In the case when in female body there are functional or structural abnormalities fallopian tubes, doctors talk about tubo-peritoneal. There are a lot of reasons for this. If you see a doctor in time and start treatment, your chances of conceiving healthy child Most infertile couples have it.

Tubal-peritoneal is diagnosed in 40% of couples facing the problem of conception.

What is tubo-peritoneal factor of infertility?

Tubal-peritoneal infertility is obstruction of the fallopian tubes. This disease causes difficulties in conceiving. It is difficult for the egg to penetrate the uterus, where it meets the male sperm.

Tubal-peritoneal occurs often, the reason for this is previous or untreated infectious diseases. They occur in organs located near the fallopian tubes.

Forms and varieties

There are several forms of infertility: tubal and peritoneal. Often these concepts are replaced. In the first case, when the tubes are obstructed, the woman will not always experience difficulty conceiving. Often the fallopian tube has severe inflammation, which in turn causes obstruction. Peritoneal factor means that there are adhesions between the reproductive organs.

Reasons for education

Most diseases of the reproductive system, namely sexually transmitted diseases, are initial stage. However, they often become the cause of tubo-peritoneal infertility.

A common cause of infertility is intrauterine manipulation. Artificial termination of pregnancy, curettage of the uterine cavity, and hydrotubation of the fallopian tubes have a negative impact. Inflammation of the fallopian tubes and ovaries also provokes the development of pathology.

Diagnostics

To diagnose the disease, laboratory and instrumental studies are performed:

• hysterosalpingography;
• hydrosalpingoscopy;
• kymographic hydrotubation;
• phalloscopy;

When determining the causes of infertility, it becomes necessary to take blood tests for hormones: LH (luteinizing hormone), FSH (follicle-stimulating hormone), prolactin, testosterone.

Hysterosalpingography

If non-tuboperitoneal infertility is suspected, hysterosalpingography is prescribed. It is performed for the sole purpose of checking the patency of the pipes.

They also determine whether there are malformations of the uterus, endometrial polyps, or intrauterine synechiae.

The result of the procedure will allow you to evaluate the presence or signs of adhesions. When they fix intrauterine pathology, hysteroscopy is prescribed. If adhesions are detected, laparoscopy is performed.

Kymographic hydrotubation

Kymographic hydrotubation is a method during which the doctor determines the patency of the fallopian tubes by inserting into the lumen medicines, as a rule, novocaine, hydrocortisone, etc.

Laparoscopy with chromopertubation

Laparoscopy with chromopertubation is performed to determine the patency of the fallopian tube by introducing the device through an incision in the anterior abdominal wall. The procedure is performed in a hospital under general anesthesia.

Echo GSS, UZGSS

When the doctor has reason to believe that the cause of female infertility is the presence of tumors, he prescribes a GSS echo (echography).

Allows you to avoid surgery if performed in different phases cycle to observe the cysts over time.

To make the picture clear, the gynecologist performs ultrasound examination. Using ultrasound, you can determine uterine pathologies: the presence of synechiae, fibroids, endometritis.

Laboratory diagnostics

If a woman is undergoing an examination to determine the cause of tubo-peritoneal infertility, it is necessary to start with tests for infectious diseases, since they are the most common. IN laboratory conditions It is necessary to conduct examinations of the uterus and appendages, and the patient’s sexual partner is also sent for examination. Often, this issue requires consultation with a gynecologist, endocrinologist and reproductive specialist.

Infertility of the 2nd tubal-peritoneal origin: what to do?

The fallopian tubes perform one of the essential functions in the process of conceiving a child. This is where the sperm meets the egg.

If there are violations, the long-awaited “meeting” does not occur. A woman is diagnosed with tubal infertility. If there are adhesions in the pelvic organs, the disease is called peritoneal. There are cases when these two diagnoses are combined.

The causes of pathology include:

• hormonal imbalances;
• stress;
• diseases of the pelvic organs;
• to the pelvic organs;
• presence of infections;
• endometriosis.

Treatment

Treatment involves taking medications; the gynecologist prescribes antispasmodics and anti-inflammatory drugs. The choice of pills depends on the cause of infertility.

You cannot take medications on your own. The girl should follow all the doctors’ instructions, in particular, undergo the necessary examination and tests. At severe forms pathology, surgical intervention is prescribed.

Treatment methods

With this diagnosis it is prescribed antibacterial drugs. This happens when the cause of infertility is inflammation of the appendages, which caused damage to the tube.

If, the gynecologist also prescribes pills that have a positive effect on the immune system. In this case, physiotherapy will have a beneficial effect.

The desire to become pregnant does not always come true without any problems. Diagnosis tubal infertility"have about 30% of women who cannot conceive a child. This complication usually occurs as a result of obstruction of the fallopian tubes. However, there are quite a few cases where, after treatment of tubal infertility, women have a chance to become a mother.

What is hidden behind the diagnosis of Infertility?

Female infertility is the inability of a woman of childbearing age to produce offspring. There are two degrees of infertility:

• 1st degree - pregnancy has never occurred;
• 2nd degree of infertility - there was a history of pregnancy.

There are also absolute and relative infertility: the first is caused by irreversible abnormalities in the development of the female reproductive system, the second can be corrected during treatment. Tubal infertility is considered relative.

Tubal infertility occurs due to the appearance of adhesions or fluid in the fallopian tubes, which prevent the mature egg from passing into the uterus and interfere with the meeting with the sperm, and, accordingly, the conception itself.

There are partial and complete obstruction of the pipes. If only one of the two fallopian tubes is obstructed or the lumen is not completely blocked, then pregnancy is possible.

With a diagnosis of “incomplete obstruction,” the possibility of getting pregnant still exists, but for women with such diagnoses, gynecologists usually prescribe special drugs to stimulate ovulation.

What are the causes of the disease?

There are known cases when obstruction of the fallopian tubes is caused by congenital pathologies development of the uterus, tubes and appendages. In addition, there are many reasons that can provoke tubal infertility in initially healthy woman. In first place among the reasons are inflammatory diseases female reproductive system. A history of sexually transmitted infections, the presence of fibroids, surgical interventions, abortions, the formation of adhesions in the pelvic organs. Endometriosis is another of the most common causes of tubal infertility.

There are cases when this disease is not associated with the above factors, but is caused by disorders hormonal levels or metabolic process in the body.

In cases where the fallopian tubes are completely passable, but in some areas there are narrowings that impair functionality or the tubes are partially obstructed, this should not be ignored; such violations can be no less dangerous and can become. Read more about ectopic pregnancy

Often, a woman may not even realize that she is suffering from obstruction of the fallopian tubes; in principle, there are no signs of the disease; it can only be detected through diagnostics. You should be concerned if you are periodically disturbed nagging pain in the lower abdomen - this may be a symptom of tubal obstruction and, therefore, a symptom of tubal infertility.

How is obstruction diagnosed?

Currently, there are several methods for diagnosing tubal infertility, which help determine how obstructed the fallopian tubes are. It is worth noting that diagnosis should be carried out only in the complete absence of inflammation and infections in the genital area.

The most accessible and accurate method is considered diagnostics of CHT (kymographic hydrotubation). The fallopian tubes are purged using a special apparatus that has an air reservoir, which allows the volume of air introduced to be determined.

The kymograph allows you to note changes in pressure in the tubes and uterus; based on the resulting curve, the doctor makes a conclusion about the degree of patency of the tubes. This research method allows not only to determine the condition of the fallopian tubes, but also is therapeutic method, providing healing effect Thus, it turns out that the woman receives double benefits.

The next research method we will consider is hysterosalpingography . Diagnostics using this method allows you to find out which particular pipe is impassable and where the adhesions are concentrated.

During this procedure, a special substance is injected into the uterus, and then pictures are taken. The first picture is taken immediately, the next one after 10 minutes, and the final one after 24 hours from the moment of administration of the substance. Based on the results of the images, the doctor makes a conclusion about the condition of the fallopian tubes and uterus.

Note that hysterosalpingography can cause an exacerbation of the inflammatory process in the uterine cavity and tubes, which in turn can lead to rupture of the fallopian tube. That is why, before deciding on a research method, you should consult a gynecologist and find out about alternative ways diagnostics

It is also worth considering that women with diagnosed infertility are not recommended to undergo X-rays more than 2 times a year.

Female infertility of tubal origin can be diagnosed using bicontrast gynecography , which allows us to identify adhesions that are located around the ovaries and fallopian tubes. The study is recommended to be carried out in the second half of the cycle, however, it is strictly contraindicated for women suffering from heart disease, hypertension, and tuberculosis.

This diagnosis cannot be carried out in case of inflammation of the genital organs or uterine bleeding. This method makes it possible to quite accurately determine the functions that pipes are capable of performing, and is also indispensable for determining the breadth of the adhesion process.

Another method for identifying pathologies is laparoscopy . This study examines tissues that are involved in the inflammatory process. This diagnostic method is widely used in preparing women for surgery to restore tubal patency.

So, as can be seen from the above, a sufficient number of methods are currently used in medicine to detect obstruction of the fallopian tubes and diagnose tubal infertility. But it is worth remembering that it is better to consult with your gynecologist in advance about the diagnostic method, who will help you choose the most suitable option for your case.

Is infertility caused by tubal factor treatable?

Despite the fact that tubal infertility is considered one of the most difficult forms, there are ways to combat this disease.

First of all, women who are diagnosed with suspected infertility are examined for the presence of infections, and if detected, anti-inflammatory treatment is prescribed. Of course, such therapy is not able to cope with the problem of infertility, but it is necessary before intrauterine interventions: diagnosis and treatment of tubal obstruction.

Anti-inflammatory treatment helps fight infection, but it is recommended to eliminate the consequences of inflammation with the help of physiotherapy, which can restore nervous reactions in tissues, soften and even remove adhesions.

Blowing out the fallopian tubes (hydrotubation) is another step in the treatment of tubal infertility. But it's worth remembering that this procedure, carried out repeatedly, can cause rupture of the fallopian tube, so it is carried out strictly according to indications and under the supervision of the attending physician.

Most effective method treatment of tubal infertility is considered operative laparoscopy , this method is used to cut adhesions that have caused pipe obstruction. The method has significantly more advantages than abdominal operations: after the intervention, the woman quickly recovers and returns to her normal life, the risk to health is minimal, and relapses adhesive disease practically doesn't happen.

Note that surgical laparoscopy may be useless in some cases.

Quite often there are situations when, after treatment and restoration of tubal patency, a woman still cannot become pregnant. This happens when there is no peristalsis or microvilli in the pipes - such pipes are called dead.

What to do if, after treatment for tubal infertility, the desired pregnancy does not occur?

Alternative methods of pregnancy

If two years or more have passed after treatment, and pregnancy has not occurred, then you should contact a specialist and find another way to solve the problem. Tubal infertility is an indication for IVF.

This procedure begins with tracking menstrual cycle, then ovulation is stimulated. The maturation of the egg is carefully monitored in order to extract it in time.

The most important stage is the stage of fertilization of the egg and the development of embryos. If everything went well at this stage, the embryo is placed in the uterus, where the baby continues to grow and develop. The woman is prescribed certain medications that help support the body.

To summarize all of the above, I would like to especially note that one of the most important factors during the treatment of tubal infertility is psychological factor. Only a positive attitude and your confidence will help you cope with the problem. Follow the doctor's instructions and be sure to believe in the success of the treatment!

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Female infertility has many causes and a variety of classifications depending on them. Tubal-peritoneal infertility is common. Although this type of pathology is common, it is quite curable in most cases. Timely therapy helps restore the ability to have children, but it is important to start treatment early. Since this pathology tends to progress, and late stages may be difficult to treat with medications.

Definition

Infertility is the inability to become pregnant in the presence of constant intimate life without means of protection. Tubal infertility refers to a condition where pregnancy does not occur because the egg is not able to pass through the fallopian tube into the uterus, where it should unite with the sperm. That is, the cause of tubal infertility lies in the physical obstruction of the fallopian tubes.

Peritoneal infertility is a different condition. With it, fibrous tissue is actively formed on the peritoneum. This tissue creates a barrier for the egg, which needs to get into the fallopian tube, since it is precisely before entering its canal that the maximum of this tissue is observed. That is, this type is not directly related to the tubes themselves, but to the impossibility of the egg getting into them.

Tubal-peritoneal infertility is a term used to describe a condition where fertilization does not occur because the egg cannot enter the uterine cavity through the fallopian tube, regardless of why this situation occurs.

Occurrence

This type of infertility is one of the most common. It accounts for more than half of all cases of impossibility of pregnancy due to pathology on the part of the woman. Some researchers claim that this figure is even higher - 60% of all infertile women suffer from this particular pathology.

Classification

The condition has a fairly diverse classification depending on the reasons for which it developed and how it proceeds. At the same time, several types of tubal infertility are distinguished separately.

Pipe factor

It is this factor that has the greatest influence on the development of infertility. Tubal obstruction much more common than overgrowth connective tissue. In this case, functional tubal infertility and infertility according to organic type.

• Functional is diagnosed when there are no physical changes or pathologies in the structure of the pipe itself. That is, it is completely passable and can normally conduct the egg. But this doesn't happen in mind functional disorders, such as hypertonicity, when as a result of contraction the canal closes and the egg does not pass through. Discoordination also occurs; with this pathology, different parts of the tube contract with different intensities and at different rates, which interferes with normal passage into the uterine cavity. Less common is hypotonicity - a condition in which contractions are so sluggish that the egg is not “pulled” into the canal, as it normally does;
• Organic type. This type of infertility is much more difficult to cure; it is associated with the fact that there are physical changes in the structure, which impede passage, significantly reducing the lumen of the canal. This occurs when the mucous membranes swell during the inflammatory process, as well as in the presence of adhesions formed during surgery or also as a result of the inflammatory process.

Tubal dysfunction is relatively easy to treat. The condition of organic tubal infertility often requires surgical intervention.

Peritoneal

Peritoneal factor of infertility occurs when there is adhesive process, which caused the formation large quantity fibrous tissues, that is, adhesions. This process develops as a result of inflammation that occurs during microbial infection in a sterile environment internal organs. Sometimes they can also form during surgery, if the patient has a certain tendency to form scars. This type of infertility has no internal classification.

Reasons

Why is this pathological process takes place? It develops as a result of the following reasons:

• Inflammatory processes that cause swelling of the mucous membrane, reducing patency pipe channel, lead to the formation of adhesions, both in the pipes and near the entrance to them. Such processes are caused by microbes, less commonly viruses and fungi. Typically, such an infection enters the body sexually, so the predisposing factor is frequent change sexual partners in the absence barrier contraception;
• Consequences of surgery, such as scars and, again, adhesions. They appear when the patient is prone to this, and also when the sanitation of the operating pit (the cavity in which the manipulations were carried out) was poorly carried out. It is also possible with frequent abortions, childbirth, miscarriages, diagnostic curettages, certain diagnostic methods (for example, laparoscopy), etc.;
• Sometimes this phenomenon develops as a complication after childbirth or surgery (without connection with adhesions);
• Functional problems develop when there is hormonal imbalance, when there is a violation of the level of those hormones that are responsible for the contraction of the canal. The reasons for the development of pathology are increased level male hormones, stress, problems with the adrenal glands, etc.;
• Peritoneal factor appears during inflammatory processes in the pelvic area.

Therapy of pathology in mandatory must take into account the reasons that caused it.

Symptoms

Strictly speaking, the main symptom of infertility is the inability to become pregnant. At the same time, inability as such is spoken of in cases where pregnancy does not occur within two years or more of regular sexual activity, including during the period of ovulation, without the use of contraception. Although this type of infertility can also manifest itself with other symptoms, such as:

1. Nagging pain in the lower abdomen, indicating adhesions;
2. Menstrual irregularities, indicating hormonal imbalance;
3. Heavy periods;
4. Pain during sexual intercourse.

Tubal infertility may not manifest itself in any way. Therefore, even in the absence of symptoms, but when pregnancy does not occur, it is necessary to consult a doctor.

Complications

The complication in this case is the actual inability to have children. While initially such infertility may be of a relative nature, that is, only reduce the likelihood of pregnancy, and not eliminate it completely, over time it can become absolute, that is, it will be impossible to get pregnant.

In addition, in the early stages, such pathology is often quite successfully curable. Whereas as it develops, the probability of a favorable prognosis and complete cure decreases. In addition, unpleasant symptoms may become very pronounced, which will cause significant discomfort.

Diagnostics

IN diagnostic purposes the following methods are used:

1. Hysterospalpingography – X-ray examination organ with contrast agent;
2. Hydrosalpingoscopy - ultrasound with filling of the appendages with water;
3. Kymographic pertubation - introduction of gases to determine the contractile activity of the tubes;
4. Falloscopy – visualization of the appendages.

As additional method Laparoscopy and blood tests for hormone levels are used.

Treatment

It depends on the type of infertility and can be surgical or medicinal.

Medication

Effective for functional infertility. Used hormonal drugs to restore hormone levels, as well as anti-inflammatory and antispasmodics. Sometimes sessions with a psychotherapist and physical therapy are indicated various methods(massage, hydrotherapy, ultrasound, balneotherapy, etc.). Sometimes it is necessary to treat the current inflammatory process with the help of antibiotics, in chronic conditions, drugs are prescribed to enhance immunity.

Surgical

It is carried out mainly in case of peritoneal factor and organic tubal obstruction. The following types of interventions are used:

1. Salpingolysis – cutting of adhesions;
2. Salpingostomy - making a hole in the site of overgrowth;
3. Removal of an impassable area with further connection of the ends of passable parts;
4. Restoration of the entrance to the tube with removal of excess fibrous tissue.

The method is quite effective, but the likelihood of pregnancy will still be reduced by 25-50%.

Tubal-peritoneal infertility is a very common reason absence of pregnancy. The problem is that adhesions in the tubes block the passage for sperm and eggs, making their meeting impossible, as well as conception. Why does this pathology occur, are there preventative measures and what is the treatment?

Let's start with what causes of tubal-peritoneal infertility are most likely. These are surgical interventions (for example, during an ectopic pregnancy to remove the fertilized egg or non-gynecological - removal of appendicitis), inflammatory diseases provoked by sexually transmitted infections in most cases, endometriosis.

Since tubal infertility is very common, women from a young age should learn about its prevention. First of all, this is a visit to the gynecologist at least once a year, as well as in case of ailments. Moreover, this applies not only to women who are sexually active. Point two is the absence of promiscuous sex life, the use of barrier contraception. Firstly, it is the prevention of abortion - one of the most common causes of female infertility, and secondly, the prevention of infection venereal diseases And hidden infections. Chlamydia, which is so widespread now, is very dangerous infection for women planning pregnancy in the future.

What symptoms of tubo-peritoneal infertility can a woman notice? Often none, if the inflammatory process is already in chronic stage. There may be periodic pain from the damaged fallopian tube. But such patients often turn to a doctor because they are unable to get pregnant. Sex life without contraception, regular, as a result of which it is not possible to conceive a child for 1-2 years - this is the main sign of infertility. And if male factor Infertility and female endocrine disorders are excluded, the doctor may suspect problems with the fallopian tubes.

Women under 35 years of age can undergo a laparoscopy procedure as a diagnosis and at the same time treatment of pathology. If the adhesive process is not widespread, tubo-peritoneal infertility in women should be treated laparoscopically, which gives a very good results.

In addition to surgery, it is also practiced conservative treatment infertility. This includes physiotherapy, anti-inflammatory therapy, gynecological irrigation, mud wraps, as well as non-traditional ones - for example, hirudotherapy. But the effectiveness of these types of treatment is in great doubt... It is better not to waste time on unconventional and ineffective methods of treatment, but to immediately contact a competent gynecologist.

Complete or partial obstruction of the tubes leads to a pathology called tubal infertility. Another type of infertility associated with obstruction is known as peritoneal. In this case, an obstacle in the form of adhesions is located between the ovary and the tube. In the presence of both pathologies at once, tubo-peritoneal infertility is diagnosed, when adhesions in the ovary are combined with obstruction inside the fallopian tubes.

Causes of tubo-peritoneal infertility

Splices formed from connective tissues change not only the anatomical, but also functional state internal genital organs. Because of this, the mechanisms of ovulation, perception and transportation of the egg are disrupted. A chronic pain syndrome, dysmenorrhea and dyspareunia occur, the functions of the intestines and urinary system are disrupted. One of these pathologies is a complete or partial obstruction of the patency of the tubes, the formation of adhesions in the ovaries, which ultimately leads to tubo-peritoneal infertility.

Main causes of pathology:

Forms of tubo-peritoneal infertility

The main forms of tubo-peritoneal infertility are considered the following types of this pathology:

• Tubal infertility associated with anatomical or functional obstruction of the fallopian tubes, or their complete absence.
• Peritoneal infertility caused by the formation of adhesions in the ovarian area.
• Functional pathology of the fallopian tubes, in which disturbances in the functioning of muscle tissue manifest themselves in the form of hypertonicity or hypotonicity. At the same time, any mechanical damage are missing.
• The main form is tubal infertility, which manifests itself in the form of dysfunction of the tubes or their organic damage. With functional disorders, the contractile activity of the fallopian tubes is disrupted. Organic lesions characterized by the presence of obstruction, adhesions and other anomalies. The development of the peritoneal form occurs under the influence of inflammation of the genital organs, the consequences of operations on the genitals, abdominal cavity and pelvic organs.

Symptoms of tubo-peritoneal infertility

The main symptom of this pathology is the inability to become pregnant for a long time. This symptom fully applies to other types of infertility. Distinctive feature the form under consideration is considered to have a history of tubal or ectopic pregnancies. In some cases, pain is felt in the lower abdomen and the regularity of the menstrual cycle is disrupted.

Diagnostics

Diagnosis of tubal-peritoneal infertility begins with collecting anamnesis in order to accurately determine the causes of the pathology. Risk factors such as previous abortions and surgical operations, availability gynecological diseases and sexually transmitted diseases, ectopic pregnancies and diagnostic curettage. The features and nature of the menstrual cycle are carefully clarified.

The next stage of diagnosis is classic gynecological examination. By palpation of the uterus, ovaries and other reproductive organs their anatomical features which may prevent you from getting pregnant. Negative sensations during vaginal examination indicate possible inflammation and damage to the genital organs.

Analysis is ordered by microscopic examination smear The biological material presented for study makes it possible to detect infectious agents. In addition, the method is used bacteriological culture, When vaginal discharge placed in a special environment favorable to harmful microorganisms. Then, as the colonies grow, their characteristics are studied.

Using classical ultrasound, visual examination of the fallopian tubes is not possible. Therefore, adhesions and other pathologies are detected using hydrosonography. For this purpose, a special sterile solution is poured into the uterine cavity. It moves inside the fallopian tubes and allows you to clearly see the obstructed areas. This method is considered the most effective and safe, allowing you to completely eliminate X-ray radiation during examination.

X-rays are still used in hysterosalpingography, when the fallopian tubes are examined for obstruction and the presence of adhesions. A visual assessment of the reproductive organs can be obtained by diagnostic laparoscopy. IN abdominal cavity A thin endoscope is inserted, displaying the obtained data on the monitor screen.

Treatment of tubo-peritoneal infertility

Methods of conservative drug therapy are not effective enough in treating the disease; they eliminate only etiotropic factors - infectious pathogens, inflammation and other similar processes.

The most rational way to eliminate adhesions, which shows good results, is surgical intervention. Surgical procedures can be performed in several ways:

• Method of therapeutic laparoscopy. In this case, during the dissection of adhesions, direct visual control is carried out using optical device inserted through small holes into the abdominal cavity. To directly restore patency, classical surgery is used, as well as electrical or laser destruction.
• With the help of fibrimolysis, the funnels of the tubes are surgically restored.
• Salpingostomy is used in cases of complete absence holes in pipes for the purpose of artificially creating it.

As a complement to surgical intervention Physiotherapeutic methods are used, with the help of medicinal electrophoresis, gynecological massage and irrigation, ultraphonophoresis of the pelvic organs, electrical stimulation of the uterus.

If the listed methods are ineffective, it is recommended to use auxiliary reproductive technologies, including in vitro fertilization.

Prevention

Preventive measures have not only medical, but also socio-economic importance. In order to prevent tubo-peritoneal infertility, it is necessary to prevent and promptly treat diseases that provoke the occurrence and development of this pathology. This work should be carried out not only by gynecologists, but also by venereologists, psycho-neuropathologists and other necessary specialists.