Who is the real culprit when the fallopian tubes are blocked?
Pregnancy and childbirth is a complex and miraculous physiological process in which every step is important, and the fallopian tubes are a major contributor, picking up eggs, being the only place for sperm-egg union and transporting fertilized eggs to the uterine cavity. However, the fallopian tubes are the most problematic area. At least 35% of infertile women have fallopian blockage and other pelvic factors, and the trend is gradually increasing. To prevent tubal blockage, we need to start at the source, now let’s find out the real culprits of tubal blockage.
One of the culprits: gynecological inflammation
The result of the hospital examination was a non-gonococcal urethritis, a chlamydial infection. But the disease is recurring and always difficult to cure. When she tried to get pregnant, she couldn’t get pregnant, and when she was examined, she had bilateral interstitial obstruction of the fallopian tubes, which the doctor said could be caused by chlamydia.
The pathogens of pelvic inflammatory disease have two sources, endogenous and exogenous, and the two pathogens can exist separately, but are usually mixed infections. Exogenous pathogens are mainly those of sexually transmitted diseases such as mycoplasma, chlamydia, and gonococcus. Endogenous pathogens come from the microbiota that originally reside in the vagina, including aerobic and anaerobic bacteria. Pathogens that invade the vulva and vagina or are found in the vagina spread along the cervical mucosa, endometrium, and fallopian tube mucosa, to the ovaries and abdominal cavity. This leads to acute cervicitis, endometritis, adnexitis and acute pelvic inflammatory disease. If pelvic inflammatory disease is not properly diagnosed and treated in time, the sequelae of pelvic inflammatory disease, namely chronic pelvic inflammatory disease, may occur. The main changes are tissue destruction, extensive adhesions, hyperplasia and scar formation, leading to
(1) obstruction of the fallopian tubes and thickening of the fallopian tubes;
(2) adhesions to the fallopian tubes and ovaries to form tubo-ovarian masses;
(3) formation of hydronephrosis or tubo-ovarian cysts;
(4) The pelvic nodal tissues become enlarged and thickened, causing adhesions and fixation of the uterus, adnexa and surrounding tissues. Tubal adhesions and blockage can lead to infertility, and the incidence of infertility after chronic pelvic inflammatory disease is 20-30%. If inflammatory infections of the pelvis and genitourinary tract can be eliminated, then the most important factor of tubal blockage can be eliminated in the cradle.
Suggestions: pay attention to sexual hygiene, reduce sexually transmitted diseases; timely standardized treatment of inflammatory diseases of the lower genital tract; timely treatment of pelvic inflammatory diseases to prevent sequelae.
Culprit No. 2: Surgical infection (infection after surgery of the uterus, pelvis and abdominal cavity)
Susan had a perforated appendicitis surgery six years ago, when the surgery went well and there was no discomfort. In the last year, Susan and her husband planned to have a baby, but they were unable to conceive. After examination, it was found that the follicles were developing normally, but the fallopian tubes were blocked. The doctor who treated her told her that a perforated appendix can increase the chances of tubal infertility by 4.8 times.
The female reproductive organs are adjacent to the urethra, bladder, ureter, rectum and appendix, and are not separate and isolated systems; inflammation of any of these organs can involve the fallopian tubes. For example, in appendicitis, the appendix is often located in the right iliac fossa and the lower end can sometimes reach the right fallopian tube and ovary, so women with appendicitis are most likely to have the right fallopian tube, ovary and uterus involved. Therefore, infection after any surgery in the uterine cavity, pelvis and abdominal cavity is also a major cause of tubal obstruction.
If the sterilization of surgical instruments is not qualified; the acute inflammation of the original reproductive system is not controlled; or the surgical indications are not strictly grasped, the preoperative preparation is not adequate, the aseptic operation is not standardized during the surgery; or the personal hygiene is not paid attention to after the surgery and the medical prescriptions are not followed, all of these may cause pelvic inflammatory disease. Therefore, to ensure the unobstructed flow of the fallopian tube, you must go to a hospital with trustworthy medical conditions for surgery, communicate more with your physician and listen to his advice, and pay attention to anti-infection treatment after the uterine operation or after surgery, even if it is a laparotomy away from the fallopian tube.
Culprit No. 3: Postpartum/abortion infection
The company’s main business is to provide a wide range of products and services to the public. But the beauty of the situation is that they have been married for five years, but they are always unable to conceive a child. In fact, she had an accidental pregnancy in the first year of marriage, but they aborted the baby for the sake of their careers. When she came to the infertility clinic, the doctor learned that she had a history of abortion and her menstruation was normal, so she underwent a tubal angiogram and found that her tubes were not working bilaterally.
Induced abortion accounts for a large proportion of hospital outpatient clinics. Due to the early sexual life of our teenagers and the lack of necessary sexual knowledge, this has led to an increase in the rate of unmarried pregnancies and repeat abortions, resulting in an increase in post-abortion complications. The main causes of post-abortion infertility are tubal obstruction, uterine adhesions, endometriosis, etc. After abortion or childbirth, the body’s resistance is weakened, and with the dilated cervical opening not yet well closed, the bacteria present in the cervix may infect the pelvis upstream. If the sterilization is not strict or post-operative anti-infection treatment is not paid attention to, it is easy to cause germs to enter the fallopian tubes, thus causing adhesions and obstruction.
Culprit No. 4: Tuberculosis – tubal tuberculosis
Ms. Yang is 35 years old, but she has not been pregnant since she got married, and she has seen many hospitals, but the cause could not be found. Then she remembered that she had tuberculosis when she was in college. After a thorough examination, she was finally diagnosed with tuberculosis tubal blockage. She was advised to get anti-tuberculosis treatment first and then consider IVF.
Unlike other germs, Mycobacterium tuberculosis can infect the internal genitalia within about one year after infection of the lungs. Tubal tuberculosis accounts for 90%-100% of female genital tuberculosis, i.e. almost all genital tuberculosis involves the fallopian tubes, which are often extensively adherent to their adjacent organs such as ovaries, uterus and intestines.
The tubes are severely damaged by tuberculosis and the mucosal cilia are destroyed, resulting in stiffness, restricted peristalsis and loss of transport function. Once blocked, it is difficult to reopen the tubes non-surgically, and even after surgical reopening, the conception rate is very low. Therefore, the prevention of tuberculosis should be strengthened, BCG vaccination, and active prevention and treatment of tuberculosis.
Culprit No. 5: Endometriosis
Ms. Zheng felt depressed because she had not suffered from gynecological inflammation and had never had any surgery. However, the cause of her years of infertility was really in her fallopian tubes. The doctor asked her if she had dysmenorrhea, and she immediately felt that the doctor was really good at guessing so accurately. She was suffering from painful menstrual cramps. Every time she had a heavy period, she had to take time off work and take painkillers. The doctor said that she was suffering from endometriosis.
The cause of endometriosis is not completely clear, but its onset is related to low fertility, late childbirth, increased caesarean section rate, abortion, increased hysteroscopic operations, the incidence of chronic pelvic pain and dysmenorrhea in patients is 20%-90%, 25%-35% of infertile patients with endometriosis. In moderate and severe cases, repeated bleeding can stimulate the proliferation of surrounding fibrous tissues and adhesions, leading to tubal inaccessibility or affecting the transport of fertilized eggs, which can result in an infertility rate of up to 40% after endometriosis.
Culprit No. 6: congenital abnormal development of fallopian tubes
Abnormal development of the fallopian tubes is one of the causes of infertility and may lead to tubal pregnancy, which is a rare clinical occurrence, i.e. it is a rare phenomenon. For example: congenital unilateral or bilateral absence or malformation of the fallopian tubes, hypoplasia, occlusion or absence of the middle part of the tubes: similar to tubal ligation. There is no way to prevent these problems, some of them can be repaired by surgery, most of them require IVF to fulfill the dream of being a mother.