Gynecology And Obstetrics-

Bonding of the fallopian tube

definition

Bonding the fallopian tube (Tuba uterina / Salpinx) is one caused by an inflammation of the fallopian tubes (Salpingitis) or narrowing of the muscle tube caused by the advanced age of the woman as a result of an increase in toughness (Viscosity increase) of the fluid present in the fallopian tube. Ultimately, this leads to a malfunction of the cilia due to the adhesion.

A woman's fertility can be significantly reduced by this sticking together, since the egg released from the ovary during ovulation cannot be transported via the fallopian tube connection towards the uterus, but remains stuck in the fallopian tube at a sticky constriction. Male sperm migration in the opposite direction can also be difficult or even no longer possible.

Adhesion of the fallopian tube also increases the likelihood of an ectopic pregnancy, i.e. the maturation of the fertilized egg within the fallopian tube, since transport to the uterus may be impossible due to the adhesion.

Symptoms

The symptoms that can be caused by one or both fallopian tubes sticking together are manifold.

Is there a fallopian tube inflammation in the fallopian tube (Salpingitis), lower abdominal pain, pain when urinating or during sexual intercourse (Cohabitation) and increased discharge (vaginal fluorine) occur. Depending on the severity of the inflammation, there may also be fever and reduced physical performance. If the inflammation causes scarring or sticking of the fallopian tube wall, infertility (Infertility) occur.

In so-called endometriosis, in which there is benign dislocation of the uterine lining in the abdominal and pelvic area, which can then stick to the fallopian tubes, in addition to many other complaints, especially Pain during menstruation (Dysmenorrhea), during sexual intercourse (Dyspareunia) or when defecating (Dyschezia) occur.

If there is an impaired transport of the fertilized egg in the direction of the uterus due to a sticky fallopian tube, a so-called extrauterine pregnancy, i.e. a pregnancy outside the uterus, can develop. In addition to spotting, in the worst case a burst (Rupture) of the fallopian tube with severe, sudden abdominal pain and heavy bleeding into the abdominal cavity. Since a fallopian tube rupture (Tubal rupture) is a life-threatening complication of an ectopic pregnancy, a doctor should be consulted as soon as possible if the pain suddenly starts to rise.

The fallopian tubes are often diagnosed if they are still not pregnant after many years of wanting to have children and therefore consult a gynecologist. In this context, one speaks of so-called tubular sterility, since childlessness is due to changes in the fallopian tubes. The adhesions usually go unnoticed for a long time and are usually in an advanced stage at the time of diagnosis.

therapy

Depending on the underlying cause of the stuck fallopian tube, this underlying disease should be treated to ensure that the fallopian tubes are open.

In the case of inflammation of the fallopian tubes, a suitable broad-spectrum antibiotic therapy (broad spectrum antibiotic therapy) should first be started to kill the pathogen, which can be replaced by a specific, more targeted antibiotic if the pathogen is precisely identified. If the inflammation is very advanced and encapsulated collections of pus (abscesses) have formed, an operative measure should be considered.

If the so-called endometriosis, a disease in which the uterine lining can become sticky in the abdominal cavity, these endometrial foci should be surgically removed (extirpated) and the fallopian tubes are freed. Depending on the extent of the findings, this operation can either be carried out using a laparoscopy (Laparoscopy), or major surgery with an abdominal incision. In addition to the surgical treatment, hormone preparations can reduce the formation of new endometrial foci.

homeopathy

Women who are sterile due to adhesions on the fallopian tubes cannot become pregnant even with homeopathic remedies. The changes in the fallopian tubes are anatomical deficits that greatly reduce the likelihood of fertilization of the egg. Affected women should seek professional help from a gynecologist and, if necessary, take homeopathic treatment as a support.

Indications for an OP

The decision as to whether and how the glued fallopian tubes are treated ultimately depends on how strong the glue is and the extent of the disease. In the case of strong adhesions, drug therapy is not very promising, so the doctor will consider surgical exposure of the fallopian tubes. The operation usually proceeds without complications and restores the fallopian tubes to full functionality.

Procedure of the operation

The operation is either performed as part of a laparoscopy (laparoscopy) or by completely opening the abdomen (laparotomy) carried out. Both procedures are performed under general anesthesia.
During a laparoscopy, a probe is inserted into the abdominal cavity through an incision in the abdominal wall. At the end of the probe there is a camera that the surgeon can use to assess the condition of the pelvic organs. Instruments are inserted into the abdomen through further incisions and the operation is carried out.

The aim of the procedure is to make the fallopian tubes fully functional again. To do this, the glued fallopian tubes are cut open and the adhesions removed so that the fallopian tube is open again. In the case of mild adhesions, irrigation of the fallopian tubes may be sufficient to restore patency. The chances of success of this operation mainly depend on how strongly the fallopian tubes were stuck together or the tissue was damaged.

Risks of the operation

In general, the opening of glued fallopian tubes is considered a procedure with few complications. Even so, there is some risk of complications.

The women who have undergone surgery usually become pregnant after the operation, but they have an increased risk of an ectopic pregnancy. An ectopic pregnancy occurs when the egg cell enters the fallopian tube opened by the operation, but is not transported towards the uterus due to damage in the fallopian tube wall. Ectopic pregnancies are life-threatening for the mother and cannot be carried to term.

Read more about the topic here: Therapy of ectopic pregnancy

forecast

The adhesion of one or both fallopian tubes can have different prognoses depending on the severity of the underlying disease, also with regard to the desire to have children.

For example, endometriosis is a chronic disease that often recurs (relapsed) and the fulfillment of the desire to have children is not always possible depending on the extent.

The prognosis of an inflammation of the fallopian tubes as the cause of the fallopian tubes sticking together is usually very good thanks to targeted and rapid therapy, but can also lead to chronic processes and sticking in some patients, and thus considerably reduce the woman's fertility.

Can you still get pregnant with glued fallopian tubes?

Adhesion to the fallopian tubes is one of the most common reasons why a woman does not become pregnant. Due to the closure of the fallopian tubes, the mature egg cell cannot be transported into the uterus and fertilized there after ovulation. Many women believe that they cannot have children because the fallopian tubes or ovaries stick together. Nowadays, however, there are promising possibilities to treat the stuck fallopian tubes or to enable the affected women to have children.

First of all, the gynecologist diagnoses the adhesions with an ultrasound examination or a laparoscopy. It can then be considered whether the adhesions on the fallopian tubes are treated with medication or whether a surgical procedure is necessary. Treatment can usually restore the fallopian tubes to function and the woman is fertile again.

Artificial fertilization

Artificial insemination is the last option if the women concerned have not responded to drug or surgical treatment or if the surgical opening of the fallopian tubes was not possible. Several egg cells are removed from the woman's ovary and artificially fertilized in the laboratory with the sperm of the partner or a donor. The fertilized egg cells are then implanted directly in the uterus, which bypasses the glued fallopian tubes, so to speak.

Find more information in our article: Artificial fertilization

causes

There are many possible causes that can cause the fallopian tube to stick together and thus reduce a woman's fertility.

One possible cause of the fallopian tubes sticking together is the increasing age of the woman. Since it is the last spontaneous menstrual bleeding (menopause) to a decrease in the fluid secretion or an increase in viscosity (Viscosity increase) the fluid comes, the viscous secretion can stick the fallopian tubes together. In addition, the number of cilia in the fallopian tubes decreases as the woman ages. The consequences are poorer evacuation of the liquid.

In addition, a disease in which benign settlements from the lining of the uterus (Endometrium) occurs in the abdomen and pelvis, lead to the fallopian tubes sticking together. This condition is known as endometriosis and is a possible cause of infertility as a result of the ovaries and fallopian tubes sticking together.

Another cause of the fallopian tubes sticking together is inflammation of the fallopian tubes (Salpingitis) for example from a chlamydial infection. This can affect one or both fallopian tubes. Germs usually rise from the vagina (vagina) or the uterus upwards towards the fallopian tubes (ascend) and can lead to inflammation there due to the spread of germs. Inflammation of the fallopian tubes can damage the cilia of the fallopian tube and cause inflammatory remodeling processes to scar the wall of the fallopian tube.

Read more on the topic: Diseases of the fallopian tubes

diagnosis

There are several ways to check the patency of the fallopian tubes and determine whether the fallopian tubes are sticking.

One possible patency test is the so-called hystero-contrast salpingography (HKSG). A hose (catheter) is inserted through the vagina into the uterus, after which the catheter is fixed there by a small liquid-filled balloon and contrast agent is injected, which is then passed through the vagina via ultrasound (transvaginal sonography) can be tracked. The doctor can now determine whether the contrast medium is flowing into the fallopian tubes and whether they are pervious or sticky.

Another way to identify a glued fallopian tube is so-called chromopertubation. During an operative laparoscopy (Laparasacopy) observes whether a blue color solution (methylene blue, indigo carmine), which was introduced via the uterus, either does not reach the fallopian tube at all (then a constriction (Stenosis) or sticking at the beginning of the fallopian tube near the uterus) or flowing out of the uterus into the fallopian tube, but not leaving it into the abdomen (then there must be a constriction or sticking to the part of the fallopian tube remote from the uterus) or whether the blue fluid from the uterus passes through the Fallopian tube drains into the abdominal cavity (then the fallopian tube is open and everything is fine).

These two examination methods for determining fallopian tube sticking are mainly used. used in women searching for the cause of their infertility.

anatomy

The fallopian tube (Tuba uterina / slapinx) is a paired female sex organ. It lies within the abdominal cavity (Peritoneal cavity), which is called the intraperitoneal location, and provides the connection between the ovaries (Ovaries) and the uterus (uterus) here. The fallopian tube has a length of approx. 10-15 cm and consists of a funnel near the ovary (Infundibulum), which with many fringes (Fimbriae) is equipped to the egg (follicle) after ovulation (ovulation) to receive. The egg is then transferred via the so-called ampulla tuba uterina, an enlargement of the fallopian tube in which fertilization with the male sperm takes place, and a constriction (isthmus) Transported towards the uterus. Since the fallopian tube consists of a layer of muscle (Myosalpinx), the egg can be transported in the direction of the uterus by rhythmic contracting (contractile) Movements are encouraged. Numerous cilia also help (Cilia) the eggs together with the fluid present in the fallopian tube downwards (caudal) to transport.

Both muscle contractions and cilia support the sperm as they migrate towards the fallopian tube dilatation (ampoule) to fertilize the egg at this location.