Fallopian tubes connect ovaries with uterus; and matured egg cell, moving from the ovary, is fertilized by a sperm cell particularly in the tube. After that tube pushes the egg cell into the uterus. Obstruction of the fallopian tubes is one of the female infertility causes.
Obstruction can be a consequence of:
- operations on pelvic organs (including appendectomy);
- previous inflammation (most often - chlamydiosis).
Obstruction can occur not only in the tube itself, but also between ovary and tube in the form of adhesion (sticking of the walls of fallopian tubes and ovaries together).
Adhesion of fallopian tube
Is the removal of fallopian tubes required in the case of their obstruction?
- Conservative treatment (without operation) is used in cases when the obstruction is caused by inflammatory processes. Anti-inflammatory medications and physiotherapy are usually prescribed in such cases, but this treatment is ineffective in case of the adhesions formation.
- Operative treatment — surgical intervention. Usually, surgical treatment is carried out by laparoscopy - it doesn't practically result in any complications. But 100% probability of infertility recovery, which is associated with impaired patency of the fallopian tubes, can't be guaranteed by anyone. Removal of the fallopian tubes is an extreme measure, and is used in exceptional cases.
How to check the patency of fallopian tubes?
Tubal patency can be verified using several methods:
- diagnostic laparoscopy (tubal patency checking is usually conducted during the operation of adhesions removal - laparoscopy is not usually prescribed only in order to check the tubes);
- HSG (hysterosalpingography, MSG metrosalpingography - other names);
- hydrosonography (ultrasound examination);
- fertiloscopy (a method similar to laparoscopy, often combined with it). Difference of fertiloscopy from laparoscopy is that instruments are inserted not through abdominal wall, but through vagina.
How to check the fallopian tubes patency; which method to choose?
Considering that laparoscopy and fertiloscopy are both traumatic methods, while ultrasound examination does not provide a clear "picture of the situation", HSG in the majority of cases is the best method.
HSG or hysterosalpingography
Hysterosalpingography (HSG) is a radiographic screening of the fallopian tubes for patency. Hysterosalpingography is an important step during examination of a woman with diagnosis of "infertility". Accuracy of the study is not less than 80%.
Hysterosalpingography allows to diagnose:
- condition of uterine cavity and presence of endometrial pathology - endometrial polyp;
- presence of deformations of internal organs and uterus development, such as arcuate uterus, intrauterine septum, bicornuate uterus, etc.
How tubal patency screening with HSG is performed?
Radiopaque agent (blue dye solution) is injected into the cervix. It fills the uterine cavity and gets into the tubes, from which it flows into the peritoneal cavity. X-ray picture, taken during this process, shows state of uterus and fallopian tubes.
In most cases, the procedure not only helps to assess the patency of fallopian tubes, but also gives an opportunity to see the presence of tube deformation:
- expansion;
- tortuosity;
- constrictions, etc.
Hysterosalpingography can be carried out only in the absence of inflammation. Before starting the examination a woman has to pass tests for HIV, hepatitis B and C, syphilis, and general smear on flora. HSG does not require general anesthesia.
As a rule, women who are trying to become pregnant, undergo hysterosalpingography on the 5-9th day of the menstrual cycle, if its duration is 28 days. If a woman uses protection from pregnancy, examination can be perform on any day of the cycle, except for menstruation.
Disadvantages of hysterosalpingography
- The procedure is quite unpleasant.
- Radiation exposure of the pelvic organs.
- It is necessary to use protection within one month after the HSG.
Hysterosalpingography
Ultrasound examination of uterine tubes patency
Screening for the uterine tubes patency by means of ultrasonography (hydrosonography) is an alternative to hysterosalpingography. Ultrasonography has several advantages over HSG:
- the procedure is less unpleasant;
- unlike HSG, there is no radiation, which may have a negative effect on woman's reproductive health.
- while it is necessary to use a precise protection after HSG, ultrasonography is safe for tubal patency.
The main disadvantage of the procedure is a lower accuracy of results, in comparison with HSG.
When is the tubal patency verification with ultrasonography performed?
Varification of tubal patency using ultrasonography is usually carried out just before ovulation: at this time the probability of spasm is reduced, and cervical canal is expanded. Unlike hysterosalpingography, in this case it is not very significant on which day of the cycle screening for the tubal patency with application of ultrasound scanner is performed. Before checking the tubal patency, it is required to get tested, in order to exclude presence of inflammatory diseases.
How verification of tubal patency using ultrasonography is performed?
Determination of tubal patency using ultrasonography is practically painless. Special catheter is introduced into the uterine cavity through the cervix; warm saline solution is poured in it under ultrasound guidance. If the solution gets into the fallopian tubes, then tubes are passable. If not - there is a probability of their obstruction.
Disadvantages of tubal patency verification using ultrasound method:
- relatively large amounts of liquid, as well as spasms of uterus and fallopian tubes may cause discomfort;
- If ultrasonography showed that saline solution does not get through, it may not always mean presence of tubal occlusion. This may be caused by a strong spasm.
Laparoscopy. How fallopian tubes patency can be checked with its application?
Laparoscopy is a surgical method of tubal patency evaluation. Exploration of internal organs is carried out with optical instruments through punctures in the abdominal wall. If you are assigned to laparoscopy, the forum can help you to choose a clinic or even a surgeon.
Laparoscopy in gynecology is a method of treatment and diagnostics of various pelvic organs pathologies. Laparoscopic surgery is one of the modern methods of surgery with minimal interference and skin damage. Laparoscopies are carried out both for diagnostic and therapeutic purposes.
Laparoscopy may be performed for clarification of various diagnoses. If you feel pain after laparoscopy, contact the clinic where the operation was carried out.
Diagnostic laparoscopy is an operative research technology, in which doctor examines organs of the abdominal cavity without making large incisions in the abdominal wall. Most often there are made two small incisions. A small amount of gas is introduced into the abdominal cavity in order to increase the field of view.
A device called a laparoscope is inserted into one of the incisions. It is represented by a thin tube with an objective at one end, and an eyepiece on the other (second end may also be connected with camera unit that transfers image to the screen). Manipulator is inserted into the second incision. This element is used by the doctor to displace abdominal cavity organs; he thoroughly examines them and makes the diagnosis.
Diagnostic laparoscopy is performed in order to evaluate the state of the fallopian tubes external surface and pelvic organs, as well as to identify their pathologies.
The most common operations:
- ovarian laparoscopy;
- fallopian tubes laparoscopy;
- laparoscopy of abdominal cavity organs.
After laparoscopy:
- Usually patient stays in hospital not more than one day: doctors monitor her state, perform ultrasound examination. It is allowed to return to work in 2-3 days.
- It is not recommended to take alcohol and heavy meals the next 2-3 weeks after the surgery. - Sex should be postponed for 2-3 weeks in order to avoid ingress of infection.
- Physical activities should be increased evenly. It is better to start with walking, gradually increasing its duration. Lifting of heavy things after the surgery should be avoided.
Ovarian laparoscopy
This procedure is performed not only for removal of cysts. At the same time, it is the most effective treatment for ovarian cysts of different nature. It can also be an effective way to treat endometriosis - a disease in which cells of the inner uterus wall layer grow beyond this layer.This can lead to the formation of endometrial cyst.
Ovarian laparoscopy allows to remove cyst and adhesions, to return woman the opportunity to have children. Just a couple of days after ovarian cyst laparoscopy performance, ovary returns to its normal boundaries and fully restores its function.
Pain after laparoscopic surgery is very rare, stitches usually heal quickly without giving any discomfort - painkillers are taken in extreme cases, on doctor's orders.
Laparoscopy of ovarian cyst is not an easy operation. Choose a good doctor, because appearance of cysts in the future and possibility of pregnancy often depend particularly on the accuracy of the operation performance.
Uterus laparoscopy
Uterus laparoscopy is an effective method of myoma treatment. The operation is also assigned for the treatment of various malformations of the uterus.
Laparoscopy of uterine myoma
The determining factors when choosing a method of uterine myoma treatment are the intention to have children in the future, size of the uterus, size of myomatous nodes and their location. Laparoscopy is a good option for removal of a small size myoma.
Laparoscopy of uterine myoma is not carried out in the following cases:
- uterine size is greater than fetus on the 11-12th week of pregnancy;
- development of multiple myomatous nodes;
- large size of nodes;
- low location of myoma nodes.
In these cases it is better to use other methods of removal, such as laparotomy.
Treatment of uterine tubes with laparoscopy
Tubal laparoscopy is a method in which general anesthesia is used, so there is no possibility of spasm occurrence. Therefore, tubal checkup with laparoscopy gives very accurate results. Laparoscopy of uterine tubes allows to remove adhesions. Laparoscopic surgery is assigned, if treatment of uterine tubes and their pathology is required.
Tubal laparoscopy may be assigned in the following cases:
- formation of uterine tubes adhesions;
- ectopic pregnancy;
- obstruction of fallopian tubes;
- diagnosis of female infertility;
- endometriosis;
- sterilization.
Menstruation after laparoscopy
If menstruations are painful, than the first menses after laparoscopy usually proceed with a greater blood loss than normally, and have a greater durability. This is determined by the fact that internal organs heal longer than incisions on the abdominal wall. In connection with this first menstruation is usually more painful. But nevertheless, in case of severe menstrual pain it is necessary to consult a physician.
Pregnancy after laparoscopy
After the laparoscopy is done, it is possible to get pregnant within a few months, but it is required to completely abandon sexual intercourses right after the surgery for 2-3 weeks. After that conception may be planed. Pregnancy after laparoscopy is quite possible in the near future.
Women who got pregnant within a few months after laparoscopy are followed up by a gynecologist. Often pregnancy is accompanied by medical treatment; a woman takes drugs to support normal hormonal background of the pregnancy. If pregnancy has not occurred after laparoscopy, this operation can be repeated several times.
Laparoscopy - reviews
If you are assigned to laparoscopy, forum is not the best source of information. It can be useful in one case, if you want to choose a clinic or a doctor: patients who underwent a laparoscopic operation leave their reviews quite willingly.
Is it worth to restore the tubal patency?
It is possible to get pregnant approximately within a year after the restoration of tubal patency - the probability of that they will soon become impassable again is very high. In addition, the tube must not be just passable: it must move a fertilized egg into the uterus. If it is not doing that, an ectopic pregnancy is formed.
Any operation on restoration of tubal patency increases the risk of ectopic pregnancy. Thus, the restoration of patency is not a guarantee that you will be able to get pregnant. Moreover, any operation can launch the formation of adhesions.
If you are young, and there are no more factors that interfere with getting pregnant, it makes sense to operate the tubes. But if you are over 35 years old and you've been unsuccessfully trying to have a child for a long time, think about artificial fertilization. With each ovulation "quality" of eggs deteriorates, and it is not worth to lose months to restore the tubes - time is playing against you. Based on everything we have described above, talk to your doctor to find out, whether it is worth to deal with restoration of tubal patency at all in your case.
