Infertility due to fallopian tube obstruction

　　The causes of infertility due to fallopian tube obstruction are mainly inflammatory, but the incidence rate of non-inflammatory lesions is also gradually increasing, which should not be ignored.

　　1. Inflammation:Patients seeking medical treatment for infertility caused by salpingitis are all suffering from chronic salpingitis. The formation of chronic salpingitis can be due to incomplete or untimely treatment of acute salpingitis, leading to adhesion of the fallopian tube mucosa or pelvic inflammatory disease. It can also be caused by local formation of lesions in the endometrium, leading to ascending infection and causing chronic salpingitis that blocks the fallopian tube lumen, such as incomplete abortion, retained placenta causing inflammation, and some women with intrauterine devices developing chronic salpingitis without clinical manifestations of acute salpingitis, or only subclinical infection, leading to varying degrees of adhesion of the fallopian tube mucosa. Salpingitis can also be secondary to inflammation of surrounding organs or tissues, especially in the fallopian tube ostium or around the ovary, forming inflammatory adhesions that prevent the fallopian tube ostium from absorbing the ovum released from the ovary into the fallopian tube to meet sperm, such as purulent appendicitis, peritonitis, etc. The causative bacteria of chronic salpingitis include bacteria, viruses, protozoa, and mycoplasma, among which bacterial infection is the most common. Common bacteria include Staphylococcus aureus, Streptococcus, Escherichia coli, and Pseudomonas aeruginosa, which are often found in unclean abortion, incomplete abortion, induced abortion, and puerperal infection. The main pathogens transmitted sexually are Neisseria gonorrhoeae, and there are also infections caused by Chlamydia trachomatis, mycoplasma, and Ureaplasma urealyticum. Whether mycoplasma and Ureaplasma urealyticum cause infertility is not yet determined, but recent reports also suggest a relationship with infertility. In addition, children or adolescents with tuberculous peritonitis may develop tuberculous salpingitis and even tuberculous endometritis, leading to infertility, and the tuberculous lesions are often extensive, mainly primary infertility, and the success rate of assisted reproductive technology is lower than that of other types of salpingitis.

　　2. Non-inflammatory:Endometriosis, pelvic endometriosis, and ovarian endometriosis can form peritoneal adhesions, causing external adhesions of the fallopian tube ostium or peritoneal adhesions around the ovary, which prevents mature eggs from being taken into the fallopian tube and leads to infertility.

　　Tubal obstruction infertility is a female infertility caused by various factors leading to fallopian tube blockage, without any further complications. However, long-term infertility may affect family happiness, so women should seek timely treatment.

　　1. Common symptoms:Female infertility, secondary infertility, low back pain, late onset menstruation, oligomenorrhea, changes in menstrual cycle, lower abdominal pain, diffused lower lumbar pain, etc.

　　2. Clinical manifestations:Lower abdominal pain, lumbar pain, or abnormal menstruation, but many patients have no自觉 symptoms other than infertility. Hysterosalpingography can diagnose the location and extent of fallopian tube obstruction (complete or partial obstruction), and if the fallopian tubes are long and appear like beads or rigid, it may be tuberculous, which is difficult to treat.

　　First and foremost, it is crucial to maintain the cleanliness and hygiene of the reproductive system and prevent infections by various pathogens.

　　In addition, most ectopic pregnancies are actually caused by inflammation leading to partial blockage of the fallopian tubes. After an ectopic pregnancy occurs, it is best to avoid surgery involving laparotomy and fallopian tube resection. Laparoscopic fallopian tube fenestration should be used as much as possible, and conservative therapy can also be adopted if the situation permits, which can preserve the fallopian tubes.

　　In addition, if there are inflammatory diseases of the reproductive system and pelvic and abdominal cavity, it is necessary to actively seek specialist doctors for effective treatment. It is not advisable to undergo fallopian tube lavage and uterine curettage treatment in some small clinics.

　　Routine examinations include: hysterosalpingography, ovarian function examination, fallopian tube patency examination, fallopian tube lavage examination, fallopian tube insufflation test, fallopian tube endoscopy, etc.

　　1. Tubal insufflation:That is, injecting carbon dioxide into the uterus through a catheter at a rate of 60ml per minute, and the pressure should not exceed 2.7kpa. If the fallopian tube is patent, a bubble sound can be heard in the lower abdomen as the gas passes through the fallopian tube into the peritoneal cavity, and the pressure drops rapidly. If the fallopian tube is not patent, no bubble sound can be heard, and the pressure does not drop.

　　2. Ultrasound imaging:Under ultrasound examination, inject ultrasound contrast agent to observe its image in the uterus, fallopian tube, and uterorectal pouch. Due to the low echo characteristics of physiological saline, etc., it cannot be directly observed in the uterus and fallopian tube under ultrasound, and can only be indirectly inferred whether the fallopian tube is patent by observing the presence of fluid in the rectal pouch, and it is impossible to determine its shape and specific blockage location.

　　3. Laparoscopic examination:By injecting dye such as methylene blue into the uterus from the cervical os, observing the flow of methylene blue through the fallopian tube under laparoscopy, and overflowing into the pelvis, it is considered patent; if there is a blockage, the location of the blockage cannot be determined. Laparoscopic examination can only understand whether the fallopian tube is patent and the condition of the fallopian tube ostium obstruction, as well as the adhesion around the fallopian tube, but it cannot understand the specific blockage location and nature inside the fallopian tube.

　　1. Patients should eat more vegetables and fruits, and also match some coarse grains. Protein and inorganic salts are particularly important. Sufficient protein can promote the improvement of the body's immune function, and it is better to eat less large fish and meat products.

　　2. Women with tubal obstruction infertility can also supplement folic acid by eating raw vegetables such as rapeseed and Chinese cabbage. In addition, green vegetables contain many nutrients needed by humans, and patients should eat more green vegetables.

　　3. Calcium and phosphorus are elements that women are prone to lack, while iron is an important element for the production of blood and tissue cells. Therefore, patients should eat more eggs, shrimp shells, beans, etc., which are rich in calcium, and lean meats that are rich in iron.

　　First, surgical treatment

　　The whole process is divided into adhesion separation surgery, fallopian tube整形 surgery, and re-passage surgery.

　　1. During the operation of separating pelvic adhesions, it is necessary to completely and thoroughly separate various adhesions to restore the normal anatomical relationship and shape of the pelvic organs. It is best to avoid damaging the serosa and blood vessels during the separation of adhesions. Hemostasis with electrocoagulation is preferred to reduce postoperative recurrence of adhesions.

　　2. The operation of separating and整形 of the fallopian tube ostium should separate the adhesions, trim scars, and restore the normal shape of the ostium. Then, it should be turned out and sutured 0.5cm, with the endometrium facing outwards, making it less likely to re-adhere in the future.

　　3. Fallopian Tube Ampulla Ostectomy In cases where the ostium is severely damaged and loses function, the ostium should be excised, the wide and soft ampulla should be exposed, then it should be longitudinally cut into 3-4 flaps, about 1 cm deep, and then sutured outwardly to form a new ostium.

　　4. Fallopian Tube Nodule Excision and Anastomosis If the fallopian tube is obstructed locally by inflammatory nodules or ectopic nodules, it can be excised and re-anastomosed to restore patency.

　　5. Fallopian Tube Cornu Anastomosis In cases where the isthmus is intact and the cornu is partially damaged and obstructed, it is excised and anastomosis is performed to restore patency.

　　6. Fallopian Tube Intracavitary Transplantation In cases where the interstitial part of the fallopian tube is severely obstructed and the isthmus and distal parts are intact, the interstitial part is excised and the fallopian tube is transplanted into the uterine cavity.

　　7. Fallopian Tube Lumen Dilation If a segment of the fallopian tube is narrowed, expand it to separate the adhesions at the narrowed section, increase the width and patency of the lumen inside.

　　Second, other treatment methods

　　Postoperative and post-treatment follow-up treatment is a necessary measure to increase the effectiveness of surgery, with the focus on preventing reinfection and adhesions, and maintaining good patency of the lumen, with treatment lasting for 1 to 2 months.

　　In the past, comprehensive measures such as hysterosalpingography, physical therapy, and oral administration of traditional Chinese medicine enema were taken for tubal infertility, but the effect was not good. There is still controversy about the efficacy of interventional therapy.

　　The principle of interventional therapy for fallopian tube obstruction is to use a fallopian tube intervention and recanalization device under the monitoring of an X-ray television fluorescent screen, insert the catheter into the ostium of the fallopian tube, inject contrast medium, observe the course of the fallopian tube and the condition of the ostium, and if it is visible, inject a mixed drug solution under pressure, utilizing the propelling force of the hydrostatic pressure of the liquid, so that the fallopian tube can be recanalized, which is the selective fallopian tube造影术（SSG）. If the fallopian tube is not visible, then a super-smooth guide wire is inserted through the catheter, the adhesions are separated, and if the recanalization is successful, contrast medium and mixed tube fluid are injected again. This process is called recanalization surgery (FTR).

　　Interventional therapy is suitable for hysterosalpingography, indicating that the fallopian tubes are not visible or only partially visible, and for cases with incomplete obstruction of the fallopian tubes, to perform catheterization and fluid therapy. Its contraindications include tubal tuberculosis, hydrosalpinx, adhesion at the ostium or surrounding encapsulation. Obstruction of the anastomosis after tubal anastomosis and tubal fibrosis.