ENDOSCOPIC PICTURE OF FALLOPIAN TUBES STATE IN KAZAKHSTAN WOMEN WITH NATURAL STERILITY COMBINED WITH REPRODUCTIVE DISEASES

Determination of level of fallopian tube affect and assessment of fallopian tube state in women with natural sterility combined with reproductive diseases. The analysis of endoscopic surgery results was presented by sampling in 200 patients, of which 98 patients with natural sterility, 102 with secondary sterility. The patients with natural sterility were distributed by three groups: 1 group was made up with patients with natural sterility combined with endometriosis (n=33), 2 made up with patients with natural sterility combined with uterine fibroid (n=26), 3 are patients with natural sterility combined with chronic salpingitis. All patients have passed the standard examination. According to data of sonographic hydrotubation in 1 group the double-sided uterine tubes patency was observed in 28%(84,85+6,24), in 2 group in 20% (76,92+8,26), in 3 group 29 %(74,36+6,99) of cases. Under laparoscopic examination of fallopian tube the changes were observed in 1 group in 10% (30,30+8,00) of cases. In 2 group the changes are observed in 20 % (76,92+8,26) of cases. In 3 group the changes are observed in 32% (82,05+6,15) of cases. Hereby in view of the presence of patients with natural sterility the frequency of fallopian tube abnormality in three groups was equal from 30% to 82,05%, despite its double-sided patency 74,36% to 84,85%. Therefore the endoscopic interventions shall be performed not with the purpose of diagnosis verification but with medical purpose.


Introduction
Relevance: The problem of female infertility remains one of the most urgent problems in modern gynecological practice [1,2,3,4,5].
The leading form of female infertility, found among all forms of infertility, is the tubularperitoneal form. The cause of tubal-peritoneal form of infertility is inflammation of the pelvic organs [6,7,8].
The cause of the fallopian tubes injury can be not only the inflammation of the pelvis, but also other major diseases of the pelvic organs (endometriosis, uterine myoma). With uterine myoma, either mechanical compression of the fallopian tubes occurs, or their functional state is disrupted. Obstruction of the fallopian tubes due to endometriosis occurs in 10-15% of cases [9].
Fallopian tubes are of great importance in the process of fertilization, transporting gametes and embryos. Therefore, evaluation of the condition of the fallopian tubes is extremely important in the investigation of female infertility and is mandatory before using assisted reproductive technologies (ART), namely, intrauterine insemination and in vitro fertilization [10].
Advancements in the field of medicine made it possible to raise medical assistance to patients with female infertility to a fundamentally new level. This became possible due to the application of the newest methods of examination, namely endoscopic methods using modern technical means [11,12].
In order to diagnose the anatomical and functional state of the fallopian tubes in infertility, laparoscopic methods of investigation are widely used. For example, in the recognition of salpingitis before the laparoscopic operation, the diagnostic error was 20.4%, with overdiagnosis-8.2%, and an insufficient assessment of salpingitis-12.2%. In laparoscopic examination, the following signs of chronic salpingitis were found: injection of the fallopian tubes (60.4%), constrictions (2.3%), thickening of the fallopian tubes (1.2%) [13,14,15].
In this regard, the issue of diagnosing the state of the fallopian tubes is of particular importance. During endoscopy, namely laparoscopy, the status of the uterus, ovaries and fallopian tubes, pictures of acute and chronic inflammation of the uterine appendages, endometriosis, uterine fibroids, which require appropriate treatment, are assessed.

Objective of Research
Determination of level of fallopian tube affect and assessment of fallopian tube state in women with natural sterility combined with reproductive diseases.

Materials and Research Methods
This research was performed in gynecology department of the Perinatal center №1 of Astana city (Kazakhstan) over a period from 2014 to 2016. 200 patients, of which 98 with natural sterility, 102 with secondary sterility were examined by us. The patients with natural sterility were distributed for three groups: 1 group was made up with the patients with natural sterility combined with endometriosis (n=33), 2 made up with the patients with natural fertility combined with uterine fibroid (n=26), 3 with natural sterility combined with chronic salpingitis.
The age of examined patients in 1 group has ranged within 24 to 41 years, average age was equal to 32,39+4,81 years The age of examined patients in 2 group has ranged within 24 to 46 years and older, average age was equal to 35,8+4,75years.
The age of examined patients in 3 group has ranged within 24 to 45 and older, average age was equal to 31,97+4,89 years.
All patients have passed the routine examination; exclusionary criteria consist of the presence of OPS (polycystic ovarian syndrome) and male factor infertility.
The obtained data were statistically processed on individual computer using the «Microsoft Excel» spreadsheets and «SPSS Statistics» application program package.
Outcome: Age of onset of menarche in 1 group was ranged within 12 to 16 and older (Table 1). The timely menarche (at the age from 12 to 16 years) was observed in majority of women in all groups.
The data analysis has shown that the distinctions between the groups are statistically valid by Fisher's exact test (р=0,10) at (р<0,05), By this attribute the groups appeared to be comparable.

Genital Function
The

Reproductive Function
The patients of 1 group have noted the absence of pregnancy within 1 to 16 years with regular sex life. The natural sterility has taken place in 33 women. The duration of natural sterility was equal on average to 3,5 +2,3 years. The patients of 2 group have noted the absence of pregnancy within 1,0 to 14 years with regular sex life. The natural sterility has taken place in 26 women. The duration of natural sterility was equal on average to 4,28+3,3 years.
The patients of 3 group have noted the absence of pregnancy within 1,0 to 17 years with regular sex life. The natural sterility has taken place in 39 women. The duration of natural sterility was equal on average to 5,12+3,76 years.
In such a manner by attributes of surgical service the statistical analysis has shown that according to Fisher р=0,30 at (р<0,05).
According to data the uterotubograhy is presented in women examined in compared groups (Fig.1). Figure 1: Characteristics of tubal patency according to the data of the examined women's hysterosalpingography (HSG).
The data analysis has shown that according to Fisher at р=0,22 at (р<0,05) there were no any statistical discrepancy.
According to data of sonographic hydrotubation in examined women in compared groups is presented in (Fig.2).  According to data of three groups during comparison by one-way ANOVA was equal by Bonferroni р =1,0; by Scheffe р =0,97; by Tukey р=0,97, at (р<0,05), that has shown that there are no significant differences between the groups.
The scope of surgical intervention during diagnostic and treatment abdominoscopy conducted in examined patients is shown in the Table 2.  The analysis of obtained data has shown that according to data of three groups during comparison by one-way ANOVA was equal by Bonferroni р =1,0; Scheffe р=0,93; Tukey р=0,92, at (р<0,05), that demonstrates that there are no significant differences between the groups.
During comparison of three groups for change of fallopian tube it was detected that in 3 group the peritubal adhesions are in 14% (35,90+7,68) cases larger than in other groups despite the double-sided uterine tubes patency (74,36 %).

Findings
In such a manner in all three analyzable groups the majority of cases have turned to be comparable. In view of the presence of patients with natural sterility combined with reproductive diseases the frequency of fallopian tube abnormality in three groups was equal from 30% to 82,05%, despite its double-sided uterine tubes patency from 74,36% to 84,85%.
Therefore the precise diagnosis establishing is possible with correct observation of algorithm for examination of patients with natural sterility combined with reproductive diseases including the careful examination of complaints, anamnesis, data of special pelvic examination, ultrasound investigation and HSG.