Blocked fallopian tubes is the closure of the lumen or dysfunction of the fallopian tubes, which makes it impossible to move eggs and spermatozoa through them, the absence of a favorable environment for fertilization and preimplantation development of the embryo. Blocked fallopian tubes tubes can be manifested by infertility, pelvic pain syndrome, algomenorrhea, whites or the development of ectopic pregnancy. The diagnosis is made based on the data of ultrasound of the pelvic organs, ECHOGSG, HSG, hysteroscopy, laparoscopy, fertiloscopy. In case of blocked fallopian tubes, drug therapy, surgical correction, IVF are used.
General information
Blocked fallopian tubes – anatomical and physiological changes of the oviducts that violate their function: contact with the ovary, the process of conception, transport of an unfertilized or fertilized egg into the uterine cavity. The topic of female infertility in reproductology and gynecology is of particular importance today: its primary form is often registered in women under 30 years of age. Blocked fallopian tubes in infertile patients acts as one of the leading (20-30% of cases) and complex causes of this pathology. It is characterized by a persistent contraceptive effect and often requires correction of the causes with the involvement of high-tech medical care and methods of assisted reproduction (ART).
The fallopian tubes (oviducts) play an important role in the process of conception, being the conductors of the sperm to the egg, and the oocyte maturing after ovulation from the abdominal cavity to the uterus, creating comfortable conditions for fertilization and the first 7-10 days of embryo development. In case of obstruction of the lumen of the fallopian tubes, the egg cannot meet with sperm and dies in an unfertilized state after a short time, and during fertilization it lingers in the tube channel, implanting into its mucous membrane with the development of ectopic pregnancy.
Causes
Blocked fallopian tubes is systematized by the side of the lesion (unilateral, bilateral), the level of closure of the canal, the degree of obstruction (complete, partial) and the cause of development. Pathology may be associated with structural changes in the oviducts (absence, underdevelopment of the organ, narrowing or closing of the lumen) or physiological disorders (hypotension, rigidity of the muscle layer, adynamic cilia, villi-fimbriae, discoordination of their actions).
Blocked fallopian tubes mainly develops as a consequence of other diseases of the reproductive sphere. The causes of blocked fallopian tubes can be common specific and nonspecific infectious and inflammatory processes of the genitals, endometriosis, mechanical injuries of the uterine mucosa and fallopian tubes, hydrosalpinx, congenital anomalies of the bookmark, embryo- and postembryogenesis of the fallopian tubes in isolation or in combination with malformations of the uterus and vagina.
STIs (gonorrhea, syphilis, chlamydia, mycoplasmosis, etc.), genital tuberculosis are the most common factors leading to changes in the structure and development of blocked fallopian tubes. In the acute phase of the inflammatory process, obstruction occurs due to severe swelling of the mucous membrane of the fallopian tubes, when inflammation subsides or its erased sluggish course – as a result of the formation of scars and adhesions. The probability of developing fallopian tube obstruction after a single episode of appendage inflammation is 12%, after 2 cases – 35%, after 3 – up to 75%. Large fibroids and endometrial polyps growing in the area of the corner of the uterus can also block the fallopian tube channel. Medical manipulations (curettage abortions, SDC, hysteroscopy, intrauterine contraception), difficult childbirth can be accompanied by the development of inflammation and adhesions (Asherman syndrome), in which connective tissue strands formed in the uterine cavity can close the entrance to the fallopian tube. The obstruction may be a consequence of a previously performed surgical crossing of the fallopian tubes for the purpose of sterilization and subsequent attempts to restore childbearing function.
A significant role is assigned to the peritoneal factor – the presence of external compression of the fallopian tubes by neoplasm or adhesions in the pelvis. Acute inflammatory processes in the abdominal and pelvic cavities (oophoritis, enterocolitis, proctitis, appendicitis, ureteritis, peritonitis) occur with the deposition of fibrin, which very quickly forms massive and dense scars that deform the structure and violate the topography of the fallopian tubes. In this case, blocked fallopian tubes may be transient if there are no adhesions left in the oviduct area after therapy. A similar reaction of the peritoneum with the appearance of fibrin splices may occur after injuries and operations in the pelvic region (rupture of the ovarian cyst and cystectomy, tubotomy in ectopic pregnancy, myomectomy, appendectomy, revision of the abdominal cavity, etc.). External adhesions, attaching directly to the wall of the fallopian tube, create its twist, or, passing close, squeeze and block its lumen (usually on one side).
Compression of the fallopian tubes by massive (>3-4 cm in size) tumors and cysts, hematomas, abscesses in the pelvic region, can cause complete closure of the tubal canal. Violations of the function of the fallopian tubes are provoked by an imbalance of hormones (dysfunction of the ovaries and adrenal glands, polycystic ovaries), disorders of innervation during prolonged stress, abdominal and lumbar spine injuries, neurodegenerative processes.
Symptoms
Blocked fallopian tubes often does not manifest itself in any way and does not affect the patient’s well-being, but is detected only during examination for the absence of a desired pregnancy. Blocked fallopian tubes has no characteristic signs, but may be accompanied by symptoms of the underlying disease that caused it, or a developing complication.
With unilateral obstruction, the probability of conception exists, but decreases by half; with bilateral obstruction, as a rule, tubal infertility occurs. With partial obstruction (narrowing of the fallopian tube in a certain area or functional insufficiency), conception is not excluded. With isolated complete tubal obstruction due to the closure of the lumen, conception is impossible, infertility is diagnosed in a married couple in the absence of pregnancy after 1 year of regular sexual relations without contraception.
With blocked fallopian tubes against the background of acute or chronic recurrent inflammatory process, in addition to the fact of infertility, a woman has moderate or severe pain in the lower abdomen, aggravated by exertion, sudden movements and sexual intercourse. There may be fever, mucous membranes or with an admixture of white pus. With a sluggish infection, pelvic pain syndrome, menstrual cramps, abundant discharge periodically bothers. The presence of an adhesive process may be indicated by pain in the lower abdomen, aggravated by mechanical irritation, in the absence of a temperature reaction.
With partial blocked fallopian tubes, ectopic pregnancy is possible. In the early stages, amenorrhea appears, pulling pains in the lower abdomen. With a confirmed fact of pregnancy at the age of 5-6 weeks, due to severe overextension and rupture of the tube, the pain turns into acute, there is profuse bleeding, weakness with palpitations, violation of urination. Pain shock develops with a sharp drop in blood pressure and fainting. With the development of pelvioperitonitis, the temperature rises. The woman’s condition is life-threatening.
Diagnosis
It is possible to establish the fact of blocked fallopian tubes with the help of ultrasound, X–ray contrast and endoscopic examination methods – ultrasound examination, hysterosalpingography (HSG), hysteroscopy, laparoscopy with chromohydrotubation, transvaginal hydrolaparoscopy (fertiloscopy).
With the help of ultrasound of the pelvic organs, the structure of the genitals is determined, the patient has regular ovulation, signs of possible inflammation, adhesions, hydrosalpinx, neoplasms. On ECHOGSG, with complete blocked fallopian tubes, you can see the stretching of the walls of the uterus and the expansion of its cavity with the injected sterile saline solution; with a partial form and adhesive process, the data are not indicative. On contrast radiographs of the fallopian tubes obtained during HSG, the fact and degree of obstruction of each section of the tubes and the localization of the barrier are determined by the shape of the lumen (without specifying its nature).
Diagnostic laparoscopy with simultaneous contrast of the fallopian tubes makes it possible to directly assess their size and shape, developmental defects, twists, the presence of narrowed and expanded sections of the tubal canals; wall rigidity, as well as the condition of the uterus and ovaries, peritoneum and other organs, the presence and severity of adhesions and external endometriosis. Within the framework of this study, various existing deviations can be corrected. Transvaginal hydrolaparoscopy (fertiloscopy) is also informative and less traumatic due to more physiological access.
Additionally, a blood and urine test is performed, a vaginal smear for flora, hormone determination, serodiagnostics (ELISA for chlamydia, ureaplasma and mycoplasma). A spermogram is assigned to the sexual partner. Consultations of a gynecologist-endocrinologist, a reproductologist are held.
Treatment
Treatment of tubal obstruction is aimed at eliminating the causes that caused it, and is prescribed after a detailed examination of the patient. Therapeutic tactics depend on the state of the reproductive function of a married couple. In the case of acute inflammatory diseases of the genital area, drug therapy is carried out early in order to avoid the development of degenerative processes of the uterine mucosa and tubes. Anti-inflammatory and antimicrobial drugs, antipyretics and analgesics are used, when combined with menstrual disorders – hormonal agents. Vitamins, Ca preparations, immunotherapy, physiotherapy (ultrasound therapy, laser therapy, medicinal electrophoresis with Ca and Mg, electrical stimulation of the uterus and appendages, gynecological massage, balneotherapy) can be used. Sexual rest is indicated for the duration of treatment.
The main directions in the treatment of blocked fallopian tubes of organic genesis are surgical interventions and methods of assisted reproduction (IVF). Surgical correction is recommended for patients under 35 years of age in case of a high probability of spontaneous pregnancy (high fertility of partners, regular ovulation, partial obstruction of tubes). Pelvic organs neoplasms, adhesions and foci of purulent inflammation are removed, tubectomy, laparoscopy is performed to restore the lumen of the fallopian tubes, reconstructive plastic surgery. Since the operation to restore the patency of the fallopian tubes increases the risk of ectopic pregnancy, when establishing the fact of pregnancy after surgical treatment in the early stages, ultrasound control is necessary.
In the absence of pregnancy for 1-1.5 years after surgery in women 40 years and older, as well as complete blocked fallopian tubes, it is advisable to use IVF methods. Prevention of the development of blocked fallopian tubes consists in measures to protect against unwanted pregnancy and STI infection, timely treatment of inflammatory processes of the genitals, endometriosis.
