. Only a doctor is able to select the appropriate procedure based on the woman's health condition. It should be borne in mind that surgical diagnostic techniques are no less dangerous than a full-fledged operation. They require lengthy preparation, the introduction of anesthesia, which means that they give a significant load on the body. Therefore, whenever possible, preference should be given to non-invasive examination methods: hysterosalpingography or hydrosonography. Additionally, a woman must pass a blood and urine test, a smear for microflora.
Complications and consequences of obstruction of the fallopian tubes
Complete obstruction of the fallopian tubes leads to the fact that a woman is not able to conceive a child naturally. With partial patency of the appendages, pregnancy may occur, but the chances of successful fertilization of the egg are significantly reduced. For a woman's life, obstruction of the fallopian tubes does not pose a threat, but this problem becomes the cause of tubal infertility very often.
Another danger that lies in wait for women with obstruction of the fallopian tubes is an ectopic pregnancy. As a result, a woman may lose one or even both appendages.
Pain in the fallopian tubes: what to do?
If, with inflammation of the fallopian tubes, severe painful sensations arise, then it is necessary to use drugs from the NSAID group, including:
- Diclofenac, Dicloberl, etc. They can be produced in the form of injections, or in the form of rectal suppositories.
- You can also take the drug in capsules or tablets. It can be Ketoprofen, Voltaren, Nimesulide, Ibuprofen, Nurofen, Indomethacin, etc.
You can also eliminate pain by taking combination drugs such as Baralgin or Spazmalgon. It is possible to use Paracetamol or Analgin as an anesthetic.
In case of acute inflammation of the fallopian tubes and uterus, you should follow a certain diet and exclude the following foods from your menu:
- Smoked products and sausages;
- Marinades and hot spices;
- Canned food and fast food;
- Mayonnaise, ketchup and mustard;
- Chocolate, confectionery;
- Cocoa and coffee.
If the inflammation is chronic, then it is enough to exclude from your menu only smoked meats, pickles, canned food and ketchup. Dishes are best baked or boiled. Do not fry food more than 2 times a week.
It is important to enrich your menu with foods with sufficient vitamin content. This primarily applies to vegetables and fruits. It is useful to drink freshly pressed juices, fruit drinks with cranberries, rosehip broth, dried fruit compote, green tea. It is imperative that the diet should include foods rich in vitamin C - kiwi, black currant, lemons, oranges, bell peppers, etc.
Methods for restoring patency of the fallopian tubes
There are 4 methods for restoring patency of the fallopian tubes, we will consider them in more detail.
Laparoscopy is a modern method of surgical intervention, which is carried out through a puncture on the anterior abdominal wall. The procedure is performed using special laparoscopic equipment and an endoscope.
With obstruction of the fallopian tubes, laparoscopy is not always performed, but only if the occlusion of the epididymis is diagnosed near the ovary and there is no pronounced adhesion process.
The procedure requires the introduction of general anesthesia. A little inert gas is injected through the navel into the abdominal cavity to lift the peritoneal wall. Gas is supplied through a special thin needle. Then 3 small incisions are made on the living, through which the doctor inserts the instruments into the woman's body. With their help, the doctor pushes and turns the fallopian tubes, excises adhesions and hydrosalpinxes, sutures the incisions, if necessary.
Laparoscopic surgery to restore fallopian tubes can be of the following types:
- Fimbriolysis - the release of the cilia of the tube from the adhesive joints;
- Salpingoanastomosis - removal of the damaged section of the pipe with its subsequent stitching;
- Salpingostomatoplasty is the cutting and formation of the correct anatomical opening in the tube from the side of the ovary;
- Salpingolysis - cutting and removing pathological areas around the fallopian tube, eliminating its kinks and curvatures.
The procedure is performed from the 7th day of the menstrual cycle, but no later than 10th day before ovulation. Although, if the operation needs to be performed in an emergency, the day of the cycle does not matter.
After the procedure, the woman is in the hospital for 3-5 days. The suture heals on average in 10-15 days. The operation is considered effective, gentle and does not damage healthy tissue.
In the event that the surgical intervention is successful, after a few months a woman may try to conceive a child. It is worth remembering that laparoscopy is not the operation of choice for obstruction of the fallopian tubes. If the adhesions are inside the pipe, then it is possible to become pregnant in 10% of cases. When they are located outside of it, the chances of successful conception increase up to 60%.
Fertiloscopy is one of the options for endoscopic surgery using the same hardware set as for laparoscopy. However, unlike laparoscopy, the fallopian tubes are accessed through the posterior vaginal fornix. The procedure can be performed both under local and general anesthesia.
A thin optical system is introduced through the posterior vaginal fornix, which allows a detailed examination of the condition of the pelvic organs. If an obstruction of the fallopian tubes is detected, salpingoscopy is performed on the spot with the same endoscope. At the end of the procedure, the endoscope is removed, and fluid flows freely from the pelvic cavity through the trocar canal. No suturing is required at the insertion site. The procedure takes about 20 minutes.
A contraindication to the procedure is fixed retroflection of the uterus, that is, its posterior curvature.
This method of treating obstruction of the fallopian tubes is outdated, and surgeons are trying to move away from it. It boils down to the introduction into the fallopian tube of an isotonic solution of sodium chloride and a drug mixture under a certain pressure. The therapeutic effect is based on mechanical (rupture of adhesions) and drug effects on the fallopian tubes from the inside. Medicinal substances are used both individually and in combination with each other.
The procedure is performed in the intermenstrual period. To achieve a positive result, 5-6 sessions may be required, which are repeated after 1-2-3 days for 1-5 menstrual cycles.
Hydrotubation is performed both on an outpatient basis and in a hospital. Some experts suggest combining hydrotubation with ultrasound, electrophoresis, diathermy, gynecological massage.
Contraindications to the procedure:
- Acute inflammation of the genitals;
- The presence of any infectious process;
- Severe extragenital diseases.
Find out more: tubal blowing
This method is designed to remove minor adhesions located in the fallopian tube. In addition, adhesions should be in the initial sections of the epididymis.
Procedure: a catheter with a balloon at the end is inserted into the tube through the uterus. The doctor gradually advances the catheter into the epididymis, forcing air into the balloon. As a result, the pipe straightens out and its permeability is normalized. The procedure begins and continues under the continuous supervision of the laparoscopic equipment.
After recanalization, all patients are prescribed antibiotic therapy in a short course of 3-5 days. A course of anti-inflammatory and anti-adhesion treatment is also shown.
Recanalization of the fallopian tubes is not used to eliminate extensive adhesions, since there will be no effect from the operation.
Leeches with obstruction of the fallopian tubes
Hirudotherapy or leech therapy is widely used for obstruction of the fallopian tubes. The saliva of these annelids contains many biologically active substances that help eliminate inflammation, improve blood circulation, and dissolve adhesions.
During a hirudotherapy session, 3-4 leeches are placed on the lower abdomen, in the area where the uterus is located. Sometimes leeches are placed in the vagina. They are left until the moment when they themselves have drunk blood and disappear. The course of treatment consists of 10-15 daily sessions. After two weeks, the course can be repeated.
For the procedure, you should contact a specialist. It is strictly forbidden to independently introduce leeches into the vagina.
Complete obstruction of the fallopian tubes: what to do?
Complete obstruction of the fallopian tubes should be treated if the normal structure of the organ is not too damaged, or when the adhesions are located only outside the appendage, but they are not in its cavity. You can start therapy on the condition that the woman does not have chronic inflammatory processes of the pelvic organs.
It will not be possible to get rid of the obstruction of the fallopian tubes in the following situations:
- There is inflammation of the genitourinary organs.
- Diagnosed with genital tuberculosis.
- The patient is over 35 years old.
- Exacerbations of inflammatory diseases of the reproductive system often occur.
- An impressive hydrosalpinx was discovered.
- Many adhesions are found in the abdominal cavity, which splices organs with each other.
- The adhesions are located inside the fallopian tubes.
It should be understood that even after the restoration of the patency of the fallopian tubes, it is not always possible to solve the problem of infertility. An important condition is the full work of the fallopian tubes so that they are able to move the fertilized egg into the uterus. Otherwise, there is a high risk that the woman will have an ectopic pregnancy. Therefore, doctors warn their patients in advance that the normalization of the patency of the fallopian tubes is not a guarantee that the organs will function correctly and fully.
IVF for obstruction of the fallopian tubes
If a woman is diagnosed with obstruction of the fallopian tubes, then she can undergo an in vitro fertilization procedure. However, first you need to get rid of all chronic inflammation in the organs of the reproductive system, treat all infections, and, if necessary, remove the fallopian tubes. This may be required when the appendages are too deformed, or disrupt the normal position of the uterus, which leads to an increased risk of miscarriage if conception is successful.
Other indications for removing pipes:
- Lack of chances to restore their patency.
- The inability to qualitatively and fully eliminate the inflammatory process.
IVF is a woman's only hope for a successful conception and bearing of a fetus with complete obstruction of the fallopian tubes. Therefore, you should not abandon the procedure.
IVF in 60% of cases allows you to conceive a child (women are up to 35 years old). While operations to eliminate obstruction of the fallopian tubes equate the chances of conception to 40-70% in the initial adhesions and to 15-20% in the advanced stage of the disease. With IVF, the risk of ectopic pregnancy does not exceed 2%, and after surgery it reaches 30%. Whether the conception was successful after in vitro fertilization becomes known already after 14 days. And the effectiveness of the operation can be judged for sure at the end of a whole year.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.