The ability to conceive, carry and give birth to a healthy baby - the main feature, the value and the joy of a woman's life. Not by chance in ancient times even the very meaning of a woman's life is measured by its ability to bear children. We live in a much more enlightened and freedom are times when women can afford to plan a family, children, and the time of their birth at its discretion. But still it remains the most important motherhood and happy period of life, without which it is difficult to fully experience all its facets. An important condition for this function is the health of the whole body and reproductive systems in particular. Especially important are the fallopian tubes and their ability to pass through himself an egg ready for fertilization.
Fallopian tubes: the structure, function, health
Fallopian tubes in science and medicine are called fallopian tubes or easier - oviducts. The second title is in itself quite clearly describes their role in the female body. Indeed, the fallopian tubes - a paired organ connecting the ovaries to the uterus cavity and create a kind of "corridors" through which the egg enters the uterus. In the fallopian tube fertilization occurs when the egg is ovulated captured ciliated epithelium and is moving into the fallopian tubes, which can be from 8 to 24 hours. All the while she remains viable thanks to the special environment inside the oviduct, and looking forward to meeting with the sperm. If that meeting takes place and the egg is fertilized, the cilia on the surface of the tubular epithelium pushing it further into the uterus. If the egg remains unfertilized, then for the same oviduct she still goes to the uterus, which gradually dies.
Thus, it is from these small tubes placed on either side of the uterus depends, combined male and female sex cells, whether there will be conception, the zygote gets there (the fertilized egg) to the uterine cavity. This is the role of the fallopian tubes in the realization of the function of procreation, and it is provided by their specific structure. The walls of the oviduct composition similar to the uterine wall and, just as it has several layers of epithelial and mucosal tissues. The tissue forms the pipe length from 8 to 20 cm (on average - about 12 cm). The main difference between the mucosa of the fallopian tubes of the endometrium - the presence of motile cilia for transporting entering the pipe elements: eggs, sperm and zygote. Thus each of the two pipes sufficiently mobile and flexible. Health, development oviducts consist of:
- Funnels situated from the abdominal cavity, i.e. ovarian, and having a diameter of about 20 cm. With a plurality of funnel covers fringes ovary and provides ingress egg into the tube, and then the movement along it.
- Ampullar portion narrower as compared with the funnel, but still wide enough to pass the egg.
- Isthmic portion, which narrows as it approaches the womb.
- Uterine area - i.e. places the transition of the uterine tube directly into the uterus.
Even medical procedures carried out without direct contact of the uterus and / or fallopian tubes can cause damage and obstruction of the fallopian tubes. For example, in the past transferred to other operations on the pelvic organs - even the common appendectomy - can lead to obstruction. "Junction" of the pipe can be in place and on its length and between the tubes and ovaries. These places are called - spike - and are, in fact, matted walls of the ovary and oviduct. The treatment in this case may be both medical and operational. Of course, no one doctor can not give a 100% guarantee of complete recovery. But the removal of the fallopian tubes in the case of the formation of adhesions - is an extreme measure, which are extremely rare. In most cases, conservative and operative treatment in combination leads to a favorable resolution of the conflict.
Check tubal patency
Today, medicine has a whole range of methods of diagnosis the state of the fallopian tubes.
- GHA, or hysterosalpingography.The same method can be found under the names of MSG, metrosalpingography - know that under these complicated names hidden the same way of checking tubal patency. It consists in the medical imaging and allows you to see not only the lumen of the oviduct, and the possible deformation of the uterus and other internal organs, to assess the condition of the endometrium and the uterine cavity. With GHA is possible to diagnose diseases such as uterine endometrial polyp, two-horned uterus, saddle-shaped uterus, uterine septum and some others. But the most important thing is that hysterosalpingography shows any extensions, banners, tortuosity of the fallopian tubes, preventing them cross. Thus results of studies report information with an accuracy not less than 80%.
GHA comprises two successive stages. First introduced into the uterine cavity fluid, contrasting color. Most often used for this solution blueprints. It is completely safe, and filling the interior space of the genital organs, ie the uterus, fallopian tubes themselves, and even the abdomen clearly shows their appearance in the photo taken x-ray machine. The main drawback of GHA - the need for careful preliminary preparation for this procedure. In particular, the HSG is performed only on certain days of the menstrual cycle so that if the standard is 28 days, the procedure can be planned with only 5 to 9 day cycle. However, if the patient is using contraceptive methods, hysterosalpingography is permitted at any time except just days menstrual bleeding.
In addition, the presence of any inflammatory pelvic holding an absolute contraindication hysterosalpingography. And the patient is required to undergo pre-testing and make sure that is not sick with syphilis, HIV, hepatitis B, hepatitis C, pass a smear to check the internal flora. Pain during the procedure carried out is not accepted, so she GHA - the process of physically quite unpleasant. After GHA was held for one menstrual cycle must be protected from pregnancy, even if the purpose of diagnosis - freedom from infertility. But in general, hysterosalpingography is today considered the best of the existing test methods of tubal patency.
- Gidrosonografiya (US)- Method, alternative hysterosalpingography, and before it has some advantages. In particular, during gidrosonografii no need to use x-ray radiation which itself can have a negative impact on the vulnerable state of the internal organs of the female body. In addition, the procedure does not cause such gidrosonografii discomfort as GHA and does not require protection from pregnancy. However, to carry it out, too, need to choose the right time: US tubal ligation is best done the day before ovulation when the cervical canal is relaxed and expanded, and the probability of a spasm, respectively, the lowest. But first pass tests to check for internal inflammation is still necessary.
Although protseduragidrosonografii almost painless, it is associated with a specific intervention into the body. Special thin catheter is inserted through the cervix to pour through it into the saline comfortable temperature. Then everything is simple: by using ultrasound machine going tracking of fluid motion. If it penetrates freely, then the fallopian tubes normally miss it, that is, the permeability is not compromised. Otherwise, it is a violation of the Fallopian tubes. However, sometimes the reasons for failure of saline may be a spasm of the uterus, and daignoz get wrong. This is the main flaw gidrosonografii - its accuracy is much lower than that of the GHA. Yes, and the liquid used to carry it out relatively more. Still ultrasound fallopian tubes today are still widely used in cases where the GHA for one reason or another is not recommended.
- Diagnostic laparoscopy- Quite traumatic method often associated with surgery to remove adhesions and usually it is not assigned to itself for the sake of checking tubal patency. But in general laparoscopy may appoint both for diagnostic purposes and therapeutic. Today, the method is considered the most restrictive of the possible surgical techniques because it is accompanied by minimal damage to the skin and interference. Nevertheless, laparoscopy - is, in fact, a puncture of the abdominal wall to using surgical apparatus could inspect the internal organs and to assess their condition. Typically, the cuts in the skin is two, but they are relatively small. In addition, the abdominal cavity is entered special gas, which expands the inner space and facilitates the inspection.
Device for laparoscopy represents two thin tubes: the first lens at one end and the camera lens at the other end, is introduced into a cavity cut. The second tube - a manipulator, by which the doctor via the second incision can move viscera into the abdominal cavity and how they should be considered. The results of this examination and the diagnosis. It gives information about the state of the outer surface of the pelvic organs and directly tubal pathology identifies possible depending on the specific purpose of laparoscopy (laparoscopy fallopian tubes, ovaries or other organs). Thereafter, for recovery after surgery the patient is left under the supervision of a hospital clinic approximately day. A couple of days it will be able to return to work and continue normal daily life, but about sex, alcohol and heavy for digestion have to forget even for a month.
Rehabilitation after laparoscopy - a long and gradual. The patient can not lift weights, and physical activity can be introduced very gradually, starting with the slow walking in the fresh air. Typically, the first menstruation after laparoscopy is particularly painful and plentiful, and pregnancy is possible quite soon, but it is not advisable to plan before a few months after the procedure. This is due to long-term healing of internal organs. But the accuracy of laparoscopy is very high, the procedure is performed under general anesthesia and therefore eliminates the spasms of the uterus. In addition to determining whether abnormalities, laparoscopy allows you to remove adhesions of the fallopian tubes and thus restore their patency. After that, during the year it is likely pregnancy.
- Fertiloscopy.This method is similar to laparoscopic indeed, but differs from it by introducing surgical apparatus: for introducing instruments used not puncture in the abdominal wall and the vagina. Fertiloscopy also relates to surgical and traumatic methods and is often combined with a laparoscopy. But for fertiloscopy abdominal incisions are not necessary and, accordingly, a general anesthetic. With this method of administration of local anesthesia is sufficient. After treatment, there are scars on the skin, and the rehabilitation process lasts less. Typically, the patient is not in hospital clinics longer fertiloscopy 3-5 hours. The whole procedure takes from 15 minutes to an hour, and as a result the doctor receives reliable picture of the fallopian tubes, their cross, the presence of adhesions and possible abnormalities of the uterus and endometrium, and even the ability to carry out small operations.
Fertiloscopy - a chance to do without a relatively traumatic laparoscopy, but it is strictly contraindicated in women with endometriosis and uterine myoma. Fertiloscopy helps restore ovulation and patency of the oviducts. At the same time, and the procedure itself, and instruments for its implementation to date remain relatively expensive and therefore only used in some clinics. Implementation fertiloscopy require physicians to the highest professional qualifications and literally jeweler's precision. Therefore, if it is possible to diagnose other first, sparing techniques (ultrasound or HSG), it is best to start with them. Only in the event that these methods showed no abnormalities, the other spouse exactly healthy, but pregnancy does not occur, it makes sense to turn to fertiloscopy.
- Pertubatsiya / kimopertubatsiyaheld less frequently compared with the above methods, but also have their place on the list of ways to check tubal patency. To implement them directly into the uterus through the finest flexible catheter introduced gas: air or oxygen. This fallopian tubes naturally reduced, and this process is recorded with special equipment, which in turn reflects it as a pattern for the curve. This procedure is almost painless and its holding patient enough to inject shpy or baralgina. Kimopertubatsiya carried out simply on the gynecological chair and usually takes no more than 5 minutes plus the short time that you want the computer to miscalculation and plotting.
Kimopertubatsiya shows the status of tubal patency or violation of their permeability and / or motility of the oviduct. In each individual case, the combination of this method with other diagnostic methods, for example, after conducting gimopertubatsii before laparoscopy or hysterosalpingography. It is necessary to plan gimopertubatsiyu before ovulation, that is, the first phase of the menstrual cycle, and eliminate the possibility of inflammatory processes in the pelvic organs. Pre-taken vaginal swabs flora. Kimopertubatsiya eliminates the doubt and start planning a pregnancy with a favorable diagnosis or makes recommendations for further examination and / or treatment in case of deviations.