Pipe-peritoneal infertility

Tubal infertility in women - infertility, caused by anatomical and functional disorders of the fallopian tubes due to diseases, injuries, scars, congenital malformations or other factors that interfere with the movement of a fertilized or unfertilized ovule into the uterus through the fallopian tubes.

[1], [2], [3], [4], [5], [6], [7]

Epidemiology

Pipe-peritoneal infertility in women occupies a leading place in the structure of infertile marriage and is the most difficult pathology in restoring reproductive function. The frequency of tubal peritoneal forms of infertility ranges from 35 to 60%. The prevalence of tubal factor (35-40%), and the peritoneal form of infertility is found in 9.2-34% of cases.

[8], [9], [10], [11], [12], [13]

Symptoms of the tubal peritoneal infertility

The main complaints in patients are the absence of pregnancy with a regular sexual life without protection. With a pronounced adhesion process in the small pelvis, endometriosis and chronic inflammatory process, there may be complaints about periodic pains in the lower abdomen, dysmenorrhea, impaired bowel function, dyspareunia.

Forms

It is accepted to distinguish 2 basic forms of tubal peritoneal infertility:

• violation of the function of the fallopian tubes - violation of the contractile activity of the fallopian tubes: hypertonus, hypotension, discoordination;
• organic lesions of the fallopian tubes - obstruction, adhesions, sterilization, etc.

[14], [15], [16], [17]

Diagnostics of the tubal peritoneal infertility

• Ultrasound of the pelvic organs allows to detect hydrosalpinks of large sizes.
• Hysterosalpingography allows to reveal the pathology of the uterine cavity (endometrial polyps, endometrial hyperplasia, intrauterine synechiae, malformations, submucous myoma), characterize the endosalpinx state (folding, hydrosalpinks, adhesions, including in the ampullar department), suggest the presence of peritubar adhesions and the nature of their distribution. In the absence of hydrosalpinks of large sizes, the reliability of the results is 60-80%.
• Laparoscopy provides an accurate assessment of the pelvic organs, the condition and patency of the fallopian tubes, the degree of spreading of the adhesion process in the small pelvis, reveals the pathology of the pelvic organs (external genital endometriosis).

[18], [19], [20]

Treatment of the tubal peritoneal infertility

Treatment begins after the exclusion of the inflammatory process of a specific etiology - tuberculosis of the genitals.

The first stage : correction of pathological changes in the pelvic organs during operative laparoscopy and hysteroscopy.

The second stage : early recovery treatment - from 1-2 days after endoscopic surgery. Duration of treatment is 3-10 days. Apply medicamentous and non-medicinal methods of treatment.

Medication

• Antibacterial therapy (begin with intraoperative administration of broad-spectrum antibiotics). Perioperative antibacterial prophylaxis consists in the introduction of a single therapeutic dose of broad-spectrum antibiotics intravenously during the operation and in the early postoperative period. Antibiotic prophylaxis reduces the risk of postoperative infectious complications by an average of 10-30%. The choice of antibiotics depends on the volume of surgical intervention and the risk of postoperative infectious complications. An adverse effect on the outcome of an operative intervention is provided by:
  • presence of chronic foci of infection (cervical erosion, chronic endometritis and salpingoophoritis, sexually transmitted infections);
  • prolonged and traumatic intervention, large blood loss.

The need to continue antibiotic therapy depends on the factors listed above, as well as the clinical picture and the indices of laboratory methods of investigation.

• Infusion therapy (use solutions of colloids and crystalloids). 

Non-drug treatment

• Physiotherapy.
• Efferent methods of treatment - plasmapheresis, endovascular laser irradiation of blood, ozonotherapy of blood.

The third stage. Delayed restorative treatment: according to indications, non-drug and hormone therapy is administered.

Medication

• Combined estrogen-progestational oral contraceptives, gestagens, GnRH agonists.

Non-drug treatment

• Physiotherapy: the procedure and the number of procedures are selected individually.
• Efferent methods of treatment.

The fourth stage : in patients with adhesive process in a small pelvis of III-IV degree according to the Hulka classification, control hysterosalpingography is performed. When confirming patency of the fallopian tubes, patients are allowed to have sex without protection on the background of ultrasonic monitoring of folliculogenesis.

The fifth stage : in the absence of a positive effect of the treatment and the continued violation of patency of the fallopian tubes, the detection of anovulation is recommended to use ovulation inductors or methods of assisted reproduction.

If as a result of the stage-by-stage treatment the pregnancy did not occur within 1 year of observation in patients with I-II degree of adhesive process and within 6 months in patients with grade III-IV adhesion, they need to recommend methods of assisted reproduction.