Tubal infertility

　　How is tubal infertility caused? The following is a brief description:

　　1. Tubal Hydrosalpinx

　　After the fallopian tube is infected by pathogens, the fallopian tube forms a swollen endometrium under the action of white blood cells, and the stroma appears edematous, with the mucosal epithelium shedding. If not treated promptly and effectively, it can lead to tubal abscess. After the inflammation subsides, the fluid in the lumen gradually changes from purulent to serous.

　　Infection of the fallopian tube in women, if not treated promptly, can lead to a long-lasting infection, further spread, and even tubal infertility.

　　2. Salpingitis

　　1. Gonococcal salpingitis

　　Chlamydia and mycoplasma infections, like gonorrhea, affect the fallopian tubes by ascending infection along the mucosa, through the cervical canal endometrium, endometrium, fallopian tube endometrium to the pelvic peritoneum, but generally without an acute stage, and the initial symptoms of infection are mild, so it does not attract attention, and then leads to tubal blockage.

　　2. Empyema salpingitis

　　Common in incomplete abortion, artificial abortion, and puerperal infection. The pathogenic bacteria are Staphylococcus aureus, Streptococcus, Escherichia coli, and Pseudomonas aeruginosa, causing interstitial salpingitis, isthmus nodular salpingitis, hydrosalpinx, and pyosalpinx.

　　3. Tuberculous salpingitis

　　Mostly secondary infection from pulmonary tuberculosis or peritoneal tuberculosis, accounting for 10% of infertility reasons, mainly through hematogenous infection, part through lymphatic system and direct spread infection. The tuberculosis bacteria first infect the muscular layer or submucosal layer, then develop to the mucosa and serous layer, causing the fallopian tube to slightly enlarge, the wall to thicken, and the surface to present multiple millet-like nodule lesions, adhering to the surrounding tissues. The endometrium of the fallopian tube is infected with tuberculosis bacteria, and the mucosa is destroyed to form caseous necrosis and adhesion.

　　The lesions mainly affect the distal part, with the fimbriae mucosa swelling and being everted into a funnel shape, which may not be closed. If secondary infection occurs, the contents of the tube may become purulent, and tubal peritubal tuberculosis can also be formed, which can widely adhere to surrounding organs. Superficial lesions can continue to develop into the interstitial and mucosal tissues of the tube wall, causing infertility.

　　3. Tubal blockage

　　Tubal blockage can generally be divided into primary and secondary types. Primary refers to congenital, present at birth, but it is very rare. Secondary is caused by postnatal factors and is the main cause of the disease. Secondary can be further divided into mechanical and pathological. Infertility caused by tubal blockage usually has no special symptoms, mainly caused by inflammation of the fallopian tubes. In the early stage of the disease, patients will not show obvious symptoms, and it is often found that there are no children for 2 to 3 years after marriage.

　　In most cases, when patients with fallopian tube blockage go to the hospital for confirmation and examination, they have already developed a chronic infection state, manifested as chronic interstitial salpingitis. At this time, the fallopian tube wall has been infiltrated by lymphocytes, and the mucosal epithelial cells have become hypertrophic. Over time, it will cause fibrosis of the tissue, making the fallopian tube thickened or curled.

　　The pathogenesis of this disease is not very clear, possibly due to chronic infection causing the fimbriae to block, with the fallopian tube fluid and inflammatory exudate accumulating in the ampulla. The isthmus wall is thick and the cavity is narrow and thin. If there is adhesion and blockage, it is difficult to expel the fluid in the tube, which is not easily absorbed, forming cystic fluid. There is no adhesion or only mild adhesion with adjacent tissues.

　　What diseases can tubal infertility cause? Briefly described as follows:

　　1. Infertility after marriage

　　After the fallopian tubes are blocked, the fallopian tubes themselves are damaged by the disease, leading to blockage, and ultimately causing infertility. Secondary infertility is more common.

　　2. Dysmenorrhea

　　Dysmenorrhea caused by pelvic congestion often begins with abdominal pain one week before the menstrual period, and becomes more severe as the menstrual period approaches, until menstruation arrives.

　　3. Abdominal discomfort

　　Patients have varying degrees of pain in the lower abdomen, mostly hidden discomfort, and there may also be soreness and distension in the lumbar and sacral area, or a sinking sensation, which often worsens due to fatigue.

　　4. Menstrual irregularity

　　The fallopian tube and ovary are adjacent. Generally, the disease of the fallopian tube will not affect the function of the ovary, nor will it have any effect on the amount of menstrual blood. However, when the inflammation spreads to the ovary and causes damage to the function of the ovary, abnormal menstruation may occur.

　　What are the symptoms of tubal infertility? Briefly described as follows:

　　I. Symptoms of tubal infertility

　　1. Symptoms of tubal obstruction: Patients generally have no obvious clinical symptoms, mainly manifested as infertility, and some patients with hydrosalpinx have symptoms of chronic abdominal pain.

　　2. Symptoms of acute salpingitis: Acute onset of lower abdominal pain and distension, frequent urination, dysuria, vaginal discharge of purulent blood, accompanied by chills and fever, and may have abdominal distension, constipation, or diarrhea. If the disease occurs during the menstrual period or after abortion, the amount of bleeding increases, the menstrual period is prolonged, and there may be a history of gynecological disease or sexual contact with sexually transmitted diseases.

　　3. Symptoms of chronic salpingitis: There may be no significant discomfort, and primary or secondary infertility is treated. Some patients have hidden lower abdominal pain, sacral and coccygeal tenderness, which worsens during the menstrual period, after sexual intercourse, or during physical exertion; daily leukorrhea increases, menstrual volume is more, menstrual period is prolonged, dysmenorrhea, etc. There may be a history of pelvic inflammatory disease and cervicitis.

　　II. Signs of tubal infertility

　　Physical examination shows lower abdominal tenderness; bimanual examination shows retroverted uterus with poor mobility, severe cases are completely fixed, moving the cervix or uterus is painful, the parauterine area can palpate thickened fallopian tubes or masses with tenderness; hydrosalpinx can palpate cystic masses, which are mobile and painless.

　　How to prevent tubal infertility? Briefly described as follows:

　　1. Prevention of vaginal infection

　　The occurrence and development of diseases all have a process and a cause. For tubal infection, it is mainly necessary to focus on the prevention of vaginitis and endometritis, especially vaginal infection, which is a key 'gateway' for many reproductive system diseases. Paying attention to the protection of the reproductive system, maintaining sexual hygiene, and preventing sexually transmitted diseases is an extremely important link.

　　2. Caution in induced abortion

　　Induced abortion is also a major cause of tubal obstruction: during induced abortion, due to mechanical or pharmacological stimulation, the uterine smooth muscle undergoes tonic contraction, and the contents of the uterine cavity not only move towards the cervix but also enter the fallopian tube cavity. The tissues entering the fallopian tube cavity are prone to retention and organization, and if the fallopian tube cavity is completely blocked, infertility will occur; if it forms a semi-blocked state, the fallopian tube will not be smooth, which is easy to form ectopic pregnancy. Therefore, abortion should be done cautiously before childbirth. In addition, once there is inflammation of the reproductive system and pelvic and abdominal cavity, it is necessary to actively seek the help of a specialist doctor for effective treatment. Many causes of tubal obstruction are due to inappropriate and excessive diagnosis and treatment during the process of diagnosing infertility, such as repeated hydrotubation and curettage treatment in some small clinics.

　　3. Prevent inflammation

　　The main cause of tubal obstruction is inflammation, including the obstruction of the fallopian tube lumen caused by salpingitis and the obstruction of the ostium caused by pelvic inflammatory disease. Therefore, paying attention to the cleanliness and hygiene of the reproductive system and preventing infections by various pathogens (especially sexually transmitted diseases) is the most crucial. In addition, ectopic pregnancy is actually mostly caused by inflammation that partially blocks the fallopian tubes. After an ectopic pregnancy occurs, it should be avoided to perform laparotomy for tubal resection and try to use laparoscopic tubal fenestration. If the situation permits, conservative therapy can also be used, which can preserve the fallopian tubes.

　　4. Timely diagnosis and prompt treatment

　　There are many ways to make a timely diagnosis, such as fallopian tube insufflation test, fallopian tube irrigation test, hysterosalpingography, uterine and fallopian tube ultrasound examination, endoscopy (laparoscopy, hysteroscopy, fallopian tube endoscopy), radioactive isotope hysterosalpingography, and other examinations. These are generally available in specialized hospitals. If necessary, an exploratory laparotomy can also be performed, in short, a timely and clear diagnosis can be made. Early and clear diagnosis is beneficial for controlling the progression of the disease.

　　What examinations should be done for tubal infertility? Briefly described as follows:

　　1. Fallopian tube insufflation and hydrodistension

　　This examination method is relatively rough and the results are not very accurate. Even when the fallopian tubes are shown to be patent, it cannot be determined whether it is unilateral or bilateral patency. Sometimes, when the surrounding tissues of the distal end of the fallopian tubes are partially adherent, although the fallopian tubes are still patent, it can still affect fertility; when there is hydrosalpinx, it can also contain more than 20ml of fluid to produce a false impression; and relying solely on the operator's feeling of resistance when injecting fluid and whether the patient has abdominal pain to make a judgment is blind. There is a risk of air embolism when gas is inhaled into the blood vessels during the pneumoperitoneum procedure. Therefore, these two methods for examining the patency of the fallopian tubes are no longer used. The hydrosalpinx procedure is still used as a treatment method because it has a certain therapeutic effect on salpingitis.

　　2. Uterine and fallopian tube iodine oil contrast (HSG)

　　The results of the HSG examination are relatively reliable and non-invasive, making it a simple and widely used method for examining the uterus and fallopian tubes. With the help of HSG, one can judge the position of the uterus, the shape of the uterine cavity, the condition of the endometrium, the shape of the fallopian tubes, the condition of the endometrial lining, and whether the tubes are patent. It can also determine whether there is adhesion around the distal end of the fallopian tubes based on the degree of dispersion of the contrast medium in the pelvic cavity, and it has a certain therapeutic effect on mild fallopian tube inflammation and adhesions.

　　3. Fallopian tube ultrasound patency test and uterine tubal ultrasound contrast

　　With the development of ultrasound diagnostic technology, hydrotubation under ultrasound guidance has been widely used in clinical practice. It has good sensitivity and specificity for fallopian tube patency detection, with the advantages of simple operation, safety and non-invasive, less time-consuming, and not affected by radiation. It can be dynamically and continuously repeated multiple times for detection. The liquid used is warm physiological saline added with gentamicin, dexamethasone,α. -Chymotrypsin and lidocaine, after the patient undergoes hydrotubation, B-ultrasound is used to observe the best section to observe the uterine filling condition, whether there is dynamic liquid imaging extending to both sides at the uterine horn, observe whether the fallopian tube is thickened and whether there is effusion in the uterine rectal陷凹, according to the分流 and accumulation of liquid in the uterine cavity, the image through the fallopian tube and the effusion in the adnexal area and the uterine rectal fossa, combined with the resistance and reflux during injection, clinical judgment can be more accurately diagnosed the patency of the fallopian tube. The method of uterine tubal ultrasound contrast is the same as that of fallopian tube ultrasound patency test, but 1.5% hydrogen peroxide is added to the liquid used for hydrotubation as a contrast agent and injected into the uterine cavity. Ultrasound observation of the filling condition of liquid and gas in the uterine cavity and the dynamic image of the liquid passing through the fallopian tube and microbubble overflow can accurately judge the patency of the fallopian tube, and clearly identify the patency or non-patency of the fallopian tube side. Sometimes, the process from blockage to patency can be observed. Therefore, hydrogen peroxide fallopian tube contrast can improve the accuracy of diagnosis of fallopian tube patency and blockage location.

　　There are some food therapy recipes for tubal infertility patients, here are three for your reference.

　　1. Stir-fried shrimps with rice wine：Fresh shrimps 400 grams, 250 grams of rice wine, vegetable oil, scallion whites, and ginger juice in appropriate amounts.

　　Wash the shrimps clean and remove the shells, soak them in rice wine for 10 minutes. Heat the vegetable oil in a hot pot, add scallion whites to stir-fry, add the shrimps, salt, and ginger, and stir-fry continuously until they are cooked. Take 50 to 100 grams per time, once a day, suitable for people with kidney yang deficiency, cold limbs, and lack of libido.

　　2. Yang-boosting dog meat soup：Dog meat 2000 grams, donkey's tail 30 grams, fuzi 15 grams, salt 5 grams, monosodium glutamate, scallion whites, ginger, and Shaoxing wine in appropriate amounts.

　　Wash the dog meat clean, put it in the pot whole, boil it through with boiling water, remove it into cold water, wash off the blood, dry the moisture, and cut it into long strips. Clean the ginger and scallion, slice the ginger, and cut the scallion into segments. Place the pot on the stove, add the dog meat and ginger slices, stir-fry, pour in Shaoxing wine to scald the pot, and then pour it all into a large pot at the same time. Wrap the donkey's tail and fuzi in cheesecloth and put it in the pot. Add clear soup, salt, monosodium glutamate, and scallion whites, place it on the strong fire to boil, skim off the foam, cover the lid, and simmer over low heat for 2 hours until the dog meat is tender and well-done. Remove the ginger and scallion whites, adjust the taste, and serve in 10 portions. Take 1 portion per day, 1 portion per time, on an empty stomach in the morning, especially in winter, which is more suitable for people with kidney yang deficiency. It is suitable for infertility due to kidney yang deficiency.

　　3. Hongqi活血汤：Goji berries 15 grams, 3 live crucian carps, coriander, scallion, sesame oil, Shaoxing wine, ground pepper, ginger juice, salt, monosodium glutamate in appropriate amounts, lard 50 grams, vinegar 75 grams, milk soup 250 milliliters, clear soup 750 milliliters.

　　Clean the crucian carp, remove the internal organs, blanch it slightly with boiling water, wash it clean with cold water, and cut straight lines on one side of the fish every 1.5 cm wide. Wash the coriander and cut it into sections, chop the scallion finely and flower it, put lard in the pan, place it on high heat and bring it to a boil, then add ground pepper, chopped scallion, and ginger juice, followed by adding clear soup, cream, ginger juice, cooking wine, monosodium glutamate, and salt, at the same time, put the fish in a pot of boiling water and blanch for 4 minutes, remove it and put it in the pot with soup, wash the goji berries with clean water and add them to the pot, place it on high heat and bring it to a boil, then change to low heat and simmer for 20 minutes, add scallion threads, coriander sections, vinegar, and sesame oil, and it is ready. This dish can be served as a side dish, taken once a day, and is recommended to be eaten regularly. It is suitable for infertility due to kidney Yin deficiency.

　　What are the methods for treating tubal infertility? Briefly described as follows:

　　1. Laparotomy and adhesion dissection surgery

　　Microsurgical surgery is still one of the important methods for treating infertility caused by fallopian tube factors. It is often used for fallopian tube anastomosis in patients who need to have children again after tubal ligation or in patients with obstructive infertility caused by inflammation. In the operation, scar tissue or inflamed obstructive parts are resected, and the two ends are sutured together to achieve fallopian tube patency; for patients with obstructive fallopian tube isthmus, fallopian tube cornual implantation surgery is performed, that is, the obstructed part of the fallopian tube is resected and a conical incision is made at the cornu, and the patent part of the fallopian tube is implanted into the uterine cavity; for patients with adhesions around the distal end of the fallopian tube, adhesion dissection is performed when conservative treatment is ineffective, and attention should be paid to avoid injury to the blood vessels around the ostium and the serosal layer of the fallopian tube during the operation to prevent recurrence of adhesions and narrowing of the fallopian tube; when the distal end of the fallopian tube is completely adherent and sealed or nodular accumulation of fluid cannot be separated, then only fallopian tube ostomy and fallopian tube ostium shaping surgery can be performed.

　　2. Laparoscopic treatment

　　The clinical application of laparoscopic technology has opened up new avenues for the diagnosis and treatment of infertility, while also avoiding unnecessary laparotomy and enabling comprehensive observation of the pelvis, thereby making a comprehensive evaluation of the morphology and lesions of the uterus, ovaries, and fallopian tubes. Due to the small injury and rapid recovery of laparoscopic surgery, it is increasingly favored by both doctors and patients. While laparoscopy can make an accurate evaluation of the morphological structure and lesions of pelvic organs, it can also perform corresponding pelvic adhesion dissection and fallopian tube ostomy according to the lesions, only through laparoscopic surgery can it restore the normal anatomical shape and function. Hysteroscopy can directly inspect the lesions within the uterine cavity, locate sampling and treatment, which is more intuitive, accurate, and reliable than traditional HSG and B-ultrasound examination, reducing missed diagnoses and significantly improving the accuracy of diagnosis. Fallopian tube microscopy is a microendoscope used for fallopian tube cavity examination, which not only can observe the physiological or pathological conditions inside the fallopian tube but also can treat certain fallopian tube lesions, and can have a direct understanding of the mucosa of the fallopian tube, while also removing fragments or adhesions within the lumen to formulate corresponding treatment plans, improve fertility, and correct false fallopian tube obstruction diagnosed by HSG and other examinations. The combination of laparoscopy with hysteroscopy and fallopian tube microscopy has been widely used in the diagnosis and treatment of infertility.

　　3. Endoscopic Technology

　　The development of endoscopic technology will bring greater blessings to infertile patients. The image clarity of the 3mm micro-laparoscope is similar to that of conventional laparoscopes and can complete surgical operations that can be completed by conventional laparoscopic instruments in the diagnosis and treatment of infertility. Transvaginal hydroscopic laparoscopy (THL) is a puncture from 10mm below the cervix under abdominal B-ultrasound monitoring into the uterine rectal凹陷, and then a micro-laparoscope is inserted into the pelvic cavity for observation, opening up a new way for laparoscopic examination of infertility. It has the advantages of accuracy, safety, economy, no hospitalization, no need for general anesthesia, etc., and can shorten the diagnosis and treatment cycle for patients, improve pregnancy rate, and its combined application with hysteroscopy will be better.

　　4. Integrated Traditional Chinese and Western Medicine Treatment

　　Traditional Chinese medicine believes that salpingitis and obstruction are related to damp-heat stagnation, qi stagnation and blood stasis, cold-damp congealing, spleen deficiency and dampness stasis, and kidney yang deficiency. Some studies have shown that rectal medication can be absorbed by 50% to 70%, and the female uterus and fallopian tubes are adjacent to the rectum. The rectal mucosa has rich blood supply, and the enema solution can directly reach the disease site through the absorption of the rectal venous plexus, fully exerting the therapeutic effect of the drug, which can promote local pelvic blood circulation, allowing the effective components of the drug to act directly on the local fallopian tube, or penetrate through the rectal mucosa and absorb, promoting the softening of proliferative adhesion tissue, eliminating local congestion and edema, accelerating the repair of fibrous scar tissue, and enhancing the function of the fallopian tube lumen mucosal cilia, thereby effectively maintaining the permeability of the fallopian tube, significantly improving the function of the fallopian tube, and regulating the reactivity of the fallopian tube smooth muscle. Through laparoscopic operation, the adhered fallopian tubes can be directly separated to achieve patency, and then combined with traditional Chinese medicine enema to achieve the therapeutic goal, which has both diagnostic and therapeutic effects, is simple with minimal injury, and the synergistic effect of the two is a safe and effective method for treating tubal infertility. Due to technical limitations, there are still many defects in the diagnosis and treatment of infertility, but with the continuous improvement of medical technology, the diagnosis and treatment of infertility will also be further improved.