(Disclaimer: This article is for general use only. The information in the following content has been processed to protect Ms. Zhang’s privacy.)
Abstract: Ms. Zhang had a history of tubal ectopic pregnancy and had been trying to conceive for the last 2 years, but she had not conceived. She was diagnosed with 1) secondary infertility and 2) left tubal atresia. Through hysteroscopic combined with laparoscopic exploration, she was given a tubal stoma on the affected side and both tubes were restored to patency after the operation.
Basic information】Female, 28 years old
Type of disease】Tubal atresia, secondary infertility
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】July 2021
Treatment plan】Surgical treatment (hysteroscopy combined with laparoscopic exploration, tubal ostomy) + medication (cefuroxime sodium for injection, metronidazole injection)
Treatment period】5 days of hospitalization
Treatment effect】Good treatment effect, both fallopian tubes restored
I. Initial consultation
Ms. Zhang described herself as having had one abortion in the past and one ectopic pregnancy in the left fallopian tube in 2017. In July 2021, she came to our clinic for outpatient treatment. After completing infertility-related examinations and tubal imaging, she was found to have poor patency of the right fallopian tube and incompetence of the umbilical end of the left fallopian tube. She was advised that the cause of infertility was probably related to the patency of the fallopian tubes and was recommended to be hospitalized for hysteroscopic combined with laparoscopic surgery to restore patency of both fallopian tubes to facilitate conception again, to which Ms. Zhang agreed. She was admitted to hospital.
II. Treatment history
After admission, she completed the relevant preoperative tests, such as blood routine, coagulation function, liver and kidney function, leucorrhoea test, infectious disease test and electrocardiogram, etc. No significant abnormalities were found. The doctor informed Ms. Zhang in detail about the surgical method, risks and complications, and signed the consent form for surgery and anesthesia, and performed hysteroscopic combined with laparoscopic exploration under general anesthesia on July 23, and placed a guidewire through the hysteroscope to unblock the patency of the right fallopian tube. Cefuroxime sodium for injection and metronidazole injection were given as intravenous anti-inflammatory treatment.
III. Treatment effect
After the operation, Ms. Zhang returned to the ward for observation and her vital signs were normal. After continuing to give intravenous anti-inflammatory treatment for 3 days, the blood routine was rechecked, white blood cell: 8.32×10^9/L, ultrasensitive C-reactive protein: 5.46 mg/L, and intravenous anti-inflammatory was given to stop. After 5 days of hospitalization, Ms. Zhang had no fever and her abdominal wound was healing well, so she was discharged from the hospital. she had her menstrual period again on August 11 and returned to the outpatient clinic for double tubal lavage 3 days after her menstrual period was cleared. the results indicated good patency of both tubes, indicating good treatment effect.
IV. Notes
We are glad that Ms. Zhang’s symptoms have improved after treatment, but we still need to pay attention to some matters in daily life: 1.
1. It is recommended to go to the outpatient clinic for tubal lavage on 3-7 days after menstruation for 2-3 consecutive months to keep the tubes open, after which conception with intercourse can begin.
2. It is recommended to improve the pregnancy preparation examination, avoid contact with toxic substances during the preparation period, pay attention to physical conditioning, scientific and nutritious diet, appropriate exercise and reduce late night.
3.Infertility may also be affected by psychological factors. It is recommended that Ms. Zhang consult a psychology clinic to maintain a good state of mind and relax under the guidance of a doctor, which is more conducive to pregnancy.
4. Ms. Zhang’s husband is recommended to go to the male clinic to improve infertility-related examination.
V. Personal insight
According to the case, Ms. Zhang’s tubal atresia was mostly related to her previous tubal ectopic pregnancy, indicating that inflammation and/or surgical trauma to the fallopian tubes may lead to adhesions at the umbilical end of the tubes and cause atresia. Therefore, women who have been infertile for a long time should undergo tubal imaging as soon as possible to clarify the patency of the fallopian tubes, and early treatment should be given to those who are incompetent or incompetent, otherwise ectopic pregnancy and infertility will easily occur.