Obstruction in Tubes and Hydrosalpinx

 

Approximately 30% of women presenting with infertility have problems with tubes. There may be a blockage at any point from the point where the tubes come out of the uterus to the tip called fimbria, the problem can be unilateral or bilateral.

The causes of problems with the tubes include pelvic infections, tuberculosis, endometriosis, and previous abdominal surgeries (ovarian cyst, pelvic abscess, appendectomy, etc.). The obstructions in the tubes that prevent passage will prevent the egg released from the ovary, unite with sperm and transport the embryo into the uterus in a healthy way.

The anatomical condition of the tubes is evaluated with medicated uterine film called hysterosalpingography. In the film of the uterus, which is taken during the delivery of the contrast agent, the entrance of the tubes in the intrauterine tissue along with the intrauterine tissue, the course of the channel along the tube is monitored and whether there is a transition into the abdomen is checked. If there is obstruction, this level is understood by reaching the contrast material up to that level. If the obstruction immediately enters the tube from the uterus, the tube cannot be displayed at all.

Infection or adhesions can affect the tubes at any level. If the ends called fimbria and opened into the abdomen are affected, an image may appear, characterized by the accumulation of fluid in the tube, normally called hydrosalpenx. Normally, special fluids are produced for the healthy development of the egg that is taken from the ovary, and then the egg-fertilized embryo, which is normally produced in the tubes, and this liquid is poured into the abdomen at the ends called fimbria. Occlusion obstruction will prevent the normal discharge of this fluid into the abdomen, and fluids accumulate in the tube. If there is an obstruction in the medicated uterine film, the tube is not displayed at all. This can be easily seen with careful ultrasonography. At the end of the occlusion, the contrast material fills the tube like a balloon, but there is no transition to the abdomen.

If there is suspicion of adhesion in tube blockages, tube repair can be performed with laparoscopic micro surgery. It has a success rate of 50%. If the couple has no other problem after surgery, they can be expected to become pregnant by themselves. After surgery, there may be congestion again and ectopic tendency may increase.

The situation is completely different in hydrosalpinx. The fluid that cannot be poured into the abdomen due to blockage at the fimbrial ends also accumulates for the tube. If there is a blockage at the entrance of the tube from the uterus and the liquid does not come into contact with the intrauterine tissue, the IVF application can be started directly. However, if the fluid is discharged into the uterus, it may cause the embryo to slip down and not be implanted after embryo transfer. At the same time, cells related to infection in the liquid content will not allow the healthy life of the embryo and will prevent the embryo from settling in a healthy way. The presence of hydrosalpinx will reduce IVF success by 50% in this case

In the hydrosalpinx, if the entrance on the uterus is blocked and the fluid does not flow into the uterus, treatment is not required and IVF can be applied directly. If this point is not blocked, fluid flow should be prevented before treatment and the problem should be resolved before embryo transfer. Different surgical models can be selected here. Tubes or tubes with hydrosalpinx can be removed laparoscopically. If there is a feeling that there is a lot of adhesion around it and the ovarian tissue may be damaged or the ovarian reserve may decrease, the point where the tube enters the uterus can be connected without removing the tube from the laparoscopic way. In the third way, special devices are placed in the entrance area of ​​the tube or tubes through the hysteroscopic way, that is, through the uterus, and the entrance is blocked after a while. Thus, anatomically correct preparation is provided before an expensive attempt that requires extremely labour, time, patience and hope for both the couple and the physician and team.

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