Uterus: structure, anatomy, photo. Anatomy of the uterus, fallopian tubes and appendages. The role of the fallopian tubes in the life of a woman diagnosed with infertility

Fallopian tubes (fallopian tubes) refer to the internal genital organs in women. They are paired tubes that connect the uterus to the ovary.

The structure of the fallopian tubes

The fallopian tubes depart from the area of ​​the bottom of the uterus, their free narrow end opens freely into the abdominal cavity. The wall of the fallopian tube is dense and elastic, formed by the outer serous membrane, the middle muscular layer and the inner mucous membrane.

Anatomically, a funnel, an ampulla, an isthmus and a uterine part are isolated in the fallopian tube. The funnel opens into the abdominal cavity, it is formed by long narrow outgrowths in the form of a fringe, which, as it were, covers the ovary. The vibrations of these outgrowths help the egg through the tube to reach the uterine cavity. Violations of their mobility can be the cause of infertility or ectopic pregnancy.

Functions of the fallopian tubes

In the lumen of the fallopian tubes, the egg is fertilized by a spermatozoon, and then the fertilized egg, while maintaining the patency of the fallopian tubes, moves into the uterine cavity, where it attaches to its wall. Special eyelashes also contribute to promotion. The secret of the epithelium contains substances that promote the onset of fertilization. During the movement, the division of the zygote begins, and until it has entered the uterus for several days, the fallopian tube nourishes and protects it.

If on its way the egg encounters violations of the patency of the fallopian tubes in the form of adhesions, polyps or other adhesions, then it cannot enter the uterus, and is attached to the wall of the fallopian tube. In this case, a tubal pregnancy occurs, which can threaten the woman's life.

Methods for examining the fallopian tubes

Laparoscopy of the fallopian tubes is usually performed along the way, during endoscopic interventions on the pelvic organs for another reason, for example, during the removal of adhesions. To conduct a study, two punctures are made in the abdominal wall, an endoscope with a video camera is inserted into one, the image from which is displayed on the monitor screen, instruments for manipulation are inserted into the other puncture. Laparoscopy of the fallopian tubes is performed under anesthesia, manipulation for a woman is painless.

HSG, or hysterosalpingography, allows you to check the fallopian tubes, as well as the condition of the endometrium in the uterine cavity, deformations and malformations of the uterus and tubes. The essence of the method is that a contrast is introduced into the cervix, which enters the fallopian tubes from the uterine cavity, and enters the abdominal cavity with sufficient patency of the fallopian tubes. An x-ray is taken to detect contrast in the abdominal cavity. This method allows you to see and deformation of the pipe, which can also be the cause of obstruction and infertility. In women who are trying to get pregnant, the study is carried out on days 5-9 of the menstrual cycle with a total cycle duration of 28 days. If pregnancy is not the purpose of the examination, then HSG can be performed on any day, except for menstruation.

Testing the fallopian tubes using ultrasound is the fastest and safest way to study. However, the accuracy of the study is lower than that of other methods. The study is carried out regardless of the menstrual cycle. Healthy fallopian tubes are barely visible on ultrasound, to improve visualization, a sample is made with saline, which is injected into the cervix, and then it enters the fallopian tubes, which can be traced using ultrasound.

Fallopian tube pathology

Inflammation of the fallopian tubes (salpingitis) is caused by various infectious pathogens - chlamydia, gonococci, etc. Provoking factors are various surgical interventions, abortion, menstruation. Symptoms of salpingitis will be pain in the lower abdomen, sharply aggravated during intercourse, urination disorders, purulent discharge from the genital tract, and sometimes fever. Antibacterial and anti-inflammatory drugs are used in the treatment. Often the consequences of inflammation are adhesions in the fallopian tubes, leading to infertility. Severe inflammation sometimes deforms and destroys the tissue of the tubes so much that it is necessary to resort to the removal of the fallopian tubes.

Violations of the patency of the fallopian tubes due to adhesions, kinks, narrowing can cause an ectopic tubal pregnancy. The fertilized egg cannot enter the uterine cavity, and is attached to the wall of the tube. It begins to increase in size and lead to rupture of the fallopian tube. This condition threatens the life of a woman, requires emergency assistance in the form of surgical removal of the fallopian tube.

Congenital pathology in the form of the absence or underdevelopment of the fallopian tubes is often combined with the underdevelopment of the uterus and ovaries. The main symptom in this case will also be infertility.

According to statistics, the cause of female infertility in 20-25% is a violation of the transport of an egg or an already fertilized egg through the fallopian (uterine) tube. Sometimes pregnancy with obstruction of the fallopian tubes is still possible if the process is unilateral or partial. However, it usually ends with an ectopic (ectopic), most often tubal location and development of the embryo. As a result, there is a need for urgent surgical treatment for the threat or already completed rupture of the fallopian tube, accompanied by profuse intra-abdominal bleeding.

Brief anatomy and causes of obstruction of the fallopian tubes

Brief anatomy and mechanism of fertilization

The fallopian tubes are a pair of tubular structures. The average length of each of them at the reproductive age is from 10 to 12 cm, and the diameter of the lumen in the initial section does not exceed 0.1 cm. There is liquid in the lumen of the tubes. Anatomically, they are divided into three sections:

1. Interstitial, located in the thickness of the muscular wall of the uterus (1-3 cm) and communicating with its lumen with its cavity.
2. Isthmus (3-4 cm), which passes between two leaves of the wide uterine ligament.
3. Ampullary, ending in a funnel, the lumen of which (mouth) communicates with the abdominal cavity. The mouth of the funnel is covered with fimbriae (villi, thin threads), the longest of which is fixed to the ovary located under the ampulla. The remaining fimbriae, with their vibrations, capture the mature and released egg from the ovary and direct it into the lumen of the tube.

The walls of the fallopian tube are made up of three layers:

1. External, or serous.
2. Internal, or mucous, in the form of branched folds. The inner layer of the mucous membrane itself is a ciliated epithelium with villi (outgrowths). The thickness of the shell is not the same, and the number of folds is uneven. The villi make oscillations, the speed of which is maximum during the period of ovulation and some time after it, which depends on the hormonal level.
3. Muscular, consisting, in turn, of three layers - two longitudinal and one transverse, which provides peristalsis (wave-like movement) of the walls of the pipe. This is reminiscent of peristaltic contractions of the intestine, contributing to the movement of food masses through its lumen.

In addition to the broad ligament, the cardinal and round ligaments are attached to the uterus. All of them provide fixation and a certain position of the uterus with appendages in the small pelvis.

General ideas about the structure of the organ make it possible to better understand the causative mechanisms and how to treat obstruction of the fallopian tubes, as well as the importance of preventing inflammatory diseases of the uterus and its appendages for the implementation of the fertilization mechanism.

The spermatozoon penetrates through the cervical canal and the uterine cavity into the fallopian tube, where it connects with the egg. Vibrations of the villi, tubal peristalsis, relaxation of the uterine muscle in the area of ​​​​its connection with the tube, as well as the directed flow of fluid in the tube ensure the advancement of the egg, and after fertilization - the fetal egg, through the tube into the uterine cavity. Here it is attached (implanted) to the endometrium (the lining of the uterus). The mechanism of the transport function is realized under the influence of hormones, mainly progesterone and estrogens, secreted by the corpus luteum of the ovary.

Causes of impaired patency

All processes of fertilization in the whole organism are closely related to the hormonal function of the endocrine glands and the central nervous system. Infertility is the result of dysfunction of any link in this complex chain. One of these links is the patency of the fallopian tubes. Depending on the causes of its violation, obstruction is distinguished:

• mechanical, resulting from anatomical obstacles - adhesions (films) in the lumen of the fallopian tubes, pulling the tube or changing its position and shape and leading to a decrease in the diameter of the lumen, as well as adhesions or other formations that close the mouth of the tube from the side of the uterus or ampullar end;
• functional, due to a violation of the peristalsis of the tube (slowdown or, conversely, excessive strengthening) or the dynamics of the fimbriae and villi of its mucous membrane.

The treatment of obstruction of the fallopian tubes and the choice of the method of fertilization depend on the identified causes. Factors causing these causes include:

1. Congenital malformations - embryonic cyst of the tube or broad ligament, atresia (fusion of the walls) of the tube or broad ligament, underdevelopment of the fallopian tubes, and some others.
2. Acute and chronic inflammatory processes in the uterus (endometritis), ovaries (oophoritis), tubes (salpingitis) caused by tuberculosis of the fallopian tubes or a banal infection. Inflammation can be triggered by the presence of endometriosis (with the subsequent formation of adhesions), an intrauterine device, medical and diagnostic manipulations in the uterus or in the small pelvis, childbirth, spontaneous or artificial termination of pregnancy.
3. Acute and chronic inflammation caused by sexually transmitted infectious agents - gonorrhea, trichomoniasis, chlamydia, genital herpes virus, mycoplasmosis, gardnerellosis. In women, very often these diseases occur without severe symptoms or without it at all and almost immediately acquire a chronic course, especially trichomoniasis.
4. Inflammatory processes and surgical interventions on the organs of the small pelvis or abdominal cavity, as well as peritonitis and pelvioperitonitis (inflammation of the peritoneum of the abdominal cavity and small pelvis). The cause of such operations or peritonitis can be ovarian cyst torsion, uterine fibroids, accidental perforation (perforation) of the uterus during instrumental abortion, perforated stomach ulcer, appendicitis and perforation of the intestinal diverticulum, acute intestinal obstruction and many others. They are always accompanied by the subsequent formation of adhesions in the abdominal cavity, which can deform or completely compress the fallopian tubes, leading to its obstruction.
5. Mechanical damage to the mouth of the fallopian tubes during diagnostic curettage or instrumental abortion, followed by the formation of adhesions, tubal submucosal fibroids.
6. Uterine fibroids, squeezing the mouth, or a large polyp in this area, an ovarian cyst.
7. Prolonged nervous tension or frequent stressful conditions, endocrine diseases or hormonal dysfunctions, as well as innervation disorders, for example, in diseases or injuries in the lumbar region of the spinal cord.

Violation of patency can be unilateral and bilateral, complete or partial.

Symptoms and Diagnosis

As a result of examining women for infertility in 30-60%, the cause is anatomical or functional obstruction, and complete occlusion of the lumen of the fallopian tubes is detected on average in 14%, partial - in 11%.

Usually there are no subjective symptoms of obstruction of the fallopian tubes. The main symptom is the absence of pregnancy in a woman with regular sexual activity without the use of contraceptives.

Also possible:

• the presence of chronic pain in the pelvic area;
• pain in the lower abdomen during heavy physical exertion;
• (painful menstruation);
• dysfunction of the bladder, manifested by symptoms of dysuria;
• dysfunction of the rectum, accompanied by pain during defecation, constipation;
• painful intercourse;
• dyspareunia.

However, these symptoms are not typical and are intermittent and optional. They are due to the presence of connective tissue adhesions (adhesions). In other cases, a symptom of pathology is usually a complication in the form of a tubal pregnancy.

Diagnostics

Basic diagnostic methods:

1. Hysterosalpingography.
2. Sonohysterosalpygoscopy.
3. Therapeutic and diagnostic laparoscopy.

Ultrasound diagnosis of obstruction of the fallopian tubes uninformative. It allows you to determine only the displacement of the position of the uterus, anomalies in its development and some types of congenital pathology of the tubes, the presence of myomatous nodes and other tumors, the size and position of the ovaries.

Hysterosalpingography (HSG) is the introduction of a contrast solution into the uterine cavity, which passes into the fallopian tubes and from there into the abdominal cavity, which is recorded by several consecutive x-rays. With the help of HSG, the presence of pathology in the uterine cavity and the absence or presence of obstructions in the lumen of the tubes are determined. The disadvantage of the method is a significant percentage of false negative and false positive results (20%).

Sonohysterosalpingography (SHSG) according to the technique, it is identical to the previous procedure, but is carried out using an ultrasound machine, and isotonic sodium chloride solution is used as a contrast. SHSG is a more gentle diagnostic method than HSG, since the pelvic organs are not exposed to X-ray irradiation. But the information content of the results is much lower, due to the lower resolution of the ultrasound machine compared to x-rays.

Laparoscopy provides an opportunity to examine in an enlarged form the abdominal cavity and the state of the peritoneum, the surface of the uterus and its appendages. Laparoscopy is more informative for tubal obstruction if it is performed simultaneously with chromohydrotubation - the introduction of a methylene blue solution into the cervix, which also enters the tubes through the uterine cavity, from where it flows into the abdominal cavity, which indicates the absence of an obstacle in them.

Treatment of obstruction of the fallopian tubes and pregnancy

With functional obstruction, the effectiveness of treatment depends on the degree of hormonal disorders and the possibility of their correction. In some cases, it is necessary to carry out adequate anti-inflammatory treatment, and sometimes it is sufficient to treat the psychosomatic state of a woman.

In case of anatomical disorders, through a laparoscopic operation, the detected adhesions around the fallopian tubes are dissected or the plastic of the latter is performed in order to restore their patency, which previously could only be done by laparotomy (an incision of the anterior abdominal wall and peritoneum) access.

However, independent pregnancy after repeated laparoscopic operations on the fallopian tubes occurs in less than 5% of cases. This is due to the repeated development of the adhesive process.

In the case of minor damage to the tubes during operations requiring dissection of a small number of adhesions, pregnancy occurs in more than half of the patients, with restoration of the patency of the ampullary section of the tube - in 15-29%. Significant damage to the fimbriae greatly reduces the possibility of a natural pregnancy.

Treatment with surgical methods is effective only with partial obstruction of the fallopian tubes, since the restoration of a normal lumen in them does not allow the restoration of the functioning of the ciliated epithelium of the mucous membrane. The possibility of a normal pregnancy in these cases is very small, but the probability of an ectopic pregnancy is greatly increased. The optimal solution to the problem in these cases is in vitro fertilization.

The uterus is the reproductive unpaired internal organ of the female. It is made up of plexuses of smooth muscle fibers. The uterus is located in the middle part of the small pelvis. It is very mobile, therefore, relative to other organs, it can be in different positions. Together with the ovaries, it makes up the female body.

General structure of the uterus

This internal muscular organ of the reproductive system is pear-shaped, which is flattened in front and behind. In the upper part of the uterus on the sides there are branches - the fallopian tubes, which pass into the ovaries. Behind is the rectum, and in front is the bladder.

The anatomy of the uterus is as follows. The muscular organ consists of several parts:

1. The bottom is the upper part, which has a convex shape and is located above the line of discharge of the fallopian tubes.
2. The body into which the bottom smoothly passes. It has a conical shape. Tapers down and forms an isthmus. This is the cavity leading to the cervix.
3. Cervix - consists of the isthmus, and the vaginal part.

The size and weight of the uterus is individual. The average values ​​of her weight in girls and nulliparous women reach 40-50 g.

The anatomy of the cervix, which is a barrier between the internal cavity and the external environment, is designed so that it protrudes into the anterior part of the vaginal fornix. At the same time, its posterior fornix remains deep, and the anterior - vice versa.

Where is the uterus?

The organ is located in the small pelvis between the rectum and the bladder. The uterus is a very mobile organ, which, in addition, has individual characteristics and shape pathologies. Its location is significantly affected by the condition and size of neighboring organs. The normal anatomy of the uterus in the characteristics of the place occupied in the small pelvis is such that its longitudinal axis should be oriented along the axis of the pelvis. Its bottom is tilted forward. When filling the bladder, it moves back a little, when emptying, it returns to its original position.

The peritoneum covers most of the uterus, except for the lower part of the cervix, forming a deep pocket. It extends from the bottom, goes to the front and reaches the neck. The back part reaches the wall of the vagina and then passes to the anterior wall of the rectum. This place is called Douglas space (recess).

Anatomy of the uterus: photo and wall structure

The organ is three-layered. It consists of: perimetrium, myometrium and endometrium. The surface of the uterine wall is covered by the serous membrane of the peritoneum - the initial layer. At the next - middle level - tissues thicken and have a more complex structure. Plexuses of smooth muscle fibers and elastic connective structures form bundles that divide the myometrium into three inner layers: inner and outer oblique, circular. The latter is also called the average circular. This name he received in connection with the structure. The most obvious is that it is the middle layer of the myometrium. The term "circular" is justified by the rich system of lymphatic and blood vessels, the number of which increases significantly as it approaches the cervix.

Bypassing the submucosa, the wall of the uterus after the myometrium passes into the endometrium - the mucous membrane. This is the inner layer, reaching a thickness of 3 mm. It has a longitudinal fold in the anterior and posterior region of the cervical canal, from which small palm-shaped branches extend at an acute angle to the right and left. The rest of the endometrium is smooth. The presence of folds protects the uterine cavity from the penetration of unfavorable contents of the vagina for the internal organ. The endometrium of the uterus is prismatic, on its surface are the uterine tubular glands with vitreous mucus. The alkaline reaction they give keeps the sperm viable. During the period of ovulation, secretion increases and substances enter the cervical canal.

Ligaments of the uterus: anatomy, purpose

In the normal state of the female body, the uterus, ovaries and other adjacent organs are supported by a ligamentous apparatus, which is formed by smooth muscle structures. The functioning of the internal reproductive organs largely depends on the condition of the muscles and fascia of the pelvic floor. The ligamentous apparatus consists of a suspension, fixation and support apparatus. The combination of the performed properties of each of them ensures the normal physiological position of the uterus among other organs and the necessary mobility.

The anatomy of the uterus and appendages, as well as other organs of the female reproductive system, consists of developed muscle tissue and fascia, which play a significant role in the normal functioning of the entire reproductive system.

Characteristics of the suspension device

The suspension apparatus is made up of paired ligaments of the uterus, thanks to which it is “attached” at a certain distance to the walls of the small pelvis. The wide uterine ligament is a fold of the peritoneum of the transverse type. It covers the body of the uterus and the fallopian tubes on both sides. For the latter, the ligament structure is an integral part of the serous cover and the mesentery. At the side walls of the pelvis, it passes into the parietal peritoneum. The supporting ligament departs from each ovary, has a wide shape. Characterized by durability. Inside it passes the uterine artery.

The proper ligaments of each of the ovaries originate at the uterine fundus from the back side below the branch of the fallopian tubes and reach the ovaries. The uterine arteries and veins pass inside them, so the structures are quite dense and strong.

One of the longest suspensory elements is the round ligament of the uterus. Its anatomy is as follows: the ligament has the form of a cord up to 12 cm long. It originates in one of the corners of the uterus and passes under the anterior sheet of the broad ligament to the internal opening of the groin. After that, the ligaments branch into numerous structures in the tissue of the pubis and labia majora, forming a spindle. It is thanks to the round ligaments of the uterus that it has a physiological inclination anteriorly.

The structure and location of the fixing ligaments

The anatomy of the uterus should have assumed its natural purpose - the bearing and birth of offspring. This process is inevitably accompanied by active contraction, growth and movement of the reproductive organ. In this connection, it is necessary not only to fix the correct position of the uterus in the abdominal cavity, but also to provide it with the necessary mobility. Just for such purposes, fixing structures arose.

The main ligament of the uterus consists of plexuses of smooth muscle fibers and connective tissue, located radially to each other. The plexus surrounds the cervix in the region of the internal os. The ligament gradually passes into the pelvic fascia, thereby fixing the organ to the position of the pelvic floor. The vesicouterine and pubic ligamentous structures originate at the bottom of the front of the uterus and attach to the bladder and pubis, respectively.

The sacro-uterine ligament is formed by fibrous fibers and smooth muscles. It departs from the back of the neck, envelops the rectum on the sides and connects to the fascia of the pelvis at the sacrum. In a standing position, they have a vertical direction and support the cervix.

Supporting apparatus: muscles and fascia

The anatomy of the uterus implies the concept of "pelvic floor". This is a set of muscles and fascia of the perineum, which make it up and perform a supporting function. The pelvic floor consists of an outer, middle and inner layer. The composition and characteristics of the elements included in each of them are given in the table:

Fallopian tubes in the structure of female infertility

Fallopian tube (tuba uterina, fallopian tubes)- a paired, tubular organ with a lumen, originating from the corner of the uterus.

Fallopian tube anatomy

The fallopian tube starts from the lateral edge of the uterus in the area of ​​its bottom (angle of the uterus), passes in the upper part of the broad ligament of the uterus to the ovaries. One end of the fallopian tube opens into the uterus (uterine opening), the other - into the abdominal cavity (abdominal opening). In the fallopian tube are distinguished:

• interstitial region (in the thickness of the uterine wall)
• isthmus (middle section)
• ampulla (gradually increasing in diameter section following the isthmus outwards)
• funnel with outgrowths-fringes of the pipe

The structure of the wall of the fallopian tube

The wall of the fallopian tube consists of mucous, muscular and serous membranes. The mucous membrane forms longitudinal folds, is represented by a single-layer cylindrical ciliated epithelium, with the inclusion of secretory cells. The muscular coat is represented by circular and longitudinal layers of smooth muscle cells. The serous membrane covers the fallopian tube from the outside. The fallopian tubes have an extensive neurovascular network. The vascular network is formed by branches from the main uterine and ovarian arteries, the venous network is connected to the utero-ovarian, cystic and other plexuses of the small pelvis. Innervation is carried out by branches of the pelvic and ovarian plexuses.

Physiology of the fallopian tube

The muscle layers of smooth muscle cells provide the possibility of successive contractions of the fallopian tube lumen, called peristaltic directed (from the fallopian tube ampulla to the uterus) movements. The activity of peristalsis increases at the time of ovulation and at the beginning of the luteal phase of the menstrual cycle. The ciliated movements of the cilia of the epithelium have the same direction. In the preovulatory period, the blood supply to the veins of the funnel of the fallopian tubes and fimbriae increases, which causes their swelling, bringing them closer to the ovary at the time of ovulation. The production of secretory cells of the epithelium ensures the constancy of the internal environment in the lumen of the fallopian tube, ensuring the normal activity of spermatozoa, the viability of the egg and the early embryo.

Physiological functions of the fallopian tubes

• Capture of the egg by the fimbriae into the infundibulum from the ovulating follicle
• Ovum capacitation
• Ensuring the transport of sperm from the uterine cavity to the site of fertilization of the egg (ampullar section of the fallopian tube)
• Sperm capacitation
• Ensuring the fertilization process
• Ensuring the development of the pre-implantation embryo
• Transport of the embryo into the uterine cavity by directed peristaltic contractions and activity of the cilia of the ciliated epithelium

The causes of damage to the fallopian tube are trivial:

• Inflammatory changes due to the activity of more (chlamydia, gonococcus) or less (the entire spectrum of opportunistic flora, mycobacterium) specific microorganism. The fallopian tube may also be involved in a non-gynecological site of infection, such as appendicitis.
• Inflammatory changes of non-infectious origin, as a result of the activity of external genital endometriosis.
• tubal pregnancy
• Iatrogenic genesis of damage to the fallopian tube. For example, patients who want to restore reproductive function after surgical treatment for the purpose of sterilization (crossing the isthmic part of the fallopian tube).
• Anomalies of the laying and development of the fallopian tube occur both in isolation and in the complex of anomalies in the development of the underlying organs of the reproductive tract.

The proportion of patients with tubal factors of infertility varies according to different authors, which is largely due to differences in research approaches. So there is no consensus on the inclusion in the statistics of patients with damage to the fallopian tubes with moderate and severe external genital endometriosis, the diagnosis accompanying an independent effect on a woman's fertility. In addition, it was noted that the frequency of damage to the fallopian tubes due to infection is socially determined, as it has noticeable fluctuations in different socio-economic regions. Summarizing the data, we can summarize that the prevalence of tubal-peritoneal infertility varies from 20 to 30%, positioning it as the leading or one of the leading reasons for visiting a reproductive specialist.
It is noted that the percentage of patients with tubal factors tends to increase from primary to highly specialized medical care, which is easily explained by the persistence of the contraceptive effect and the complexity of correcting the cause, without involving the possibilities of assisted reproduction technologies.

Methods for diagnosing the pathology of the fallopian tubes

• Manipulation laparoscopy with chromohydrotubation.
• Transvaginal hydrolaparoscopy (Fertiloscopy)
• X-ray Hysterosalpingography
• Ultrasound Hysterosalpingography

Advantages of laparoscopy compared to open microsurgery:

• reduced risk of postoperative adhesion formation
• less risk of surgical complications
• shorter hospital stay.

1. Invasiveness entailing surgical risks
2. Objective high cost
3. The need for short hospitalization and temporary disability
4. The need for intubation anesthesia

It differs from the classical endoscopic examination of the pelvic organs by laparoscopy in principle in that access to the lower floor of the abdominal cavity - the small pelvis is made not through incisions on the anterior abdominal wall, but through the posterior vaginal fornix (a small incision behind the cervix). The working space is organized by injecting a small amount of liquid, instead of gas, in which the internal reproductive organs (uterus, ovaries, fallopian tubes) are comfortably examined. As part of fertiloscopy, it also remains possible to assess the patency of the fallopian tubes and carry out minor corrective interventions, since fertiloscopes have a channel for inserting one instrument, like hysteroscopes.

1. Comparable diagnostic capabilities within the framework of fallopian tube pathology
2. Less invasive
3. No need for hospitalization
4. Enough intravenous short-term anesthesia

1. Biased high cost, commensurate in cost with laparoscopy
2. Limited diagnostic capabilities, allowing to reliably assess only a small area in the volume of the small pelvis.
3. Extremely low operational capability. In practice, in the next stage, the operator is often forced to recommend to the patient an operative laparoscopy for therapeutic purposes, which further delays the examination stage, organizing it unfriendly to the patient.

An indirect imaging method based on the assessment of the fallopian tubes by the shape of their lumen when tightly filled with a special solution that traps ionizing radiation with greater resistance than the surrounding soft tissues.

Advantages regarding laparoscopy

1. Less invasive, not requiring hospitalization but insisting on adequate analgesia
2. lower cost

1. Less diagnostic capability. The weak point of the technique remains a false result about the obstruction of the fallopian tube, in addition, in controversial cases, it is often not possible to make a truly objective conclusion about the integrity of the organ, the presence of an adhesive or other pathological process.

Proposed as an alternative to X-ray examination, excluding the negative effect of ionizing radiation. The essence of the technique lies in the ultrasonic control of the emptying of the tightly filled uterine cavity with a special echogenic contrast fluid through the fallopian tubes into the abdominal cavity. The appearance of echogenic fluid in the pelvic cavity is considered a positive criterion for the physical patency of the fallopian tube

Advantages regarding laparoscopy

1. Absence of invasiveness, respectively, specific complications, the need for anesthesia and hospitalization
2. lower cost

1. Negligible diagnostic possibilities. In practice, the researcher does not receive valuable information not only about the color, shape, areas of narrowing and expansion of the lumen of the fallopian tube, but also the fact of the viability of one of the fallopian tubes in general, forming a conclusion such as: “passability of at least one fallopian tube”
2. Lack of any corrective options

As an additional less important auxiliary diagnostic technique, it is also worth noting a serological analysis for the detection of immunoglobulins A, G, M to chlamydia, the presence of which may also indicate inflammatory diseases of the pelvic organs.

Approaches to the treatment of fallopian tube pathology

Data are given that since the introduction of laparoscopic microsurgery into practice, the frequency of pregnancy in patients with tubal-peritoneal factor of infertility has doubled. However, to date, the development of assisted reproduction technologies, their effectiveness in patients with tubal infertility factor in conditions of generally low efficiency of other therapeutic and surgical approaches in this category of patients, treatment and diagnostic algorithms have been revised.
In general, the tactics of treating tubal pathology depends on the state of the reproductive function of the applied couple. Corrective surgery is recommended only if a high rate of spontaneous pregnancy is expected. Otherwise (for example, in conditions of reduced partner fertility), surgical treatment is recommended only for the purpose of sanitation (tubectomy with hydrosalpinx) or correction of concomitant pathology (for example, manifestations of external genital endometriosis), if necessary.
It has been noted that in patients with hydrosalpinx IVF efficiency is significantly lower than in patients without hydrosalpinx, so this pathology stands apart in the general pathology of the fallopian tubes. Hydrosalpinx (“hydro” - water, “salpinx” - pipe) literally translated as a pipe filled with water. It is interesting, but there is no consensus on the mechanism of the pathological effect of hydrosalpinx during in vitro fertilization, so an embryotoxic theory is proposed, stating that the fluid that accumulates inside the tube during hydrosalpinx is toxic to gametes and the developing embryo, according to another theory, due to the pathological effect of fluid from the hydrosalpinx, the process is disrupted implantation, or even the pre-implantation embryo is washed out. Diagnosis of hydrosalpinx is similar to the diagnosis of general tubal pathology, however, in this case, the sensitivity and specificity of transvaginal ultrasound is higher than in other tubal pathologies. The results of a meta-analysis comparing IVF after salpingectomy and without previous surgical treatment support surgery to remove the altered fallopian tube (highest level of evidence).

Oviduct (Fallopian tube),tuba uterina ( sal - pinx ), - a paired organ (see Fig. 13), serves to carry the egg from the ovary (from the peritoneal cavity) into the uterine cavity. The fallopian tubes are located in the pelvic cavity and are cylindrical ducts that run from the uterus to the ovaries. Each tube lies in the upper edge of the broad ligament of the uterus, part of which, bounded from above by the fallopian tube, from below by the ovary, is, as it were, the mesentery of the fallopian tube. The length of the fallopian tube is 10-12 cm, the lumen of the tube ranges from 2 to 4 mm. The lumen of the fallopian tube on one side communicates with the uterine cavity is very narrow uterine opening,dstium uterine tubae, opens on the other side abdominal opening,dstium abdominale tubae uterinae, into the peritoneal cavity, near the ovary. Thus, in a woman, the peritoneal cavity through the lumen of the fallopian tubes, the uterine cavity and the vagina communicates with the external environment.

The fallopian tube initially has a horizontal position, then, having reached the wall of the small pelvis, it goes around the ovary at its tubal end and ends at its medial surface. In the fallopian tube, the following parts are distinguished: uterine part,pars uterina, which is enclosed in the thickness of the wall of the uterus. Next comes the part closest to the uterus - isthmus of the fallopian tube,isthmus tubae uterinae. This is the narrowest and at the same time the most thick-walled part of the fallopian tube, which is located between the sheets of the broad ligament of the uterus. The part following the isthmus - fallopian tube ampullaampulla tubae uterinae, which accounts for almost half the length of the entire fallopian tube. The ampullar part gradually increases in diameter and passes into the next part - fallopian tube funnel,fundibulum tubae uterinae, that ends long and narrow fringed pipe,fimbriae tubae. One of the fringes differs from the rest in greater length. It reaches the ovary and often adheres to it - this is the so-called ovarian fringe, fimbria ovarica. The fringes of the tube direct the movement of the egg towards the funnel of the fallopian tube. At the bottom of the funnel there is an abdominal opening of the fallopian tube, through which the egg released from the ovary enters the lumen of the fallopian tube.

The structure of the wall of the fallopian tube. The wall of the fallopian tube is shown from the outside serous membrane,tunica serosa, under which is subserosal base,body subserosa. The next layer of the wall of the fallopian tube is formed muscle sheath,tunica muscles, continuing into the muscles of the uterus and consisting of two layers. The outer layer is formed by longitudinally arranged bundles of smooth muscle (non-striated) cells. The inner layer, thicker, consists of circularly oriented bundles of muscle cells. Under the muscular layer is mucous membrane,tunica mucosa, forming longitudinal pipe folds,plicae tubariae, throughout the fallopian tube. Closer to the abdominal opening of the fallopian tube, the mucous membrane becomes thicker and has more folds. They are especially numerous in the funnel of the fallopian tube. The mucous membrane is covered with epithelium, the cilia of which fluctuate towards the uterus.

Vessels and nerves of the fallopian tubes. The blood supply to the fallopian tube comes from two sources: a tubal branch of the uterine artery and a branch from the ovarian artery. Venous blood from the fallopian tube flows through the veins of the same name into the uterine venous plexus. The lymphatic vessels of the tube flow into the lumbar lymph nodes. The innervation of the fallopian tubes comes from the ovarian and uterovaginal plexuses.

On the radiograph the fallopian tubes look like long and narrow shadows, expanded in the region of the ampullar part.