Sometimes, infertility can be traced to pelvic scarring and adhesions. Infertility is caused when abdominal adhesions prevent the fertilized egg from reaching the uterus. Adhesions around the fallopian tubes can also make it difficult for sperm to reach the ovum. Tubal ectopic pregnancy is very often traced to adhesions in or around the fallopian tubes. Surgical intervention is needed to remove the adhesions which may be causing infertility.
What are Adhesions?
Adhesions or injuries are a type of scar tissue that may form between organs and tissues after a surgical procedure. Adhesions that form after surgery in the pelvic area and after surgeries to remove fibroids are among the leading causes of post-operative infertility. The main cause of intrauterine adhesions is trauma to the uterine cavity following a D&C procedure, prolonged use of an intrauterine device (IUD), endometritis and removal of fibroids in the uterus.
These injuries are typically caused by cauterization, suturing, and abrading tissues and organs during surgery. This internal trauma may lead to infertility and other issues. Once formed, adhesions need to be surgically removed. This means that adhesions that form in one surgery may require future surgery to cut through them to correct infertility or other complications.
Diagnosing Adhesions
Intrauterine adhesions may be diagnosed using an x-ray procedure called hysterosalpingography (HSG). Hysteroscopy is also another method of diagnosis where a hysteroscope (a thin telescope-like instrument) is inserted through the cervix to allow direct visualization of the uterine cavity. Both HSG and hysteroscopy can be performed without general anesthesia.
How are Adhesions removed?
Generally, trauma caused by intrauterine adhesions is removed with hysteroscopic guidance using instruments such as a laser, electrocautery device, or scissors. They are inserted through small incisions. Pelvic adhesions may sometimes be treated by laparoscopy. A laparoscopy is conducted under general anesthesia where the laparoscope is inserted into the pelvic cavity through a tiny incision made just below the woman's navel. After the adhesions are removed, surgeons recommend placing a device such as a plastic catheter temporarily inside the uterus to prevent the adhesions from forming again. Hormonal treatment with progestins estrogens and non-steroidal anti-inflammatory medications are prescribed post surgery to lessen the chance of adhesion reformation.
Conception Chances
After treatment it is seen that patients with mild to moderate adhesions have full-term pregnancy rates of around 70 to 80 percent. Patients with severe adhesions may only have full-term pregnancy rates in the 20 to 40 percent range after treatment. In-vitro fertilization (IVF) is ideally suited for women with blocked fallopian tubes or pelvic adhesions.
East Bay Fertility Center specializes in the comprehensive evaluation and treatment of infertility providing a complete mind-body experience for fertility couples. The Center performs extensive tests to find out the cause of infertility that also includes investigating suspected adhesions in the uterine cavity. Call 925.828.9235 for a free initial consultation.
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