Tubal-peritoneal factor is currently the leading cause of female infertility, accounting, according to various authors, from 20 to 72%. Despite the achievements of modern medicine, tubal-peritoneal infertility is still one of the most serious pathological conditions, taking into account the difficulty of its diagnosis and treatment, as well as the possibility of restoring reproductive function.
The main causes of tubal-peritoneal infertility are:
- previously transmitted inflammatory diseases of the pelvic organs of a specific and non-specific nature, of which the most important are chlamydia, gonorrhea, mycoplasma and trichomonas infections;
- various intrauterine manipulations (artificial termination of pregnancy, separate diagnostic scraping of the endometrium and endocervix, hysteroscopy with removal of endometrial polyps or submucous myomatous nodes, etc.);
- postpartum and postabortem complications of traumatic and inflammatory genesis;
- previous surgical interventions on the pelvic organs (ovarian resection, conservative myomectomy, tubectomy, tubal ligation) and the abdominal cavity, especially those performed according to emergency indications from traditional laparotomy access and complicated by the development of peritonitis (for example, appendectomy).
Damage to the abdominal cavity during surgery and the subsequent development of aseptic inflammation lead to the deposition of fibrin in the area of the surgical wound with local activation of fibrinolysis and proteolysis, which ultimately contributes to the resorption of primary fibrinous deposits without the formation of adhesions. With the development of postoperative infection, the inflammatory-dystrophic process is delayed, which does not allow fibrinous formations to dissolve and contributes to excessive local collagen production with the formation of powerful connective tissue junctions – adhesions.
The severity of the adhesive process in the pelvis directly depends on the extent of the spread of adhesions in the abdominal cavity, which is mainly determined by the volume and type of surgical intervention. In this regard, in order to prevent the development of the adhesive process in the abdominal cavity, one should strive to minimize the surgical intervention, giving preference to the laparoscopic method (especially when performing planned surgical interventions on the pelvic organs in women of reproductive age).
Treatment of tubal-peritoneal infertility
Treatment of tubal-peritoneal infertility includes conservative and surgical methods used sequentially or in combination with each other. Conservative treatment of tubal-peritoneal infertility involves anti-inflammatory antibacterial, immunomodulatory, antifibrosing therapy and physiotherapy.
When sexually transmitted infections are detected and / or a morphologically verified diagnosis of chronic endometritis, therapy should be comprehensive, etiopathogenetic and aimed at the complete elimination of the identified pathogens. Immunomodulatory therapy is an indispensable part of the treatment of tubal-peritoneal infertility, since chronic inflammatory processes of the pelvic organs are always accompanied by immunological disorders, which requires mandatory correction.
One of the options for antifibrosing therapy is the general and local use of various drugs with a resorbing effect – biostimulants, enzymes and glucocorticosteroids (hydrocortisone) in the form of tampons, as well as hydrotubation. Unfortunately, the clinical experience of using hydrotubation as a method of local treatment of tubal-peritoneal infertility has demonstrated insufficient effectiveness and a high frequency of various complications. Among them, most often there is an exacerbation of chronic inflammatory diseases of the pelvic organs with a violation of the functional ability of endosalpinx cells and the development of hydrosalpinx, which significantly reduces the peristaltic activity of the fallopian tubes and disrupts the transport of gametes through them.
Thus, tubal-peritoneal infertility requires early diagnosis and gradual long-term rehabilitation after undergoing surgical treatment. Also remember that ovulation stimulation is possible with the help of the drug clomid. One of the most effective ways to preserve the reproductive function is the prevention of tubal-peritoneal infertility, which consists in the prevention and timely treatment of inflammatory diseases of the pelvic organs, the rational management of childbirth and the postpartum period, and the implementation of rehabilitation measures in the near future after gynecological operations.