Fallopian tubes, they are also fallopian. What is this organ? Fallopian tube in women - what is it? Fallopian tube inflammation

Fallopian tubes in the structure of female infertility

Fallopian tube (tuba uterina, fallopian tubes)- a paired, tubular organ with a lumen, originating from the corner of the uterus.

Anatomy fallopian tubes

The fallopian tube starts from the lateral edge of the uterus in the area of ​​its bottom (angle of the uterus), passes in the upper part of the broad ligament of the uterus to the ovaries. One end of the fallopian tube opens into the uterus (uterine opening), the other - into abdominal cavity(abdominal opening). In the fallopian tube are distinguished:

• interstitial region (in the thickness of the uterine wall)
• isthmus (middle section)
• ampulla (gradually increasing in diameter section following the isthmus outwards)
• funnel with outgrowths-fringes of the pipe

The structure of the wall of the fallopian tube

The wall of the fallopian tube consists of mucous, muscular and serous membranes. The mucous membrane forms longitudinal folds, is represented by a single-layer cylindrical ciliated epithelium, with the inclusion of secretory cells. The muscular coat is represented by circular and longitudinal layers of smooth muscle cells. The serous membrane covers the fallopian tube from the outside. The fallopian tubes have an extensive neurovascular network. Vascular network formed by branches from the main uterine and ovarian arteries, the venous network is connected to the utero-ovarian, cystic and other plexuses of the small pelvis. Innervation is carried out by branches of the pelvic and ovarian plexuses.

Physiology of the fallopian tube

The muscle layers of smooth muscle cells provide the possibility of successive contractions of the lumen of the fallopian tube, called peristaltic directed (from the ampulla of the fallopian tube to the uterus) movements. The activity of peristalsis increases at the time of ovulation and at the beginning of the luteal phase menstrual cycle. The ciliated movements of the cilia of the epithelium have the same direction. In the preovulatory period, the blood filling of the veins of the funnel of the fallopian tubes and fimbriae increases, which causes their swelling, bringing them closer to the ovary at the time of ovulation. Production of secretory cells of the epithelium ensures constancy internal environment in the lumen of the fallopian tube, ensuring the normal activity of spermatozoa, the viability of the egg and the early embryo.

Physiological functions of the fallopian tubes

• Capture of the egg by the fimbriae into the infundibulum from the ovulating follicle
• Ovum capacitation
• Ensuring the transport of sperm from the uterine cavity to the site of fertilization of the egg (ampullar section of the fallopian tube)
• Sperm capacitation
• Ensuring the fertilization process
• Ensuring the development of the pre-implantation embryo
• Transport of the embryo into the uterine cavity by directed peristaltic contractions and activity of the cilia of the ciliated epithelium

The causes of damage to the fallopian tube are trivial:

• Inflammatory changes due to the activity of more (chlamydia, gonococcus) or less (the entire spectrum of opportunistic flora, mycobacterium) of a specific microorganism. The fallopian tube may also be involved in a non-gynecological site of infection, such as appendicitis.
• Inflammatory changes of non-infectious origin, as a result of the activity of external genital endometriosis.
• tubal pregnancy
• Iatrogenic genesis of damage to the fallopian tube. For example, patients who wish to restore reproductive function after surgical treatment for the purpose of sterilization (crossing the isthmic department of the fallopian tube).
• Anomalies of the laying and development of the fallopian tube occur both in isolation and in the complex of anomalies in the development of the underlying organs of the reproductive tract.

The proportion of patients with tubal infertility factors varies according to different authors largely due to differences in research approaches. So no consensus regarding the inclusion in the statistics of patients with damage to the fallopian tubes with moderate and severe external genital endometriosis, the diagnosis accompanying an independent effect on a woman's fertility. In addition, it was noted that the frequency of damage to the fallopian tubes due to infection is socially determined, as it has noticeable fluctuations in different socio-economic regions. Summarizing the data, we can summarize that the prevalence of tubal-peritoneal infertility varies from 20 to 30%, positioning it as the leading or one of the leading reasons for visiting a reproductologist.
It is noted that the percentage of patients with tubal factors tends to increase from primary to highly specialized. medical care, which is easily explained by the persistence of the contraceptive effect and the complexity of correcting the cause, without involving the possibilities of assisted reproduction technologies.

Methods for diagnosing the pathology of the fallopian tubes

• Manipulation laparoscopy with chromohydrotubation.
• Transvaginal hydrolaparoscopy (Fertiloscopy)
• X-ray Hysterosalpingography
• Ultrasound Hysterosalpingography

Advantages of laparoscopy compared to open microsurgery:

• reduced risk of postoperative adhesion formation
• less risk of surgical complications
• shorter hospital stay.

1. Invasiveness entailing surgical risks
2. Objective high cost
3. The need for short hospitalization and temporary disability
4. The need for intubation anesthesia

different from the classic endoscopic examination of the pelvic organs by laparoscopy, it is important that access to the lower floor of the abdominal cavity - small the pelvis is produced not through incisions on the anterior abdominal wall, but through posterior fornix vagina (a small incision behind the cervix). The working space is organized by injecting a small amount of liquid, instead of gas, in which the internal reproductive organs (uterus, ovaries, fallopian tubes) are comfortably examined. As part of fertiloscopy, it also remains possible to assess the patency of the fallopian tubes and carry out minor corrective interventions, since fertiloscopes have a channel for inserting one instrument, like hysteroscopes.

1. Comparable diagnostic capabilities within the framework of fallopian tube pathology
2. Less invasive
3. No need for hospitalization
4. Enough intravenous short-term anesthesia

1. Biased high cost, commensurate in cost with laparoscopy
2. Limited diagnostic capabilities, allowing to reliably assess only a small area in the volume of the small pelvis.
3. Extremely low operational capability. In practice, in the next step, the operator is often forced to recommend to the patient operative laparoscopy with curative purpose, which further delays the examination stage, organizing it unfriendly to the patient.

indirect method visualization, based on the assessment of the fallopian tubes according to the shape of their lumen when tightly filled with a special solution that traps ionizing radiation with greater resistance than the surrounding soft tissues.

Advantages regarding laparoscopy

1. Less invasive, not requiring hospitalization but insisting on adequate analgesia
2. lower cost

1. Less diagnostic capability. The weak point of the methodology remains false result about the obstruction of the fallopian tube, in addition, in controversial cases, it is often not possible to make a truly objective conclusion about the integrity of the organ, the presence of an adhesive or other pathological process.

Proposed as an alternative to X-ray examination, excluding the negative effect ionizing radiation. The essence of the technique lies in the ultrasonic control of the emptying of the tightly filled uterine cavity with a special echogenic contrast fluid through the fallopian tubes into the abdominal cavity. The appearance of echogenic fluid in the pelvic cavity is considered a positive criterion for the physical patency of the fallopian tube

Advantages regarding laparoscopy

1. Absence of invasiveness, respectively, specific complications, the need for anesthesia and hospitalization
2. lower cost

1. Negligible diagnostic possibilities. In practice, the researcher does not receive valuable information not only about the color, shape, areas of narrowing and expansion of the lumen of the fallopian tube, but also the fact of the viability of one of the fallopian tubes in general, forming a conclusion such as: “passability of at least one fallopian tube”
2. Lack of any corrective options

As an additional less important auxiliary diagnostic technique, it is also worth noting serological analysis to identify immunoglobulins A, G, M to chlamydia, the presence of which may also indicate inflammatory diseases pelvic organs.

Approaches to the treatment of fallopian tube pathology

Data are presented that since the introduction of laparoscopic microsurgery into practice, the frequency of pregnancy in patients with tubal-peritoneal factor of infertility has doubled. However, to date, the development of assisted reproduction technologies, their effectiveness in patients with pipe factor infertility in conditions of generally low efficiency of other therapeutic and surgical approaches in this category of patients, treatment and diagnostic algorithms have been revised.
In general, the tactics of treating tubal pathology depends on the state of the reproductive function of the applied couple. Surgical corrective surgery is only recommended if high frequency the onset of spontaneous pregnancy. Otherwise (for example, in conditions of reduced partner fertility), surgical treatment is recommended only for the purpose of sanitation (tubectomy with hydrosalpinx) or correction of concomitant pathology (for example, manifestations of external genital endometriosis), if necessary.
It is noticed that in patients with hydrosalpinx IVF efficiency is significantly lower than in patients without hydrosalpinx, therefore this pathology stands out in general pathology fallopian tubes. Hydrosalpinx ("hydro" - water, "salpinx" - pipe) in literal translation pipe filled with water. Interestingly, there is no consensus on the mechanism of the pathological effect of hydrosalpinx during in vitro fertilization, so an embryotoxic theory is proposed, stating that the fluid that accumulates inside the tube during hydrosalpinx is toxic to gametes and developing embryo, according to another theory, due to the pathological influence of fluid from the hydrosalpinx, the implantation process is disrupted or even the pre-implantation embryo is washed out. Diagnosis of hydrosalpinx is similar to the diagnosis of general tube pathology, however, in this case, the sensitivity and specificity of transvaginal ultrasound higher than in other tubal pathology. The results of a meta-analysis comparing IVF after salpingectomy and without previous surgical treatment support surgery to remove the altered fallopian tube (the most high level evidence).

The fallopian tube (tubae uterinae; salpinx) (Fig. 6--7) is a paired duct that departs from the bottom of the uterus in the region of its corners and goes towards the side walls of the pelvis, located in the folds of the peritoneum that make up the upper part of the wide uterine ligaments and bearing the name of the mesentery of the tube (mesosalpinx).

Rice. 6-7. The structure of the fallopian tube: 1 - the uterine part; 2 - isthmus; 3 - ampoule; 4 - funnel; 5 - fimbrial department.

The length of the pipe is on average 10-12 cm, and the right one is usually longer than the left one. The section of the tube closest to the uterus has a horizontal direction for 1–2 cm. Having reached the pelvic wall, the tube goes around the ovary, goes up along its front edge, and then back and down, in contact with the medial surface of the ovary. The following sections are distinguished in the tube: the uterine part (pars uterina) - the part of the canal enclosed in the wall of the uterus; isthmus (isthmus) - the evenly narrowed section closest to the uterus (inner third of the tube) with a diameter of about 2–3 mm; ampulla (ampulla) - the department following the isthmus outwards, gradually increasing in diameter and making up about half the length of the pipe, and, as a direct continuation of the ampulla, a funnel (infundibulum). According to the name, this section is a funnel-shaped extension of the tube, the edges of which are equipped with numerous processes. irregular shape- fringes (fimbriae tubae). The fringes are in continuous motion (similar to sweeping) and may reach the ovary. One of the fringes, the most significant in size, stretches in the fold of the peritoneum to the very ovary and is called fimbria ovarica. The movement of the fringes ensures that the ovulated egg is picked up into the open funnel of the tube through a round hole (ostium abdominale tubae uterinae).

The function of the fallopian tubes is to transport the egg from the ovary towards the uterine cavity, during which its fertilization becomes possible. This is determined by the structure of the pipe wall. Directly under the peritoneum covering the tubes (tunica serosa), there is a subserous base (tela subserosa), containing vessels and nerves. Under the connective tissue lies the muscular membrane (tunica muscularis), consisting of two layers of unstriated muscle fibers: external (longitudinal) and internal (circular), which is especially well expressed closer to the uterus. The mucous membrane (tunica mucosa) lies in numerous longitudinal folds (plicae tubariae). It is covered with ciliated epithelium, the cilia of which fluctuate towards the uterine cavity. Along with peristaltic contractions of the muscle layer, this ensures the promotion of the egg and the contents of the tube towards the uterine cavity. If the cilia are damaged, pathological implantation of the embryo can occur. On the one hand, the mucous membrane of the tube continues into the mucous membrane of the uterus, on the other hand, through the ostium abdominale, it adjoins the serous membrane of the abdominal cavity. As a result, the tube opens into the peritoneal cavity, which in a woman, unlike a man, is not a closed serous sac, which is of great importance in terms of the possibility of intraperitoneal spread of ascending infection and the entry of carcinogens into the pelvic cavity.

OVARIAN

The ovary (ovarium) is paired organ flat oval shape, which has a stable location on the surface of the posterior leaf of the broad ligament of the uterus, providing it with the ability to perform specific functions of the female gonad. The ovary of a sexually mature woman is 2.5 cm long, 1.5 cm wide, 1 cm thick, and its average volume is 8.3 cm3. The ovary has two ends. The upper one, somewhat rounded, faces the pipe and is called the pipe (extremitas tubaria). The lower, sharper one (extremitas uterina), is connected to the uterus by a special ligament (lig. ovarii proprium). Two surfaces (facies lateralis et medialis) are separated from each other by edges. The rear, more convex, is called free (margo liber). The anterior, more direct, which is attached to the mesentery, is the mesenteric (margo mesovaricus). This region is called the gates of the ovary (hilum ovarii), since here the vessels and nerves enter the ovary.

The lateral surface of the ovary is adjacent to the side wall of the pelvis between vasa iliaca externa and m. psoas major from above, lig. umbilicale laterale in front and ureter behind. The length of the ovary is located vertically. The medial side faces the pelvic cavity. For a considerable extent, it is covered with a tube that goes up the mesenteric edge of the ovary, then wraps up at its tubular end and goes down the free edge of the ovary. The ovary is connected to the uterus by own bundle(lig. ovarii proprium), which stretches from the uterine end of the ovary to the lateral corner of the uterus and is a round cord enclosed between two sheets of the broad ligament of the uterus and consisting mainly of smooth muscle fibers continuing into the muscles of the uterus.

The ovary has a short mesentery (mesovarium) - a duplication of the peritoneum, through which it is attached along its anterior edge to the posterior leaf of the broad ligament of the uterus. Attached to the upper tubular end of the ovary are: the largest of the fringes surrounding the abdominal end of the tube (fimbria ovarica), and a triangular fold of the peritoneum (lig. suspensorium ovarii), which descends to the ovary from above the line of entry into the small pelvis and encloses the ovarian vessels and nerves.

The ovary is peripheral endocrine organs, but, in addition to the endocrine function, it also performs a reproductive function. Its free surface is covered with a single-layer cubic (ovarian, germinal) epithelium, due to which it can be repeatedly traumatized during ovulation, the egg can immediately enter the surface of the ovary and then into the fallopian tube. Numerous ovulations lead to the fact that the surface of the ovary becomes covered with wrinkles and depressions over time. The gate area is covered with peritoneal mesothelium. Under the epithelium is dense connective tissue- albuginea (tunica albuginea), which, without sharp boundaries, passes into the stroma of the cortical layer of the ovaries (stroma ovarii), rich in cells, spindle-shaped embedded in a network of collagen fibers, in which vessels and nerves pass. The third (main) layer is the cortex (cortex ovari), which, with a wide border, covers the fourth layer of the ovary - the medulla (medulla ovarii).

The cortex is represented large quantity follicles in various stages of development, which are "scattered" directly under the albuginea. Each of them contains a developing female sex cell- oocyte (Fig. 6-10).

Rice. 6-10. Ovary.
a - cortical layer of the ovary; b - mature follicle.

At the time of birth, the human ovary contains about 2 million oocytes, by the beginning of puberty - about 100 thousand. When a mature follicle bursts (ovulation), its cavity is filled with blood, the walls collapse, the cells lining the follicle from the inside are quickly filled with lipids and acquire a yellowish color. A new endocrine gland- yellow body (corpus luteum). The oocyte develops into a mature egg after ovulation, in the fallopian tube. During pregnancy, the corpus luteum increases and turns into a large, about 1 cm in diameter, formation - the yellow body of pregnancy (corpus luteum graviditatis), traces of which can persist for years. corpus luteum, formed in the absence of fertilization, is smaller. In the course of regression, its cells atrophy and lose yellow. Formed white body(corpus albicans), which eventually completely disappears.

The ovary receives nourishment from a. ovarica and ramus ovaricus a. uterinae. Veins correspond to arteries. Starting from the plexus ovaricus, the veins go from the lig. suspensorium ovarii and flow into the inferior vena cava (right) and into the left renal vein (left). These anatomical differences are very important, since the lateral course of the left ovarian vein makes it more susceptible to obliteration and thrombosis, especially during pregnancy. Lymphatic vessels carry lymph to the lumbar The lymph nodes. The ovary has sympathetic (plexus coeliacus, plexus ovaricus and plexus hypogastricus inferior) and possibly parasympathetic innervation.

Fallopian tubes (fallopian tubes) refer to the internal genital organs in women. They are paired tubes that connect the uterus to the ovary.

The structure of the fallopian tubes

The fallopian tubes depart from the area of ​​the bottom of the uterus, their free narrow end opens freely into the abdominal cavity. The wall of the fallopian tube is dense and elastic, formed by the outer serous membrane, the middle muscle layer and internal mucosa.

Anatomically, a funnel, an ampulla, an isthmus and a uterine part are isolated in the fallopian tube. The funnel opens into the abdominal cavity, it is formed by long narrow outgrowths in the form of a fringe, which, as it were, covers the ovary. The vibrations of these outgrowths help the egg through the tube to reach the uterine cavity. Violations of their mobility can cause infertility or ectopic pregnancy.

Functions of the fallopian tubes

In the lumen of the fallopian tubes, the egg is fertilized by a spermatozoon, and then the fertilized egg, while maintaining the patency of the fallopian tubes, moves into the uterine cavity, where it attaches to its wall. Special eyelashes also contribute to promotion. The secret of the epithelium contains substances that promote the onset of fertilization. During the movement, the division of the zygote begins, and until it has entered the uterus for several days, the fallopian tube nourishes and protects it.

If on its way the egg encounters violations of the patency of the fallopian tubes in the form of adhesions, polyps or other adhesions, then it cannot enter the uterus, and is attached to the wall of the fallopian tube. In this case, a tubal pregnancy occurs, which can threaten the woman's life.

Methods for examining the fallopian tubes

Laparoscopy of the fallopian tubes is usually performed along the way, during endoscopic interventions on the pelvic organs for another reason, for example, during the removal of adhesions. To conduct a study, two punctures are made in the abdominal wall, an endoscope with a video camera is inserted into one, the image from which is displayed on the monitor screen, instruments for manipulation are inserted into the other puncture. Laparoscopy of the fallopian tubes is performed under anesthesia, manipulation for a woman is painless.

HSG, or hysterosalpingography, allows you to check the fallopian tubes, as well as the condition of the endometrium in the uterine cavity, deformations and malformations of the uterus and tubes. The essence of the method is that a contrast is introduced into the cervix, which enters the fallopian tubes from the uterine cavity, and enters the abdominal cavity with sufficient patency of the fallopian tubes. An x-ray is taken to detect contrast in the abdominal cavity. This method allows you to see and deformation of the pipe, which can also be the cause of obstruction and infertility. In women who are trying to get pregnant, the study is carried out on days 5-9 of the menstrual cycle with a total cycle duration of 28 days. If pregnancy is not the purpose of the examination, then HSG can be performed on any day, except for menstruation.

Testing the fallopian tubes using ultrasound is the fastest and safest way to study. However, the accuracy of the study is lower than that of other methods. The study is carried out regardless of the menstrual cycle. Healthy fallopian tubes are barely visible on ultrasound, to improve visualization, a sample is made with saline, which is injected into the cervix, and then it enters the fallopian tubes, which can be traced using ultrasound.

Fallopian tube pathology

Inflammation of the fallopian tubes (salpingitis) is caused by various infectious pathogens - chlamydia, gonococci, etc. Provoking factors are various surgical interventions, abortion, menstruation. Symptoms of salpingitis will be pain in the lower abdomen, sharply aggravated during intercourse, urination disorders, purulent discharge from the genital tract, and sometimes fever. Antibacterial and anti-inflammatory drugs are used in the treatment. Often the consequences of inflammation are adhesions in the fallopian tubes, leading to infertility. Severe inflammation sometimes deforms and destroys the tissue of the tubes so much that it is necessary to resort to the removal of the fallopian tubes.

Violations of the patency of the fallopian tubes due to adhesions, kinks, narrowing can cause an ectopic tubal pregnancy. fertilized egg cannot enter the uterine cavity, and is attached to the wall of the tube. It begins to increase in size and lead to rupture of the fallopian tube. This condition threatens the woman's life, requires emergency assistance as surgical removal fallopian tube.

Congenital pathology in the form of the absence or underdevelopment of the fallopian tubes is often combined with the underdevelopment of the uterus and ovaries. The main symptom in this case will also be infertility.

(fallopian or oviducts) - two tube-shaped organs that continue the horns of the uterus. The description of these organs was given in the sixteenth century by the Italian scientist Fallopius after which they are named.

Structure and function

Pipe functions:

• The place where the fertilization of the egg takes place
• Movement of a fertilized egg to the uterus.

Permeability and impassability

Tube obstruction happens:

• Organic (pipes are clogged with a neoplasm, their shape is changed)
• functional (despite the normal lumen of the tubes, the egg does not move to the uterus).

• Inflammatory processes
• Infectious complications of abortion
• Hormonal disruptions
• Neoplasms
• Mental and emotional overload, stress.

• Hysterosalpingography
• echohysterosalpingography

X-ray (Hysterosalpingography)

ultrasound

Laparoscopy

• Diagnosis of the disease
• Elimination of adhesions
• Restoration of patency of pipes
• Elimination of accumulations of fluid in the pipe
• Elimination of ectopic pregnancy
• Sterilization.

Fluid in the fallopian tubes (hydrosalpinx)

Causes:

• spikes
• Inflammatory processes
• Ectopic pregnancy
• Sterilization
• Surgical interventions.

Inflammation (salpingitis)

Signs:

• Pain in the lower abdomen
• urinary disorder
• Pain during intercourse
• Purulent discharge.

Gap

Cause: ectopic pregnancy, large neoplasm.

Treatment: surgery with the removal of the affected tube.

Cancer

Symptoms:

• Allocations of a serous, serous-bloody nature, not passing from six months to a year
• Pain in the lower abdomen, often on the side where the tumor develops
• It is often possible to palpate a neoplasm with a diameter of more than 3 cm.
• Ascites ( accumulation of fluid in tissues)

• Only surgery.

Hydatida

Twisted fallopian tubes

Absence of fallopian tubes

Removal (salpingectomy)

• Ectopic pregnancy
• Severe pipe damage.

After salpingectomy, the probability of pregnancy and childbirth is about 60%.

Blowing

Contraindications:

• Endocervicitis
• Neoplasms of the organs of reproduction
• Inflammatory processes
• Inflammation treatment period.

Possible complications that appear with an illiterately performed procedure:

• Exacerbations of inflammatory processes
• pipe rupture
• Air embolism causing death.

Bandaging (surgical sterilization)

Medical indications:

• The desire of a woman age at least 32 years old, with at least one child, or any age with two or more children)
• Defects of the cardiovascular system, urinary, respiratory, nervous system, cancerous tumors, as well as other diseases that are a contraindication to pregnancy and childbirth.

• Acute inflammatory processes of reproductive organs.

• Inflammatory phenomena
• Epididymitis.

Recovery

2. After tubal ligation, it is also possible to restore the function of the fallopian tubes. The effectiveness of treatment depends on the method of ligation, the presence of tubal damage, and the length of time after ligation. The efficiency is 70 - 80%. 50% of women who want to restore the tubes are denied for medical reasons, and only 50% of those who have undergone restoration can become pregnant.

Artificial fallopian tubes

Alternative treatment

2. 100 gr. cherry pits white color , 2 tbsp. l. dry wormwood, 500 ml of dry white wine, 1 liter of water - mix everything and boil over low heat by half. Pass through a sieve and consume 100 ml 2 hours after a meal. Drink 5 days before menstruation and the same amount after.

3. 50 gr. soapwort root and green cuffs, 100 gr. harrow root- mix well. For 2 st. l. collect 500 ml of boiling water, simmer under the lid for half an hour. Take 100 ml three times a day on an empty stomach.

For obstruction:
1. 5 st. l. upland uterus pour 500 ml of vodka, stand for 14 days in the pantry. Shake the bottle every day. Take 40 drops in the morning, afternoon and evening for 60 minutes. before meals.

2. It is desirable to combine the first recipe with this: 1h. l. milk thistle steam with a glass of boiling water for 20 minutes, pass through a sieve. Drink warm slowly, 150 ml three times a day before meals and at bedtime.

3. 1 st. l. adonis brew 200 ml of boiling water, cover with a cap and hold for 2 hours, use three times a day.

4. 3 - 4 tbsp. l. knotweed pour 500 ml of boiling water, hold under a cap for 4 hours, pass through a sieve. Take 100 ml four times a day 20 minutes before a meal.

The fallopian tube in structure is something like a tunnel, inside having a very gentle, elegant and fine structure. The fimbriae of the fallopian tubes meet the ovulated egg from the ovary, hug it, wrap it in a fringe and lure it into the tunnel. The tunnel is lined with a kind of pile (ciliated epithelium), the oscillatory movements of which favor the meeting of spermatozoa with the egg, and then the transportation of the already fertilized egg into the uterine cavity. As you can see, the fallopian tubes play a huge role in the conception of a child, and obstruction of the fallopian tubes is the main cause of infertility in 40% of women with this diagnosis.

Where are the fallopian tubes

Very often you can meet the question: "Where are the fallopian tubes?". The location of the fallopian tubes in a woman's body is normal on both sides of the bottom of the uterus. One side of the fallopian tube is almost horizontally connected to the uterus, and the other side is adjacent to the ovary. Often you can find an abnormal location of the fallopian tubes and their underdevelopment, which in most cases leads to infertility.

Fallopian tube length

The length of the fallopian tube depends on individual features organism, the average length of the fallopian tube is 10-12 cm. Interestingly, the length of the left fallopian tube can differ significantly from the length of the right fallopian tube. There are frequent cases of abnormal development of the tubes, when the length of the fallopian tubes is excessive, often they are tortuous, have narrow lumen and the peristalsis of the tubes is reduced, which leads to violations of the transport of the egg.

The structure of the fallopian tube

Fallopian tube fimbriae

In the upper figure on the left, the ovary is not covered by the fallopian tube, but is located next to it. The fallopian tube is conditionally attached to the ovary by a long ovarian fimbria. The fimbria of the fallopian tubes resemble a fringe turned towards the ovary and waiting for ovulation. On a wave of follicular fluid, the egg emerging from the ovary is deftly captured by the fimbria of the fallopian tubes and dragged into the tunnel of the fallopian tube.

Ciliated epithelium

Further, the egg enters a very delicate and finely organized space of the fallopian tube, the mucous membrane of which is lined with ciliated epithelium, each of its cells has a long outgrowth. Due to the oscillatory movements of the villi (cilia) along the fallopian tube, the egg moves towards the uterus and towards the sperm. With a favorable set of circumstances, the egg is fertilized, and the newly-made embryo continues its journey through the fallopian tube for about seven more days before being implanted in the uterus.

So, drawing conclusions from the above, we can say that the structure of the fallopian tube is very delicate and thin. Without exception, all inflammatory processes in the fallopian tubes cause tremendous damage, damaging, and sometimes leading to death, finely organized villi.

The consequence of inflammatory processes in the tubes may be the formation of "bald patches" in the ciliated epithelium and the inability to move the fertilized egg through the tube, which leads to an ectopic pregnancy and often with such a diagnosis, one fallopian tube can be removed.

Gonorrhea, tuberculosis and chlamydia cause severe inflammation due to their extremely aggressive pathogenic flora, which inevitably leads to a pronounced adhesive process, tubal constriction occurs, which can also lead to ectopic pregnancy. Constriction of the fallopian tubes with adhesions often leads to infertility. Chlamydia very often settles in the fimbriae (in the fimbriae of the fallopian tubes), which leads to their complete gluing, respectively, no one expects an ovulated egg, and it simply dies without getting into the fallopian tube.

Genital endometriosis, especially in chronic form, causes inflammatory processes with the formation of adhesions, which can also lead to constriction of the fallopian tubes, ectopic pregnancy, and subsequently one fallopian tube can be removed. Often, in chronic inflammatory processes, fallopian tube adenocarcinoma is diagnosed - this is a classic cancer, the symptoms of which begin to appear only in the last stages.

How can you protect yourself from problems with the fallopian tubes, because the constriction of the fallopian tubes or the death of the ciliated epithelium is so difficult to diagnose? AT modern gynecology There are a huge number of research methods with the help of which timely medical intervention is possible.

Techniques used include laparoscopy, echohysterosalpingography (HSG Echo) of the fallopian tubes, and sonohysterography of the fallopian tubes ( ultrasonic methods), hysterosalpingography of the fallopian tubes and metrosalpinography (MSG) of the fallopian tubes (X-ray methods). Also, some methods are often used not only as diagnostics: when fluid is injected with a syringe under pressure into the uterine cavity, the fallopian tubes are washed or the fallopian tubes are cleaned, according to statistics, pregnancy occurs in 15% of cases after diagnosis.

Methods for examining the fallopian tubes

Tubal hysterosalpinography (HSG) or metrosalpinography (MSG) of the fallopian tubes.

Fallopian tube hysterosalpinography (HSG) or metrosalpinography (MSG) of the fallopian tubes is x-ray diagnostics fallopian tubes for the presence of constrictions of the fallopian tubes (for patency). This is the method most commonly used in the examination of patients diagnosed with infertility. The accuracy of the study reaches 80%.

The essence of the hysterosalpinography of the fallopian tubes (or MSG of the fallopian tubes) is the introduction of a contrast agent into the cervix, then it fills the uterine cavity and fallopian tubes, flowing into the abdominal cavity. After produced X-ray, by which a specialist can assess the condition of the uterine cavity and the location of the fallopian tubes, expansion, tortuosity and constriction of the fallopian tubes, etc. (if any).

But, despite the widespread use of this method research has its drawbacks. Hysterosalpinography of the fallopian tubes (or MSG of the fallopian tubes) is performed only in the absence of inflammatory processes, because when a sterile contrast fluid is injected into the uterine cavity (for example: a patient diagnosed with endometriosis), the fluid transfers individual fragments of the endometrium into the abdominal cavity and after some months Passable fallopian tubes become completely impassable.

The disadvantages include the fact that the procedure is rather unpleasant, to say the least, many patients simply scream out loud when the contrast fluid is injected. Also, do not forget about exposure to X-rays, which is why the procedure is prescribed on the 5-9th day of the cycle, in order to avoid irradiation of the egg, or it is recommended to protect yourself during intimacy for the next month.

Echohysterosalpingography (Echo-HSG) of the fallopian tubes or sonohysterography of the fallopian tubes.

Echohysterosalpingography (Echo-HSG) of the fallopian tubes, or sonohysterography of the fallopian tubes, is a method for diagnosing the uterine cavity and fallopian tubes based on the ultrasound method. When using this method, the highest accuracy is achieved: from 80 to 90%, while it does not carry a radiation load, and is also less painful and minimally invasive.

The essence of the procedure Echo-HSG of the fallopian tubes or sonohysterography of the fallopian tubes is the introduction of a special contrast agent into the uterine cavity, then into the fallopian tubes and abdominal cavity, which indicates the patency of the fallopian tubes. After that, transvaginal and abdominal ultrasound of the uterus with 3d reconstruction is performed, which allows the specialist to assess the shape of the uterine cavity, the surface of the formations in the uterus and the condition of the fallopian tubes (their patency).

Also, the use of both of these methods often leads to pregnancy due to washing the fallopian tubes or some kind of cleaning of the fallopian tubes with a contrast liquid, but, unfortunately, the effect does not last long. These methods are most effective for detecting fallopian tube adenocarcinoma. Leading experts insist on the diagnosis of the fallopian tubes, even with the slightest suspicion of adenocarcinoma of the fallopian tube, because this disease is extremely difficult to diagnose, and symptoms appear only in the last stages.