Female infertility, causes, treatment and diagnosiswhich is worried by thousands of gynecologists, is a big social problem at the moment, because it not only reduces demographic indicators, but also leads to psychological problems in women, affecting the quality of their lives and health in general.
Childless couples are becoming more and more, theseindicators already reach 20% in some countries, which is a critical mark, and tubal-pertonal infertility accounts for more than 35% of all recorded cases. And this is not surprising, since the fallopian tubes are a very sensitive part of the reproductive system and suffer greatly from the inflammatory process.
Causes
Peritoneal infertility arises as a result ofadhesion process in the cavity of the small pelvis, and tubal in the case of the appearance of adhesions in the fallopian tubes. The combination of these two conditions is referred to as tubal peritoneal infertility.
Normally the ovum is fertilized in the abdominalcavity, and then moves to the uterus by reducing the villi lining the tubes from the inside. The egg can not move independently. Damaged villi or the presence of adhesions interfere with the advancement of the sperm to the egg and fertilization.
Adhesion in the small pelvis develops because ofinflammation caused by infection, penetrating into the body during sexual intercourse (chlamydia, gonorrhea, etc.) or with the appearance of appendicitis. Pipe-peritoneal infertility can be a consequence of abortion or surgery on the abdomen and ovaries.
A great deal of attention is now devoted to the study of herpes infection, as a factor leading to infertility.
It is known from scientific works that more than 40% of women,who have tubular peritoneal infertility, suffer from endometriosis, polycystic ovaries or have a benign tumor of the reproductive system.
Such phenomena as the bending or narrowing of the pipes can also prevent the onset of pregnancy.
Diagnostics
Diagnosis and treatment of tubal infertility should be thorough and gradual.
First of all, such methodsexaminations, as hormonal, immunological, cytogenetic, and also the analysis on the diseases transferred sexual by. All this is aimed at excluding tubal infertility.
Then, hysterosalpingography is performed forevaluation of the patency of pipes. The method is based on an x-ray examination, in which a contrast agent is injected into the uterine cavity. In the picture, one can see that the solution did not fall into the fallopian tubes, which means that they are not passable. However, the probability of an incorrect result in this study is about 20%.
A similar method is consideredsonogasterosalpingoscopy, carried out with the help of ultrasound. It is considered sparing in connection with the lack of irradiation from the X-ray, but less reliable because of the low resolving power of the ultrasonic device.
A reliable method laparoscopy, during whichthe abdominal cavity, the ovaries, the fallopian tubes and the uterus are visualized. This procedure is considered a mini-operation, therefore it is conducted under anesthesia. In addition, it can be considered and therapeutic, since the spikes found during the examination are dissected with the help of special equipment.
Treatment
Tube-peritoneal infertility is treated firstturn, surgically. Today, laparoscopy is used, during which small incisions of the abdominal wall are made, whereas previously used laparotomy (dissection of the peritoneum), which itself is the cause of the formation of adhesions.
With partial obstruction of pipes and goodthe state of villi laparoscopy gives a positive result in 50-60% of cases. In neglected cases, even repeated operation of this operation does not restore patency.
The second stage of treatment can be considered conductingantibacterial, immunocorrecting and infusion therapy, as well as the use of non-drug therapies (physiotherapy, plasmapheresis, ozone therapy, phytotherapy) aimed at preventing the formation of new adhesions.
Then a control hysterosalpingography is given to confirm that the fallopian tubes are free.
If the patency is not restored or the pregnancy is absent 1 year after careful treatment, in vitro fertilization is prescribed.
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