Freedom of manners and disregard for mechanical contraceptives (condoms) contributes to the wide spread of diseases, sexually transmitted diseases. As is well known, often they are hidden within, and are found only in the development of adhesions in the pelvis. In turn, the development of surgery and operative gynecology is not only the positive aspects but also negative, in the form of such consequences as the pelvic adhesions, and tubal-peritoneal infertility. The treatment of adhesions in the pelvis presents certain difficulties and not always effective.

Adhesions in the pelvis

The internal organs of small pelvis and abdomen are covered with grayish film - peritoneum. The peritoneum allocates peritoneal fluid, which provides mobility and displaceability of the uterus and tubes. With the development of peritonitis (inflammation of the peritoneum), this will protect - the formation of adhesions, so that there is delimitation of the inflammatory process.

Types of adhesions in the pelvis:

• adhesions between the ovaries and fallopian tubes;
• adhesions between the ovary and uterus or uterine ligaments;
• adhesions between the ovaries, fallopian tubes, uterus, bowel loops and a large gland.

If adhesions were formed in the end regions of the fallopian tubes (fimbrial), is their blockage, fluid builds up in the pipes to form gidrosalpinksa that leads to the development of tubal infertility.

Causes of adhesions in the pelvis

All causes of adhesions in the pelvis can be divided into several groups:

• Transactions made through laparotomy access

This is usually appendectomy, resection of the ovary, tubektomiya (ectopic pregnancy), conservative myomectomy, hysterectomy Hysterectomy (removal of the uterus) - a terrible need   (removal of the uterus). The formation of adhesions in the pelvis depends on: the duration of the operation (tissue ischemia), drying the tissues during surgery, mistreatment of bodies, the presence of foreign bodies (pieces of talc from gloves, gauze of fiber), the presence of blood.

• Endometriosis

Endometrioid heterotopias, located on the peritoneum (external genital endometriosis) also contribute to the formation of adhesions in the pelvis. From plots of pathological endometrium each month poured blood that corresponds menstruation, resulting in the pelvic cavity misses blood contributes to the formation of adhesions.

• Inflammatory diseases of the pelvic organs

Acute and chronic adnexitis, infections, sexually transmitted infections (chlamydia, ureaplasmosis Ureaplasmosis - inflammation of the urogenital system , Mycoplasmosis) cause inflammatory exudate effusion in the pelvic area. The affected tissues become swollen, they formed fibrin, which occurs due to adhesion of the pelvic organs and peritoneum together. Frequently inflammation and adhesions leading to infertility.

• Apoplexy, ectopic pregnancy

These diseases are accompanied by intra-abdominal bleeding and the formation of adhesions.

• Abortion, IUDs

Abortion and intrauterine devices provoke an inflammatory process, especially in cases of uterine perforation (puncture). Such manipulations are complicated adhesive process. As a special case, may develop complications such as uterine adhesions.

The treatment of adhesions in the pelvis

Treating adhesions depends on the severity of the process. When conservative treatment prescribed fermentoterapii, pelvic massage Gynecologic massage physical therapy in a female , Mud treatment Mud - a pleasant and useful procedure   and physical therapy. In severe cases, infertility is performed laparoscopic adhesiolysis or by adgeolizisa. Using adgeolizisa includes three methods:

• laser - laser separation of adhesions;
• akvadissektsiya - adhesiotomy water, which is supplied under pressure;
• elektohirurgiya - adhesiotomy electrocautery.

Patients with adhesions in the pelvis appointed balanced diet that includes frequent meals (five times a day or more), with the exception of products that contribute to gas formation.

Anna Sozinova

Infertility - the inability to conceive after a year of unprotected intercourse. About 10% of couples are infertile. Infertility is both male and female. About a third of cases, the absence of children the couple infertility caused by man, in the third - the infertile women, the remaining third - a combination of factors.

How age affects infertility?

The number of infertile couples increases with age. Women have a finite number of eggs. Thus, over time, their quantity and quality is reduced. The chances of getting pregnant are reduced by 3-5% every year since 30 years. After 40 years of decline in the probability is much stronger.

What causes female infertility?

The factors that cause female infertility may be:

• Damage to the fallopian tubes. This may prevent the contact of sperm with the egg. Infections, endometriosis and gynecological surgery can lead to scarring and damage to the fallopian tubes.
• Hormonal causes. Some women may have problems with ovulation - there is no simultaneous change in hormones, which leads to the output of egg from the ovary and the thickening of the endometrium. This problem can be determined by measuring the basal temperature or using Test ovulation Ovulation Test - the exact calculation? .
• Problems cervix. Occasionally it happens that sperm can not penetrate the cervix. The reason for this may be abnormal mucus production and the effects of surgery. In this case helps intrauterine insemination.
• Unexplained infertility. Approximately 20% of couples the cause of infertility can not be identified.

How is the cause of infertility?

To find out the causes of female infertility, the doctor may prescribe the following examinations:

• Blood test to determine the hormonal
• Endometrial biopsy to determine its condition
• To determine the scarring or blockage of pipes can be used hysterosalpingography and laparoscopy.
• Hysterosalpingography - a procedure which includes an ultrasound or X-ray examination of the reproductive organs. Dye and saline or air is introduced into the cervix, moving from the fallopian tubes. This allows you to see whether the tubes are passable.
• Laparoscopy - an operation in which a laparoscope (a thin tube with a camera) is inserted through a small incision in the abdomen. The laparoscope allows you to see the outside of the uterus, ovaries and fallopian tubes, and to find out if there are any abnormal growths.

How is female infertility?

Female infertility can be treated in several ways, including:

• Laparoscopic surgery. In the case of diseases of the reproductive organs may be assigned or reconstructive surgery performed in vitro fertilization. Tools in this operation are introduced through a small incision during surgery can remove scar tissue, endometriosis, ovarian cysts, or open pipe impassable. Using hysteroscope introduced into the cervix, can remove polyps or fibroid tumor, scar tissue, or to open the tube.
• Medication. Women who have problems with ovulation Ovulation - How to determine as accurately as possible? May prescribe medications such as clomiphene citrate or gonadotropins that lead to ovulation. Gonadotropins can also cause simultaneous ovulation of multiple eggs, which increases the likelihood of conception. Also gonadotropins used when the cause of infertility is not clear. Another drug to restore ovulation - metformin, which can be used in women with insulin resistance or polycystic ovary syndrome.
• Intrauterine insemination. This is a procedure in which semen is collected, washed with a special solution and placed in the uterus during ovulation using a catheter.
• In vitro fertilization (IVF). This is a procedure where the egg is fertilized in the laboratory and then placed into the uterus. Woman takes gonadotropin to stimulate ovulation of multiple eggs ripened egg is removed and collected separately fertilized by sperm. After a few days the fertilized eggs are placed in the uterus. Some of them can be frozen and later used as desired pair.
• Egg donors. If a woman's ovaries are functioning properly, but the queen is all right, it can be used egg donation. In this case, the donor are retrieved from the ovary ovules that are fertilized through IVF and then placed into the uterus of the recipient.

Blocking the fallopian tubes

Blocking the fallopian tubes helps to identify hysterosalpingogram (HSG), but to confirm this diagnosis should be made laparoscopy.

The most common reason for blocking the fallopian tubes - infection and the most common pathogen infection - chlamydia. Approximately 70% of women who have been diagnosed blocking the fallopian tubes are infected hlamidoznoy infection, though they can do not even suspect until after the examination to determine the cause of infertility.

Ovulatory failure

The normal menstrual cycle - is, above all, regular ovulation and hormonal changes that it causes. Thus, irregular menstruation indicates that the egg will appear in a woman every month.

Sometimes a woman has no problems with the menstrual cycle, but, nevertheless, do not ovulate each month. The test of ovulation can serve as a secretion of the hormone progesterone Progesterone - norm and pathology   21 day cycle (for a twenty-eight day menstrual cycle). The medical term "anovulation" refers to the absence of ovulation. In some cases, ovulation does not occur because of excessive activity of the pituitary gland to produce more (even excessive) amounts of the hormone prolactin (mammotropina).

Polycystic ovarian syndrome - another reason anovulation. Sometimes, during the surveys reveal hormonal disorders, and the picture at the edges of ovarian cysts are seen small. By themselves, they are completely safe and threats to health are not, however, indicate that the egg begins to develop, but never released.

Endometriosis

Endometriosis - a pathological process by which tissue similar to the lining of the uterus (the endometrium) begins to grow outside its normal position. Obviously, extensive endometriosis, exciting fallopian tubes and ovaries, violates the movement of the egg and ovulation, but it is not clear how easy or moderate endometriosis can affect fertility.

Treatment for endometriosis is aimed at the complete elimination of any of his surgically or by burning endothermy or laser therapy, the destruction of all adhesions and adhesions and maximum preservation of ovarian tissue in a normal state. Light and medium endometriosis can be identified and cured with laparoscopy, but more severe cases require surgery.

Unexplained infertility

Unexplained infertility is a very negative impact on the mental health of the woman, because this diagnosis means that treatment is very difficult, because the cause of infertility can not be determined. However, approximately 60% of couples who have been diagnosed with "unexplained infertility" and who have lived with this diagnosis less than three years, in the next three years have successfully become pregnant without any treatment. Recent studies of the effect of clomiphene did not confirm its efficacy in the treatment of infertility Infertility Treatment - What principles are priority .

For the treatment of infertility recommend ovarian stimulation (stimulation of the ovaries) in combination with direct fertilization and pre-cooked "optimized" sperm partner. To do this, carry out routine control of ovarian stimulation and fertilization in the expected time of ovulation, that is, with the help of vaginal speculum (as when taking a smear) is introduced into the uterus of a sperm sample. The probability of conception in this case is usually 15% per cycle. If this procedure is ineffective and after 6 cycles is recommended to conduct in vitro fertilization (IVF).