Hello friends, we meet again this month. Today I would like to discuss with you some questions about the process of preparing for pregnancy. Some women who have been preparing for pregnancy for a while and have not conceived have such and such worries and doubts, among which, tubal problems are the most frequently mentioned by them. How long does it take to check the fallopian tubes? How long do I need to have my tubes checked? What kind of tests are needed? What are the risks of these tests? Let’s start with the anatomy and physiology of the female reproductive organs. In the previous column, we talked about sperm entering from the vaginal cavity through the cervical canal to the uterine cavity and then to the fallopian tube cavity after ejaculation. If at this time, the ovulated egg happens to also enter the fallopian tube cavity, then the sperm will meet and unite with the egg to form a fertilized egg. Afterwards, the fertilized egg has to return from the tubal lumen to the uterine cavity and implant in the endometrium, marking the beginning of pregnancy. If any part of this process goes wrong, or with so little luck, the final result of a smooth fertilization of the egg will not be achieved. Theoretically, any person who is not contraceptive after marriage, has a normal sexual life, and has lived together for 2 years without conception is called infertility. Those who have never had a pregnancy are called primary infertility, while those who have had a pregnancy and are still infertile 2 years later are called secondary infertility. The time in the World Health Organization (WHO) definition of infertility is 1 year, with the aim of early diagnosis and early treatment. The current clinical practice in China is in line with WHO, which also considers those who are ready to have children but have not had them for one year as infertility. At present, domestic sample survey data show that the infertility rate is close to 10%, which means that one out of 10 couples needs to face the problem of infertility. Among the various causes of infertility, female factors account for 40% to 55%, male factors account for 25% to 40%, factors of both spouses account for 20%, and immune and unknown causes account for 10%. Other factors include ovarian luteal insufficiency, uterine malformation, endometrial tuberculosis or inflammation leading to uterine adhesions, multiple abortions leading to endometrial thinning, uterine fibroids, endometriosis and so on. Today we will mainly talk about the fallopian tubes. The fallopian tubes have the function of collecting eggs, transporting sperm and fertilized eggs, and are the site of normal fertilization. Abnormal or non-specific inflammation of the fallopian tubes, endometriosis, various tubal surgeries, and even peri-tubal pathologies such as appendicitis can all cause infertility by affecting the function of the fallopian tubes. These factors may cause mechanical obstruction of the fallopian tubes or affect the peristaltic function of the fallopian tubes and the egg picking function of the umbilical end, resulting in infertility. Many sources have shown that sexually transmitted infections such as gonorrhea, Chlamydia trachomatis, and mycoplasma are associated with infertility, possibly because the infection has caused damage to the fallopian tubes, obstruction, or poor tubal passage. Returning to the question we asked at the beginning of this article: Is there something wrong with my fallopian tubes? In our clinic, we often encounter couples who do not want to have children for various reasons when they are young, strictly contraceptive, or even choose to abort after an unplanned pregnancy. Only when all factors are considered ripe do they start to prepare for pregnancy. It is often the case that when couples prepare for pregnancy for six months and still do not get pregnant, they already get impatient and start going to various hospitals for various tests. Nowadays, it seems that such a mentality and practice is not desirable. First of all, it is not advisable to deliberately use contraception at the optimal reproductive age (before a woman is 28 years old), and it is especially undesirable to have random abortions and medication abortions. Secondly, it is very common to have no pregnancy for six months, and it should be said that it is still normal. Theoretically, the chances of a couple without any infertility factors getting pregnant after one year of normal intercourse are 70 to 80 percent. It is not true that if you prepare for pregnancy, you will get pregnant immediately, there is a skill of having intercourse during ovulation and of course, there is also an element of luck. Only couples who have been preparing for pregnancy for more than 1 year and still have not gotten pregnant need to undergo the appropriate tests, and it is not recommended to do so too early. Moreover, such infertility tests are sequential, following the principle of simple first and then complex, non-invasive first and then invasive. If you start all kinds of tests after six months of pregnancy preparation, sometimes it often turns out to be botched and leads to artificial infertility. If a couple has been preparing for pregnancy for 1 year without conception, they need to start a series of tests. The first of these tests is the semen test for the male partner, followed by the test for the female partner. The female partner’s examination begins with a general medical history and a general gynecologic physical examination and pelvic ultrasound. Then ovarian function examination is performed to understand ovulatory function, endocrine function and ovarian reserve capacity. Common methods include basal body temperature measurement, blood sampling for the six female endocrine tests and ultrasound monitoring of follicular development and ovulation. If no significant abnormality is found in these tests, tubal patency test is required. Because tubal examinations are often invasive and may lead to medical inflammation during the examination, it is recommended that one should be cautious about whether or not to undergo a tubal examination and try to choose a regular hospital that can guarantee strict sterilization. Of course, there are exceptions. If you have a history of ectopic pregnancy, it is recommended that a tubal patency test be performed at the early stage of pregnancy preparation. The main types of tubal patency tests are hysterosalpingography, hysterosalpingography and direct laparoscopic tubal lavage (Melanotomy). Tubal lavage is simple and inexpensive, but not very accurate. Hysterosalpingography can show the uterine cavity and the fallopian tubes. A more objective and accurate method is to perform tubal lavage (US blue) under direct laparoscopic view. Ultrasound with hydrogen peroxide or other positive contrast agents is also used to visualize the uterine tubes. In view of the high number of inquiries in this area, we will use a larger space to explain it below. Tubal lavage is performed by injecting fluid (containing gentamicin, dexamethasone, hyaluronidase and lidocaine) into the uterine cavity through a catheter. The patency of the fallopian tubes is judged according to the amount of resistance, the presence or absence of reflux, the amount of fluid injected and the sensation of the subject when the fluid is pushed. Since it is easy to perform and no special equipment is needed, it is widely used in clinical practice because it can determine the patency of the fallopian tubes and also has the effect of unblocking mild adhesions in the mucosa of the fallopian tubes. It is necessary to avoid menstrual period and inflammation period. During the examination, if 20ml of fluid is injected smoothly without resistance, or if there is a slight resistance at the beginning, and then the resistance disappears and there is no reflux of fluid, and the patient does not feel any discomfort, it indicates that the fallopian tubes are open. If resistance is felt when 5 ml of fluid is injected and the patient feels distension and pain in the lower abdomen, and the fluid flows back into the syringe after stopping the injection, this indicates tubal obstruction. The criterion for a patent fallopian tube is: if there is resistance to pushing the fluid, and then it can be pushed again with pressure, it means that mild adhesions have been separated and the patient feels mild abdominal pain. The patient feels slight abdominal pain. Bathing and sexual intercourse are prohibited for 2 weeks after the examination, and antibiotics can be given to prevent infection as appropriate. Because of the need for timely feedback from the subject on whether or not there is pain during the examination, painless anesthesia cannot be applied, which is the less humane aspect of this examination. Hysterosalpingogram is performed by injecting contrast into the uterine cavity and fallopian tubes through a catheter, fluoroscopy and radiographs under X-ray, and understanding the patency of the fallopian tubes, the site of obstruction and the morphology of the uterine cavity based on the visualization of contrast in the fallopian tubes and pelvis. The test is less invasive and can make a more correct diagnosis of tubal obstruction with an accuracy rate of up to 80% and also has a certain therapeutic effect. The test also needs to avoid menstruation, pregnancy and inflammation. It is contraindicated within 6 weeks after miscarriage or curettage and in patients with iodine allergy. The examination can be performed under painless anesthesia. There are two types of contrast agents: oil (40% iodinated oil) has high density, good contrast effect, low irritation and less allergy, but the examination time is long and absorption is slow, which can easily cause foreign body reaction, granuloma or oil embolism formation; water (76% pantethine glucosamine) has fast absorption and short examination time, but the marginal part of the uterine tube is poorly developed, and subtle lesions are not easily observed. During the examination, if the oil is applied, another pelvic radiograph is needed 24 hours after the examination; if the aqueous agent is applied, the radiograph should be taken immediately after the injection, and a second radiograph 10-20 minutes later is sufficient. The preliminary image interpretation of the radiograph is as follows: the normal uterine cavity is in the shape of an inverted triangle, the bilateral fallopian tubes show a soft morphology, and scattered contrast is seen in the pelvis 24 hours after the radiograph. In the case of tubal abnormalities, the fallopian tubes are irregular, rigid or beaded; in the case of hydrocele, the distal tubes are dilated in the form of a balloon; no scattered contrast is seen in the pelvic cavity on the pelvic radiograph 24 hours later, indicating that the fallopian tubes are incompetent. Likewise, tub bathing and sexual intercourse are prohibited for 2 weeks after contrast. If you are planning to get pregnant, it is better to wait for 2-3 months after the examination before having a baby. The accuracy rate of direct laparoscopic tubal lavage examination or combined hysteroscopic and laparoscopic examination methods can be as high as 90% to 95%, but it is not recommended as a routine examination method because it is an invasive procedure. Usually, tubal lavage (melanin) is performed routinely during laparoscopic surgery in patients with infertility or infertility. Dear friends, the content of the topic we are discussing today is a bit abstract and difficult to understand, if there is any unclear place welcome microblogging @LuneNam to discuss.