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Verification of tubal patency - types of diagnostics, indications

Fallopian tubes are a paired organ located in the pelvic cavity. One end of it is adjacent to the uterus, and the other is in close proximity to the ovary. It is not attached to the ovary, so women who have only one fallopian tube, have chances of conceiving even if ovulation occurred in the ovary from the opposite side.

The mature egg breaks through the capsule of the dominant follicle and extends beyond the ovary. With the help of a chemical signal, it is attracted to the funnel of the fallopian tube and begins to move along it to the uterus.

If at this moment there are viable sperm cells, then one of them has chances for fertilization. Thus, the fallopian tube performs the function of transporting the egg and sperm to merge them, and then the ovum to enter the uterus.

In the absence of tubes or obstruction, independent pregnancy is impossible, even if the ovaries consistently produce eggs every month, but how to check the patency of the fallopian tubes?

Content

Indications for verification

Verification of tubal patency

The procedure for checking the patency of the fallopian tubes requires special preparation and, in addition, it is very painful. Therefore, the indication for diagnostic procedures can be the absence of pregnancy, when all other tests are normal and the gynecologist does not reveal a single obstacle to conception. Fallopian tube, clogged with adhesions, is not able to function normally.

This means that either the sperm does not have the ability to reach the egg, or the fetal egg cannot sink into the uterus. Both have very serious consequences:

  • Infertility - in this case arises due to mechanical obstacles. Obstruction may be partial, but even then it is often the case that sperm can penetrate into the cavity of the fallopian tube, and the egg cell does not, because it is much larger and the adhesions prevent it from moving freely.
  • Ectopic pregnancy - arises from the fact that the fertilized egg is not able to penetrate the uterus and is forced to implant in the wall of the fallopian tube. This is the most terrible complication caused by adhesions and obstruction.

Every year in Russia, 0.4% of women from the total number of pregnant women die as a result of ectopic pregnancy.

Causes of obstruction of the fallopian tubes

Treatment will directly depend on what caused the problem. The narrowing of the lumen of the fallopian tubes or its complete absence may be a result of their internal blockage, as well as the result of compression from the outside. Gynecologists identify several factors that may be due to complete or partial obstruction:

  • Adhesive processes resulting from STDs.
  • Adhesions formed after inflammation of the ovaries, urethra, uterus, or cervical canal.
  • Polyps overlapping the entrance to the fallopian tube.
  • Disruption of the function of the microvilli, through which the fertilized egg falls down to the uterus.
  • Squeezing of the fallopian tubes with internal organs, which initially had the wrong anatomical position, or adopted it as a result of omission or operations.
  • Mechanical damage to the mucous membrane of the tube cavity as a result of surgical interventions.
  • Congenital malformations of the reproductive system.

Sometimes the cause of the obstruction is difficult to establish through diagnostic procedures. In these cases, laparoscopy is prescribed, which is considered the most informative.

Types of obstruction

After analyzing the patency of the fallopian tubes, the doctor will determine the type of disease. Further correction of the adhesions process will occur in accordance with how extensive its localization is.

By the type of prevalence of pathological changes, obstruction of the fallopian tubes is of two types:

  1. Unilateral - implies a dysfunction of one oviduct. In this case, the woman has a chance to conceive, if ovulation occurs in the ovary, which is adjacent to a healthy pipe. There are cases when pregnancy was obtained as a result of an egg entering a healthy oviduct from the opposite ovary.
  2. Bilateral - involves the violation of the functioning of the oviducts on both sides. It is impossible to become pregnant on your own in this case, therefore the only possibility to become a mother will be to use the IVF or ICSI method.

Degree of obstruction

Adhesions or compression of the fallopian tube by internal organs can have different effects on the degree of narrowing of its lumen. There are two forms of obstruction:

  • Partial obstruction - there is a gap in the tube, but it is so small that the fertilized egg can not always fall into the uterus. This degree of obstruction is most dangerous in terms of ectopic pregnancy.
  • Complete obstruction - the lumen in the tube is not visible, the organ is completely blocked by the adhesive process and cannot even provide a fusion of the sperm and the egg.

Localization of adhesions

The fallopian tube has different departments, so adhesions can accumulate and affect the narrowing of the lumen in different places of this organ of the reproductive system.

The oviduct consists of the interstitial part, which is located near the lateral edge of the uterus, the isthmus, the ampulla (the long part), and the funnel that extends into the abdominal cavity. Accordingly, the localization of adhesions can be at any of these levels:

  • Intramural obstruction - the fallopian tube is blocked in the place where it adjoins the uterus.
  • Obstruction of the isthmus — a blockage occurs in the narrowed section of the tube closest to the uterus.
  • Obstruction of the winding section - a cluster of adhesions is observed in the longest part of the pipe.
  • Obstruction of the funnel - adhesions are diagnosed in the part of the pipe that is in close proximity to the ovary and receives a ripe egg cell.

According to the observations of specialists, most cases of obstruction are recorded in the winding section of the oviduct. Least of all - in the area of ​​the funnel.

How to check the patency of the fallopian tubes?

How to check the patency of the fallopian tubes?

Often a woman does not even realize that the functioning of the organs of her reproductive system is impaired. But to check the obstruction of the fallopian tubes in the home is impossible, so you need to consult a doctor who will choose the most appropriate method of diagnosis.

Conventional ultrasound will not be able to give a complete picture of pathological changes in the fallopian tubes, therefore, it is necessary to resort to endoscopic methods of testing and methods involving filling the cavity of the tubes with a contrast agent.

These procedures are quite painful, and some of them require the introduction of anesthesia to the patient. Consider in detail how to check the patency of the fallopian tubes.

Studies using a contrast agent

  • Hysterosalpingography (GHA)

The study is performed using X-rays, is painful and involves the filling of the fallopian tubes with a special solution. Among the most commonly used are cardiovascular, triomust, urostrast, and urografin.

: сделать клизму, опорожнить мочевой пузырь, провести эпиляцию волос на половых органах. Preparation for the procedure : make an enema, empty the bladder, epilation of hair on the genitals.

: пациентку помещают на специальный стол таким образом, чтобы рентгеновский луч проходил через верхний край лона. The procedure : the patient is placed on a special table so that the x-ray beam passes through the upper edge of the womb. First you need to get a relief image of the contours of the uterus. To do this, enter 3 ml of a contrast agent and take a picture.

Then an additional 4 ml of contrast material is injected, so that the uterus is filled — such manipulation provokes the liquid to pour into the fallopian tubes, and from there, if they pass, into the abdominal cavity. After that make the second picture.

: маточные трубы считаются хорошо проходимыми, если контрастное вещество изливается в брюшную полость на большое расстояние. Interpretation of results : the fallopian tubes are considered to be well passable if the contrast agent is poured into the abdominal cavity for a long distance.

  • Echohysterosalpingography (Echo-GHA)

It is possible to investigate the patency of the fallopian tubes using ultrasound. The procedure also involves the use of fluid, but in this case it is not a contrast agent that is injected, as in the GHA, but a physiological solution (sodium chloride).

Another feature of this method is that it is carried out only in the first phase of the menstrual cycle.

необходимо сделать клизму, выпить пол-литра жидкости и провести эпиляцию волос на лобке. Preparation for the procedure: you need to do an enema, drink half a liter of fluid and carry out hair removal of pubic hair.

в матку через катетер вводится физиологический раствор, который заполняет ее полностью и изливается в полости обеих труб. Procedure: a physiological solution is injected into the uterus through the catheter, which fills it completely and pours into the cavities of both tubes. After that, the doctor starts every 3-4 minutes to conduct ultrasound monitoring with a vaginal sensor. As a result, it is possible to detect areas of the oviduct whose lumen is narrowed or completely blocked.

при полной проходимости труб раствор свободно будет изливаться в брюшную полость. Interpretation of results: when the pipes are completely passable, the solution will freely pour into the abdominal cavity.

Endoscopic examination

  • Office and surgical hysteroscopy

It assumes the introduction of a hysteroscope (camera) into the uterine cavity, the image from which is displayed on a monitor. There are two types of this procedure: office, performed under local anesthesia for diagnostic purposes, and surgical, performed under general anesthesia. Hysteroscopy is performed on the 5-7 day of the menstrual cycle.

опорожнить мочевой пузырь и удалить волосы с интимной зоны. Preparation for the procedure: empty the bladder and remove hair from the intimate area.

в полость матки вводится гистероскоп. Procedure: a hysteroscope is inserted into the uterine cavity. It is designed in such a way that it allows you to simultaneously take pictures and supply the fluid that fills the body of the uterus. The monitor displays not only the image of the inner layer of the uterus, but also the cavity of the mouth of the fallopian tubes.

  • Laparoscopy

The procedure is performed only under general anesthesia. It is a surgical intervention in the abdominal cavity, which performs both diagnostic and therapeutic functions.

пациентка должна опорожнить мочевой пузырь и сбрить волосы на лобке. Preparation for the procedure: the patient must empty the bladder and shave pubic hair.

после введения наркоза по передней брюшной стенке врач делает 3-4 прокола. The procedure: after the introduction of anesthesia on the anterior abdominal wall, the doctor makes 3-4 punctures. They are needed in order to introduce a mini-camera and the necessary surgical instruments. To expand the abdominal space, carbon dioxide is supplied through the navel.

If laparoscopy is diagnostic, the operation lasts 20-30 minutes. If the surgeon decides to remove adhesions or other obstructions that block the lumen of the fallopian tube, the operation time is extended.

Laparoscopy is considered to be the most effective way to diagnose obstruction of the fallopian tubes. Sometimes it is only thanks to this procedure that it is possible to detect spikes that could not be seen on the GHA and the ECH-GHA.

Consequences of testing tubal patency

Verification of the fallopian tubes is one of the most troublesome procedures in the list of examinations for female infertility. However, in order to avoid the risk of ectopic pregnancy, you should not postpone the visit to the doctor and do not try to treat the adhesive process on your own.

The consequences of checking the patency of the fallopian tubes, usually, does not happen. Only the procedures carried out with non-compliance with the rules of antisepsis and asepsis, can cause inflammatory processes in the pelvis.

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