How to check the patency of the fallopian tubes in women?
The passage of the fallopian tubes plays a great role in the process of fertilization.
These anatomical structures extend from the bottom of the uterus and approach the gates of the ovary. For fallopian tubes, peristalsis is characteristic, which is directed towards the uterus.
This allows you to move the egg, released after ovulation in the abdominal cavity, toward the uterus. It is in the fallopian tube that its subsequent meeting with the spermatozoon takes place, that is, fertilization. Therefore, if the patency of the pipes is violated, the fertile function of the woman is also violated. In this material, we will consider how to check the patency of the fallopian tubes, and how to prepare for it.
Fallopian tubes extend to the left and right of the uterus. They consist of several departments, while the ovaries are subject to the fimbrial department. Its structure facilitates the capture of an ovum that leaves the ovary in the middle of the menstrual cycle.
Then the egg moves along the fallopian tube. When a sperm enters the female genital tract, the probability of fertilization increases. However, if the enzymatic activity of the fetal egg is increased, it can not be implanted in the uterus, where it should fall, but in the tube with the development of an ectopic pregnancy.
The latter is usually interrupted for a period of 7-8 weeks, since in the fallopian tube there are no conditions for the normal development of pregnancy. Thus, patency of the fallopian tubes is a key factor in the onset of pregnancy. Otherwise, tubal peritoneal infertility develops, which after the endocrine( anovulatory) takes the second place in the overall structure.
The main causes of obstruction of the fallopian tubes are the following:
The earlier it is diagnosed( at early stages before the development of its spontaneous interruption), the higher the likelihood of organ-saving treatment. With a large fetal egg or with intra-abdominal bleeding, against the background of this pathology, a tube is already being removed to save the woman's life.
Obstruction of the fallopian tubes can be either one-sided or two-sided. In the latter, the chances of pregnancy are severely limited, which is an indication for the use of assisted reproductive technologies.
To assess the patency of the fallopian tubes is necessary when a thorough examination of a woman is performed if it is impossible to conceive.
The standard program for examining a barren couple includes:
Checking the patency of the fallopian tubes with laparoscopy is a medical diagnostic procedure. To conduct it, special equipment is inserted through three holes in the anterior abdominal wall, previously creating a pneumoperitoneum( introduction of gas into the abdominal cavity).
The image is obtained on the screen with a large magnification, which allows you to accurately assess the status of the uterus and appendages and conduct appropriate therapeutic manipulations. However, due to invasiveness, laparoscopy is performed as the last diagnostic study.
Operative intervention is performed under anesthesia. Most commonly, general anesthesia with unconsciousness is indicated. The use of spinal anesthesia for this purpose is limited, since the gas introduced into the abdominal cavity disrupts the respiratory function.
Therefore, before laparoscopy, it is necessary to assess the degree of anesthesia risk. And if it is high, then as the first stage of treatment, you can use pertubation, that is, the introduction of gas into the fallopian tubes, which will restore a minor violation of their patency.
Checking the patency of the fallopian tubes by hysterosalpingography is an x-ray study of the evaluation of the uterus and fallopian tubes. For its carrying out, the introduction of X-ray contrast substance into the uterine cavity is required. For this, the cervix of the uterus should be fixed with bullet forceps, which is accompanied by certain pain sensations.
In addition, another drawback of this study is the ingress of X-ray contrast material into the abdominal cavity with the subsequent development of adhesive process. Also after the study, there is a pain syndrome of varying severity, which is self-terminated within a few days. It is associated with the presence of contrast in the fallopian tubes, increasing the pressure in them. Therefore, hysterosalpingography is replaced by a more perfect ultrasound method, devoid of these drawbacks.
However, when performing hysterosalpingography, there is one advantage - obtaining radiographic images that exclude a subjective evaluation of the diagnostician. This makes it possible to evaluate the results of the ongoing treatment in dynamics by comparing the pictures with each other. But because of the radiation load, too frequent re-conducting hysterosalpingography is not recommended.
Interpretation of the results is based on the following principles:
Echistosterosalpingography is a modern method for diagnosing the state of fallopian tubes. The essence of the method is as follows:
Its main advantages are:
Timely diagnosis of this condition at an early stage( before the development of gross cicatricial changes) will allow for effective treatment and will give the woman a chance to become pregnant.
These anatomical structures extend from the bottom of the uterus and approach the gates of the ovary. For fallopian tubes, peristalsis is characteristic, which is directed towards the uterus.
This allows you to move the egg, released after ovulation in the abdominal cavity, toward the uterus. It is in the fallopian tube that its subsequent meeting with the spermatozoon takes place, that is, fertilization. Therefore, if the patency of the pipes is violated, the fertile function of the woman is also violated. In this material, we will consider how to check the patency of the fallopian tubes, and how to prepare for it.
Fallopian tubes and their patency
Fallopian tubes extend to the left and right of the uterus. They consist of several departments, while the ovaries are subject to the fimbrial department. Its structure facilitates the capture of an ovum that leaves the ovary in the middle of the menstrual cycle.
Then the egg moves along the fallopian tube. When a sperm enters the female genital tract, the probability of fertilization increases. However, if the enzymatic activity of the fetal egg is increased, it can not be implanted in the uterus, where it should fall, but in the tube with the development of an ectopic pregnancy.
The latter is usually interrupted for a period of 7-8 weeks, since in the fallopian tube there are no conditions for the normal development of pregnancy. Thus, patency of the fallopian tubes is a key factor in the onset of pregnancy. Otherwise, tubal peritoneal infertility develops, which after the endocrine( anovulatory) takes the second place in the overall structure.
Causes of obstruction of the fallopian tubes
The main causes of obstruction of the fallopian tubes are the following:
- inflammatory processes( salpingo-oophoritis)
- adhesive process after surgery on the pelvic organs
- congenital underdevelopment of the fallopian tubes
- treatment of ectopic pregnancy.
The earlier it is diagnosed( at early stages before the development of its spontaneous interruption), the higher the likelihood of organ-saving treatment. With a large fetal egg or with intra-abdominal bleeding, against the background of this pathology, a tube is already being removed to save the woman's life.
Obstruction of the fallopian tubes can be either one-sided or two-sided. In the latter, the chances of pregnancy are severely limited, which is an indication for the use of assisted reproductive technologies.
Methods for assessing the passableness of the fallopian tubes
To assess the patency of the fallopian tubes is necessary when a thorough examination of a woman is performed if it is impossible to conceive.
The standard program for examining a barren couple includes:
- 1) Evaluation of ovulation( performed either by ultrasound in dynamics or hormonal study)
- 2) Evaluation of tubal permeability by various methods
- 3) Spermogram - examination of cellular and qualitative sperm composition in compliance with allrules of its collection( sexual abstinence for 2 days, fast transportation to the laboratory, use of a special container, etc.).
- hysterosalpingography - X-ray study
- echistosterosalpingography - ultrasound
- laparoscopy as the last stage that can also pursue a therapeutic goal( restoring the patency of pipes).
Laparoscopy
Checking the patency of the fallopian tubes with laparoscopy is a medical diagnostic procedure. To conduct it, special equipment is inserted through three holes in the anterior abdominal wall, previously creating a pneumoperitoneum( introduction of gas into the abdominal cavity).
The image is obtained on the screen with a large magnification, which allows you to accurately assess the status of the uterus and appendages and conduct appropriate therapeutic manipulations. However, due to invasiveness, laparoscopy is performed as the last diagnostic study.
Operative intervention is performed under anesthesia. Most commonly, general anesthesia with unconsciousness is indicated. The use of spinal anesthesia for this purpose is limited, since the gas introduced into the abdominal cavity disrupts the respiratory function.
Therefore, before laparoscopy, it is necessary to assess the degree of anesthesia risk. And if it is high, then as the first stage of treatment, you can use pertubation, that is, the introduction of gas into the fallopian tubes, which will restore a minor violation of their patency.
Hysterosalpingography
Checking the patency of the fallopian tubes by hysterosalpingography is an x-ray study of the evaluation of the uterus and fallopian tubes. For its carrying out, the introduction of X-ray contrast substance into the uterine cavity is required. For this, the cervix of the uterus should be fixed with bullet forceps, which is accompanied by certain pain sensations.
In addition, another drawback of this study is the ingress of X-ray contrast material into the abdominal cavity with the subsequent development of adhesive process. Also after the study, there is a pain syndrome of varying severity, which is self-terminated within a few days. It is associated with the presence of contrast in the fallopian tubes, increasing the pressure in them. Therefore, hysterosalpingography is replaced by a more perfect ultrasound method, devoid of these drawbacks.
However, when performing hysterosalpingography, there is one advantage - obtaining radiographic images that exclude a subjective evaluation of the diagnostician. This makes it possible to evaluate the results of the ongoing treatment in dynamics by comparing the pictures with each other. But because of the radiation load, too frequent re-conducting hysterosalpingography is not recommended.
Interpretation of the results is based on the following principles:
- Is there a deformation of the uterine cavity and what is its condition
- whether there is a contrast in the abdominal cavity or not
- visualization of the fallopian tubes, while their ampoule enlargement with absence of contrast in the small pelvis can be determinedobstruction).
Echistosterosalpingography( US)
Echistosterosalpingography is a modern method for diagnosing the state of fallopian tubes. The essence of the method is as follows:
- the introduction of physiological solution into the uterine cavity through a special catheter
- an evaluation of its condition, since the fluid is a good acoustic environment
- an estimate of the time of fluid entering the abdominal cavity.
Its main advantages are:
- 1) Absence of reflex spasm of the fallopian tubes, which can lead to false positive results related to obstruction of the fallopian tubes. This is due to the fact that there is no moment of fixing the cervix by means of bullet forceps to introduce the solution into the uterine cavity.
- 2) Practically complete painlessness of procedure
- 3) Possibility of carrying out of research in dynamics as there is no radial load as at X-ray examination.
Timely diagnosis of this condition at an early stage( before the development of gross cicatricial changes) will allow for effective treatment and will give the woman a chance to become pregnant.