Determination of cross-country ability fallopian tubes- one of the most important components in identifying the causes of infertility in women. Statistics show that approximately 35% of infertility in women is associated precisely with tubal factors, because one of the necessary and most important conditions for fertilization is the ability of the fallopian tube to carry the egg toward the sperm.

Laparoscopic chromopertubation is now considered the “golden” standard for determining fallopian tube patency. But this is a rather complex procedure that requires hospitalization of the patient and general anesthesia, since the essence of the study is to make an incision in the abdominal wall and monitor the patency of the fallopian tubes under direct supervision.

Another common method is x-ray examination, in which a special substance (“contrast”) is injected into the fallopian tubes, which is impenetrable to x-rays. But this method has its own rather serious drawbacks - the use of rather dangerous x-rays and the possibility of developing an allergic reaction to the contrast agent.

The accuracy of the methods described above is quite high, so the most accurate option is laparoscopic chromopertubation, the accuracy of which is close to 100%. But both of these methods have their drawbacks, so recently hydrotubation (ultrasound of fallopian tube patency) has been increasingly used. This study provides fairly accurate data, so its accuracy is about 90% and in 89% of cases coincides with the results of laparoscopic chromopertubation, while it is not such a difficult procedure to perform, does not require hospitalization of the patient, and is absolutely safe for human body. Thanks to all these parameters, ultrasound of the fallopian tubes has become the method of choice for the initial diagnosis of the causes of infertility in women, in particular, to determine the patency of the fallopian tubes.

When performing hydrotubation, a special solution is injected into the fallopian tubes and uterine cavity, which is “visible” to ultrasound. An indicator is the appearance of injected fluid near the ovaries - this means that the fallopian tubes are passable. And although this technique does not allow us to examine specific points of tubal narrowing or obstruction, but the data obtained during this procedure often plays a key role in determining the causes of infertility.

What are the causes of tubal obstruction and in what situations can it develop?

What could be the reason for the development of such a problem? There are quite a lot of options, and there are quite a lot of diseases and problems that lead to such consequences. The most common reasons for the development of fallopian tube obstruction are:

• various inflammations that are associated with sexually transmitted infections. Due to such inflammations, obstruction often develops. Such infections include chlamydia, gonorrhea, mycoplasmosis, ureaplasmosis, trichomoniasis, etc. diseases;
• obstruction can also develop due to nonspecific inflammatory processes in the fallopian tubes. This problem usually develops due to bacteria that in good condition live in a woman’s body, but for some reason their number may increase, or they populate places unusual for them, which becomes the cause of the development of inflammation. This can happen if bacteria from the intestines, for example, enter the genitals;
• One of the rare causes is various congenital anatomical anomalies that are associated with the absence of part of the fallopian tubes. Although such problems are extremely rare, they require quite complex treatment;
• the cause may be severe stenosis or fusion of the fallopian tube. Most often, the appearance of such a problem is associated with gross therapeutic or diagnostic intervention in the uterine cavity. So, a similar problem can develop after curettage of the walls of the uterus with excessive scraping, when the basal layer is exposed, causing scar tissue to form. Sometimes such a complication occurs after an abortion;
• Also, the cause of the development of such a problem can be surgical intervention in the abdominal organs and, especially in various purulent-inflammatory processes. So, the cause may be appendicitis with peritonitis, phlegmonous appendicitis, ulcers on the ovaries. Such operations lead to the formation large quantity adhesions, which also form in the fallopian tubes, leading to the development of obstruction.

Characteristic is the fact that most problems leading to obstruction do not manifest themselves with any symptoms. Therefore, you should know that the development of such a pathology is possible if:

• you have had a sexually transmitted infection, especially in cases where the infection was not diagnosed and treated immediately, or you were sick several times;
• you suffer from inflammation of the ovaries of a nonspecific etiology;
• does not occur after an abortion (especially in cases where it was accompanied by complications);
• An operation was performed during which there was pus in the abdomen.

In all of these cases, the risk of developing pathology is significantly increased, so you should immediately consult a doctor for advice.

What are the advantages of this diagnostic technique?

Hydrotubation of the fallopian tubes is one of the most common methods for early diagnosis of obstruction. Doctors often prescribe it, since this technique has a number of advantages over others. So, one of the main advantages is safety. Since ultrasound does not use ionizing radiation, this technique does not harm the patient’s body, therefore, if necessary, it can be performed even several times in a row. This advantage also includes the absence of the need for hospitalization of the patient, which is necessary in some other studies.

Also undoubted advantages this method diagnostics is the speed of the study, prevalence and relative cheapness. Ultrasound machines are now available in almost every self-respecting clinic, and there are quite a lot of qualified specialists who work on them.

It is also worth mentioning separately high precision and information content of this technique. In the standard version, a conventional two-dimensional study is performed, the main disadvantage of which is the inability to examine the fallopian tube completely, since it bends in three planes. The solution to this problem was 3D and 4D ultrasound, which allows you to build a three-dimensional and fairly accurate and detailed image.

Practice shows that this technique allows one to obtain results that in 91% of cases coincide with the results of laparoscopy. But the reason for the discrepancy often lies in the fact that ultrasound is an operator-dependent method; in it, much is decided by the qualifications and experience of the person who conducts the study. Also, other factors can affect the quality of an ultrasound examination - gases, obesity, etc.

Hydrotubation is the introduction of a special liquid through the uterine cavity into the fallopian tubes in order to assess their condition or treat obstruction. It has been used for this purpose for more than 50 years. In modern medicine, this manipulation is used less and less to diagnose tubal infertility. However, it has advantages over other methods of "blowing" pipes.

Indications for the procedure

The fallopian tubes play a large role in the process of conception. They are necessary for the movement of a mature egg towards the sperm. If the patency is impaired in any way, fertility is significantly reduced, and in 25% of cases, conception becomes impossible.

Preparation for hydrotubation involves emptying the bowel and bladder.

A special apparatus is used to blow out pipes. It is equipped with a vessel for isotonic sodium chloride solution and a uterine probe connected to a control cuff.

Hydrotubation scheme: 1 - uterine probe; 2 - syringe for medicine; 3 - vessel for isotonic sodium chloride solution; 4- pressure gauge

For diagnostic purposes, an isotonic solution is injected into the fallopian tubes, observing the general condition of the patient and pressure indicators in the uterine cavity.

If the organs are patency, the fluid is introduced freely, does not spill out, and a drop in pressure (60 mm Hg) is noted on the recorder tape. Partial obstruction of the pipes causes a decrease in pressure to 100-120 mm Hg. Art., and with complete fusion there is no decrease in indicators. The flow of liquid stops and it begins to flow back.

The patient may experience pain of varying degrees of intensity, which is regarded as a basis for stopping the procedure. After hydrotubation, the woman should be in medical institution under medical supervision for several hours.

Therapeutic hydrotubation

WITH therapeutic purpose manipulation is carried out during the intermenstrual period. Typically, 5-6 manipulations are required over several cycles. Various are used for the medicinal solution. medicines, which are combined with novocaine or isotonic sodium chloride solution.

There is no consensus among doctors about the number of procedures that will be optimal for treatment. Some experts believe that 5-6 will not be enough and their number should be increased to 12-15.

Typically, the following medications are used:

• antibacterial agents - penicillin, streptomycin;
• corticosteroids – (hydrocortisone, prednisolone) to relieve inflammation and allergic reactions;
• lidase for resorption of adhesive scars;
• proteolytic enzymes - (trypsin, chymotrypsin), which have an antimicrobial effect.

Hydrotubation leads to an improvement in the condition of the fallopian tubes and effective separation of adhesions. It is prescribed in a comprehensive treatment protocol with electrophoresis, ultrasound, and gynecological massage. During the treatment period, sexual intercourse or the use of contraception is excluded.

A positive result can only be achieved if non-stop therapy is followed for three cycles, although their number may vary depending on the degree of obstruction, general health, the body's response to the procedures and other factors.

Hydrotubation also refers to therapeutic measures after cyst removal. It is prescribed during the recovery period after. The administration of medicinal fluids prevents the formation of adhesions.

The most effective results are achieved using chymotrypsin and a combination of pipe blowing with physiotherapy.

Therapeutic hydrotubation is contraindicated in the presence of acute inflammatory processes and infectious diseases.

Complications

Negative consequences occur in approximately 5% of patients. These include:

• a sharp rise in body temperature;
• painful spasms of the tubes or their ruptures;
• allergic reactions to administered medications;
• pathological changes in the cervix;
• exacerbation of inflammatory processes in the genital organs.

Ruptures occur due to the introduction of an excessive volume of fluid, which happens in exceptional cases. Most a common complication are painful sensations that are accompanied by pallor skin, falling heart rate, intermittent breathing. Sharp pain occurs against the background of defective endometrium, in the presence of polyps or. To reduce the risk of such a complication, it is recommended to reduce the volume of injected fluid and the level of pressure in the device.

Complications associated with exacerbation of the inflammatory process make themselves felt several days later. There is an increase in temperature, general weakness, and minor pain in the groin area. To prevent inflammation, antibiotics and sulfa drugs are prescribed.

Some patients experience allergic reactions after the administration of a certain drug. Possible redness of the skin, swelling of the mucous membranes, cough, intermittent breathing. In such cases, exclude the drug that caused the allergy.

Pregnancy after hydrotubation

Throughout treatment, it is recommended to protect against conception (read about contraceptive methods). After therapy, pregnancy can occur in the first month menstrual cycle. However, such a pregnancy can often be interrupted early stages or turn out to be ectopic.

During two or three menstrual cycles it is necessary to take contraceptives and only after the end of the rehabilitation period to plan a pregnancy. Successful conception noted in approximately a third of patients.

After therapeutic hydrotubation, the disappearance of signs of inflammation is noted, which is confirmed by the results of a vaginal examination. Most patients experience normal menstruation, restoration of the menstrual cycle and feelings of sexual desire.

In the absence of a positive result, they resort to fertilization of the egg with a sperm outside the body with further transfer of the embryo to the uterus.

Although you may hear the opinion that hydrotubation is an outdated method, reviews from many women indicate its effectiveness and safety.

One of the brightest events in a woman’s life is motherhood. Her whole nature is subordinated to this the most important task, thanks to which the human race is extended. However, due to various circumstances, a woman is deprived of the opportunity to become pregnant, and in many cases this is due to obstruction of the fallopian tubes.

Why do you need to bleed the fallopian tubes?

To understand in more detail what role the fallopian tubes play in the process of conceiving a child, you need to look at a schematic representation of the female genital organs.

The diagram shows the fallopian tubes located above the testicles

The uterine or fallopian tubes, having a length of 10–12 cm and a lumen diameter of 5 mm, play vital role during the process of conception, the mature egg moves along them towards the sperm. If the patency of the fallopian tubes is disrupted, the traditional process of fertilizing the egg becomes impossible, since it becomes blocked in the ovary, which leads to infertility. If there is no patency of one tube, the likelihood of conception is reduced by 50%. In this case, it becomes necessary to carry out the procedure of blowing out the fallopian tubes.

What is the procedure

If a problem of infertility arises, it is necessary to conduct a detailed examination, which will answer the question of what is the cause of this pathology. There are many such reasons, but very often the culprit is the obstruction of the fallopian tubes, which can be disrupted as a result of an unsuccessful abortion, inflammatory diseases uterus and appendages, hormonal disorders, etc.

Infertility is a serious problem for many women

Pipe blowing is both diagnostic and medical procedure. On the one hand, it allows you to determine the degree of patency of the pipe, and on the other, to restore this patency if there are no serious violations that require special measures.

The blowing procedure is performed for women with complaints of infertility, who do not have inflammatory diseases of the genital organs in the acute and subacute stages, as well as chronic diseases in the acute phase. In order to exclude the presence of these pathologies, appropriate laboratory tests are first carried out and a smear is taken from the vagina.

Methods of manipulation

Blowing of the fallopian tubes can be done either with air - pertubation, or with liquid - hydrotubation.

Pertubation

Before pertubation, the patient needs to undergo special preparation - the evening before the procedure, cleanse the intestines with an enema and immediately before the procedure, empty the bladder. It is also desirable for the patient to stay in the middle of the menstrual cycle - from 8 to 20 days. The procedure cannot be performed before or during menstruation.

Pertubation is carried out by a gynecologist who uses a special apparatus equipped with an oxygen tank and a rubber tube with a special tip inserted into the cervical canal of the cervix.

The procedure is performed by a gynecologist

At the beginning of the procedure, the doctor will disinfect the external genitalia and vaginal cavity, and then, using gynecological instruments, insert the tip of the tube into the cervix. After installing the tip, a gentle air supply begins.

With normal patency of pipes, air freely enters abdominal cavity. In this case, a pressure gauge installed on the device supplying air will demonstrate a drop in pressure in the system. In addition, the noise created by the movement of air will be clearly audible in the abdominal cavity. If the tubes are blocked, air will accumulate in the uterus. The patient should not worry about the fact that excessive air pressure injures the tubes or walls of the uterus - for the blowing procedure, a pressure that is safe for the internal genital organs is recommended - no higher than 150 mm Hg.

Hydrotubation

Hydrotubation is in many ways similar to pertubation, but with this procedure, the patency of the fallopian tubes is diagnosed using a fluid, which is also injected under pressure into the uterine cavity. At the same time, hydrotubation, unlike pertubation, is carried out not so much for diagnostic purposes as for therapeutic purposes, helping to restore the full functioning of the fallopian tubes.

In the recent past, hydrotubation, along with pertubation, was used for diagnostic and therapeutic purposes. Today, this procedure is mostly used after laparoscopic surgery on the fallopian tubes as a means of monitoring the postoperative condition of the tube and preventing inflammation and the formation of adhesions.

The diagram shows the process of hydrotubation using a special apparatus: 1 - uterine probe connected to a control cuff (bottom); 2 - syringe for medicine; 3 - vessel for isotonic sodium chloride solution; 4- pressure gauge; 5 - indicators; 6 - “speed” knob; 7 - “time” knob; 8 - recording device; 9 - “network” key; 10 - “stop” key; 11 - “reset” key; 12 - “start” key

Before hydrotubation, the patient must undergo the same preparation as for pertubation. The procedure is usually performed on an outpatient basis. The gynecologist uses a syringe or a special device to inject liquid into the uterine cavity. Most often it is isotonic saline solution or a solution of novocaine with antibacterial or steroid drugs - it all depends on the goal that the procedure should achieve. To resolve adhesions, the injected solution may contain lidase, which eliminates scars.

If the pipes are passable, the liquid is introduced without effort and does not leak out. With partial obstruction, the solution enters the uterus slowly, and with complete obstruction, the introduction of fluid gradually begins to be accompanied by pain in the groin area, which increases as the pressure on the walls of the uterus increases.

In the case when the procedure is carried out using a device equipped with control sensors, the doctor can judge the condition of the fallopian tubes, focusing on readings of fluid pressure in the system.

Laparoscopy and tubal patency testing

Under laparoscopy in in this case implies minimally invasive surgery on the internal genital organs, carried out using special equipment- laparoscope. During this operation, traditional surgical incisions are not made, but several small punctures are made through which special instruments equipped with fiber optics are inserted. This technique allows not only to detect pathologies of the uterus and appendages, but also to eliminate many of them.

Surgery using a laparoscope will help eliminate adhesions that interfere with the normal patency of the fallopian tubes

The operating surgeon controls the progress of the operation, which is reflected on a color monitor. With the help of laparoscopy, a number of causes of tubal obstruction can be effectively eliminated - adhesions, small tumors, etc. This operation is resorted to in cases where pertubation and hydrotubation cannot bring the desired result.

Contraindications and consequences

The procedure for blowing out the fallopian tubes is prohibited in the following cases:

• during mud treatment;
• in the presence of inflammatory diseases of the pelvic organs and external genitalia;
• in the presence of malignant neoplasms of the female genital area;
• if there is bleeding from the vagina;
• if pregnancy is suspected.

• colpitis
• endocervicitis

In addition, this fairly simple procedure carries certain risks if not carried out properly. If all necessary measures precautions on the part of the gynecologist, the patient may experience injury, or in the most undesirable case, rupture of the fallopian tubes and uterus, which is fraught with serious consequences.

When can you get pregnant after blowing?

If it is possible to restore the patency of the fallopian tubes, pregnancy can occur immediately. If you still cannot conceive a child, you need to look for another cause of infertility. With persistent tubal obstruction, the patient has a chance to become pregnant using the in vitro fertilization method, when the woman’s egg is fertilized with her husband’s sperm outside female body, and the already fertilized cell is planted in the mother’s uterus for further maturation.

Blowing pipes can result in happy motherhood

Establishing the patency of the fallopian tubes takes important place in diagnostics. According to statistics, about 35% of all cases of female infertility are caused by tubal factors. The ability of the fallopian tube to carry the egg towards the sperm is a necessary condition for successful fertilization. Currently, the gold standard for determining tubal patency is laparoscopic chromopertubation. This procedure requires hospitalization of the patient and general anesthesia, since the essence of the study is to insert a laparoscope through an incision in the anterior abdominal wall and monitor the patency of the fallopian tube directly under visual control on the monitor. X-ray hysterosalpingography is also used to determine the patency of the fallopian tubes. To carry it out, a substance that is impenetrable to X-rays is injected into the uterine cavity and fallopian tubes. The undesirable effects of such a diagnostic procedure are the impact of X-rays on the woman’s reproductive organs and the likelihood of developing allergic reactions to the contrast agent.

Despite the fact that laparoscopic chromopertubation is the most accurate diagnostic method, the accuracy of which is almost 100%, determining the patency of the fallopian tubes using ultrasound (echohydrotubation) is 90% accurate and coincides with the data of laparoscopic chromopertubation in 89% of cases. Such indicators make echohydrotubation the method of choice in the initial diagnosis of the causes of female infertility and in determining the patency of the fallopian tubes in particular. The procedure is carried out on an outpatient basis and consists of introducing a special solution into the uterine cavity and fallopian tubes, which is visible during an ultrasound examination. If the fallopian tubes are passable, it is clear that fluid appears near the ovaries. And although using ultrasound it is impossible to directly see the place of narrowing of the fallopian tube or obstruction, the data obtained on patency play a decisive role in establishing the causes of infertility.

Mechanisms of normal functioning of the fallopian tubes

The fertilized egg moves through the fallopian tubes (oviducts) into the uterine cavity. The meeting of the egg with the sperm normally occurs in the fallopian tube, therefore the patency of the fallopian tubes is an important condition for pregnancy. In addition to mechanical patency, the activity of the fimbriae, which are located in the fallopian tubes and, with their wave-like movements, contribute to the normal advancement of the egg, is extremely important. For the sperm, the fimbriae are not important; it is able to move forward independently using the tail. Unfortunately, the egg is deprived of this and needs the help of the fimbriae of the patent fallopian tubes.

Causes of fallopian tube obstruction

1. Inflammation associated with sexually transmitted infections can cause obstruction of the fallopian tubes. Sexually transmitted infections include gonorrhea, chlamydia, ureaplasmosis, mycoplasmosis, trichomoniasis, etc.
2. Nonspecific inflammatory processes can cause obstruction of the fallopian tubes. Nonspecific inflammations are caused by bacteria that normally live in a woman’s body, but have developed in large quantities and/or settled in places unusual for these bacteria (for example, from the intestines to the genitals).
3. Anatomical congenital anomalies associated with the absence of fallopian tubes and their parts. Such anomalies leading to tubal obstruction are extremely rare.
4. Overgrowth or severe stenosis of the fallopian tube, leading to obstruction of the fallopian tubes, associated with gross therapeutic and diagnostic interventions in the uterine cavity. Obstruction of the fallopian tubes can develop after an abortion or curettage of the walls of the uterine cavity due to excessive scraping, when the basal layer is exposed, which leads to the formation of scar tissue. After such procedures, the fallopian tube becomes impassable at the point of exit from the uterine cavity.

1. Tubal obstruction may be associated with surgical interventions in the pelvic organs, abdominal cavity, especially in purulent-inflammatory processes - for example, phlegmonous appendicitis, appendicitis with peritonitis, ulcers on the ovaries (tubovorial formations of inflammatory origin). After such operations, multiple adhesions are formed, including the formation of adhesions in the fallopian tubes, which leads to obstruction of the fallopian tubes.

When to think about possible tubal obstruction

Firstly, if you have unsuccessfully tried to get pregnant within six months or more, provided you have regular sex life and you have had these conditions in your life:

1. You have had a sexually transmitted infection, especially if the infection was not treated immediately and/or you have had it repeatedly.
2. You suffer from inflammation of the appendages (ovaries) of nonspecific etiology
3. Pregnancy failure was preceded by an abortion (especially with complications).
4. A previous operation with pus in the abdomen.

In any case, to diagnose the causes of infertility, a tubal patency test is one of the first diagnostic procedures.

Diagnosis of fallopian tube patency

The gold standard for diagnosing tubal patency is surgical laparoscopy, when the pipes can be inspected directly and see how the diagnostic fluid passes and pours out of them. But laparoscopy is a surgical intervention that requires anesthesia and a hospital stay. In addition, this is a fairly expensive operation. It is more appropriate to recommend this particular method for diagnosing tubal patency if it is necessary to solve other necessary problems, if any, (removal of cysts on the ovaries, uterine tumors - fibroids, dissection of adhesions, etc.).

The most informative, safe, painless procedure is ultrasound hysterosalpingoscopy or hydrotubation. The cost of hydrotubation is low compared to laparoscopy due to the fact that the procedure is outpatient (does not require a hospital stay) and is performed without anesthesia.

The technique for carrying it out is as follows: a disposable sterile thin catheter with a special inflating balloon (for fixation) is inserted through the cervical canal in the cervix. Then a special solution (Echovist, saline solution or a combination of both) is injected through this catheter, which, passing through the uterine cavity and fallopian tubes, makes the internal structures visible.

When a catheter is inserted for hydrotubation, the patient may experience some discomfort, similar to menstrual cramps. The amount of solution used for hydrotubation does not exceed 13 ml.

During hysterosalpingoscopy, the uterine cavity is first assessed for the presence of adhesions, submucosal nodes, polyps (all these structures prevent the development of pregnancy), then the fluid begins to enter the fallopian tubes, passes through all their sections (if the tubes are passable), pours out around the ovaries and behind the uterus.

The method allows you to assess in which specific section of the pipe the block is located; the patient’s management tactics depend on this.

With ultrasound hysterosalpingoscopy (hydrotubation), there is no influence of ionizing radiation (as with radiography), which makes it possible to plan pregnancy in the same cycle.

The onset of pregnancy becomes more obvious in the same cycle, because the liquid is able to wash away the derivative that clogs the fallopian tubes, activate the fimbria for more effective capture and advancement of the egg, and disconnect rough thin adhesions.

There is no need to undergo anesthesia and make punctures in the anterior abdominal wall (as with laparoscopy).

Advantages of ultrasound diagnostics of fallopian tube patency

• Speed ​​of implementation
• No need for hospitalization
• Completely harmless to the patient
• Relative cheapness
• High accuracy
• Possibility of incidental detection of disorders in the uterine cavity

Most clinics currently use two-dimensional ultrasound sonohysterosalpingography. A vaginal probe is used to visualize the fallopian tubes. However, the use of a conventional two-dimensional ultrasound does not allow us to see the fallopian tube completely, since it has bends in all three planes.

The use of 3d/4d ultrasound for diagnosing tubal patency

Our clinic has implemented the ability to diagnose tubal patency in three dimensions in real time - 4d. When using this mode, the time required to find and evaluate the fallopian tubes is reduced. It becomes possible to see the spatial relationships and shape of the intrauterine structures. The most important difference 4d echohydrotubation is almost 100% sensitive compared to conventional one. That is, using this method, the same accuracy is achieved as with laparoscopy. The agreement between the results of 4d echohydrotubation and laparoscopic hydrotubation is 91%. That is, laparoscopy is still more sensitive than ultrasound. This is explained by the fact that echohydrotubation is an operator-dependent technique, where the experience of a specialist is very important. Also, the sensitivity of ultrasound is influenced by such objective factors as obesity, excess gas in the intestines and the possibility of spasm of the fallopian tubes during manipulation.

Our clinic has accumulated great experience carrying out both conventional and 4 d echohydrotubation.

Hysterosalpingography — tubal patency test by injecting a radiopaque contrast agent and using x-rays to assess the patency of the fallopian tubes. The only advantage of the method, besides the price comparable to ultrasonic hydrotubation, is the receipt of clear X-ray images that confirm the patency or obstruction of the fallopian tube. The disadvantages of the method include the need for ionizing radiation of the pelvis and all ovarian eggs. In addition, when taking an x-ray, you can only take two pictures. The limit is associated with the same ionizing radiation. You can get false results and conclude that the pipes are obstructed, and this was only a consequence of a painful spasm. When carrying out ultrasound control, this possibility is excluded due to the possibility of waiting and carrying out ultrasound control as many times as you like, even for an hour, you can immediately introduce drugs into the fallopian tube, relieving its spasm. Such agents are not administered during x-rays, because they are not radiopaque.

Conditions for ultrasonic hydrotubation (hysterosalpingoscopy)

Despite the fact that echohydrotubation is a minimally invasive technique and in most cases is quite safe, it is still necessary to adhere to certain conditions for its implementation. Since the liquid during this diagnostic procedure enters through the cervical canal (strictly speaking, directly into the uterine cavity, but there is the possibility of contamination with the contents of the cervical canal of the uterine cavity during the insertion of a catheter for echohydrotubation), there is always a risk of infection entering the uterine cavity, fallopian tubes and further into the abdominal cavity. In order to avoid this, you need to be sure that there is no inflammation in the cervical canal and in the vagina. Another reason that prevents the procedure is the presence of severe dysplasia or. Firstly, there is no point in trying to get pregnant against the background of severe cervical dysplasia, since progression of oncological processes is possible during pregnancy. Secondly, any manipulation of the cervix with severe dysplasia or cervical cancer will aggravate the condition. Another circumstance that makes the procedure easier is the maximum opening of the cervical canal. With the cervical canal as open as possible, passing the catheter through the cervix is ​​the most painless. As is known, such a condition occurs in the days close to ovulation. Thus, to safely perform echohydrotubation, the following conditions are needed:

1. No inflammation in the pelvic organs, no sexually transmitted infections.
2. Confidence that there are no precancerous processes in the cervix and on the surface of the uterus.
3. The day of the menstrual cycle close to ovulation, when the physiological expansion of the cervical canal (cervix) occurs, and insertion of the catheter becomes less painful.

Necessary tests before the hydrotubation procedure:

1. Analysis of urogenital secretions (smear).
2. Cytology (PAPP test)
3. Analysis for sexually transmitted infections - chlamydia, ureaplasmosis, mycoplasmosis - by PCR method

Preparation for the hydrotubation procedure:

1. Treatment of inflammation of the lower parts of the urogenital tract.
2. Availability of the listed tests.
3. Hygienic toilet for genital organs.
4. 40 minutes before the procedure, take an antispasmodic (on the preliminary recommendation of the doctor).

Is it painful to do echohydrotubation?

All manipulations on the cervix are quite unpleasant and some women may experience pain. A lot depends on the specialist who performs the manipulation. In most cases, the pain is insignificant, as during normal periods. Pain can occur when the cervical canal is narrow and there are obstacles to the passage of contrast fluid in the uterine cavity and fallopian tubes. If you take antispasmodics first, pain can be avoided. As a rule, when the tubes are completely patent, there is no pain at all.

How much does it cost to diagnose tubal patency?

The cost of examining the patency of the fallopian tubes in 4D mode is 700 hryvnia. The components of this price are the price of a disposable intrauterine catheter for administering echo-contrast liquid (the cost of the catheter can reach, depending on the manufacturer, from 200 to 400 UAH), the price of echo-contrast liquid, and consumables. All data obtained during the procedure is documented in a research protocol and is additionally documented on video and, if desired, can be recorded on disk. The procedure can take up to 1 hour (the entire process).

Hydrotubation(Greek hyd?r water + lat. tuba pipe) - the introduction of fluid through the uterine cavity into the fallopian tubes to establish their patency or for therapeutic purposes. Previously, hydrotubation was widely used for the diagnosis and treatment of tubal infertility. IN modern conditions hydrotubation is carried out after plastic surgery on the fallopian tubes for the purpose of dynamic monitoring of the patency of the operated tube and the prevention of inflammatory and adhesive processes, as well as after removal of one of the fallopian tubes (salpingotomy) to clarify the patency of the remaining tube. The use of hydrotubation for the treatment of tubal infertility is disputed by many researchers. To diagnose tubal infertility, chromosalpingoscopy is used - examination of the fallopian tubes during laparoscopy with the simultaneous introduction of solutions of dyes (indigo carmine, methylene blue) into them through the uterine cavity, which allows you to visually clarify the patency and functional state of the fallopian tubes, identify peritubar adhesions and other causes of infertility .

The conditions for hydrotubation are I and II degrees of vaginal cleanliness, the absence of pathogenic flora in smears from the cervical canal and urethra, absence of pathological changes in blood and urine. Hydrotubation is contraindicated in acute and subacute inflammatory processes in the genital organs, tumors of the uterus and its appendages, severe cardiovascular diseases, infectious diseases.

Hydrotubation is performed by a doctor in a hospital or on an outpatient basis. It is carried out in the treatment room on a gynecological chair. To establish the patency of the fallopian tubes, hydrotubation is carried out from the 7th-8th to the 24th day of the menstrual cycle. Before hydrotubation, the intestines and bladder are emptied, the external genitalia are treated with iodonate solution. An isotonic sodium chloride solution is injected into the uterine cavity using a syringe for intrauterine infusion with a device for sealing the cervical canal or a special device. With complete patency of the fallopian tubes, the solution from the syringe flows easily with pressure on the piston and does not flow out after removing the tip from the cervical canal. If the fallopian tubes are obstructed in the area of ​​the isthmus, 2-3 ml of solution are injected freely, then the flow of liquid is stopped and when the pressure on the piston is weakened, it flows back. If the fallopian tubes are obstructed in the area of ​​the ampulla, the introduction of liquid is accompanied by pain in the groin areas, reflux appears after infusion of 4-5 ml of liquid; Often fluid from the fallopian tubes enters the vagina a few minutes or hours after insertion - the phenomenon of hydrops tubae. If the fallopian tubes are partially passable, the flow of fluid occurs very slowly.

When conducting a study using special devices, the pressure in the uterus is recorded on a recorder tape. In the case of complete patency of the fallopian tubes, the pressure in the system drops upon reaching 60 mm Hg. Art. (as a result of the passage of fluid from the fallopian tubes into the abdominal cavity); with partial patency of the fallopian tubes, the pressure drop occurs at 100-120 mm Hg. Art., with complete obstruction there is no drop in pressure. With obstruction in the isthmus area, pressure fluctuations in the system do not occur; with obstruction in the ampullary sections, rhythmic small fluctuations in pressure are possible due to peristalsis of the fallopian tubes. If the fallopian tubes are stretched, the pressure drops slightly and pain in the lower abdomen may appear.

To prevent inflammatory and adhesive processes, antibiotics, glucocorticoids, proteolytic enzymes, lidase, etc. are introduced into the fallopian tubes; they are first dissolved in a 0.25% solution of novocaine or isotonic sodium chloride solution (solutions injected into the uterine cavity must be sterile). Procedures begin 2-3 days after the end of menstruation and end 2-3 days before the expected menstruation.