Pelvic adhesions

All of the organs in a woman’s abdomen are covered with a slippery tissue layer that prevents them from sticking to each other. When the surface of the organs becomes damaged or inflamed, scar tissue can form. There are multiple potential causes of scar tissue, such as a previous pelvic infection, endometriosis, certain medical conditions, or previous surgery. This scar tissue, called pelvic adhesions, can cause infertility and/or raise the risk of a woman developing a tubal (ectopic) pregnancy.

How do pelvic adhesions cause infertility?

The organs in the abdomen need to be able to glide past each other in order for pregnancy to occur. Specifically, the fallopian tube must be mobile so that the finger-like projections on the end of the tube, the fimbria, can pick up the ovulating egg as it comes out of the ovary. If the tube or ovary is stuck to other organs or to the side of the pelvis, it will not be in the appropriate position for egg pick-up.

How do I know if I have adhesions?

A history of a pelvic infection, endometriosis, previous surgery or certain medical conditions can suggest the diagnosis of pelvic adhesive disease. However, only a surgical procedure called laparoscopy can make the diagnosis. Laparoscopy involves the placement of a small operative telescope with an attached camera through a small incision in the abdomen so that the pelvic organs can be visualized directly.

How is this condition treated?

If adhesions are diagnosed during laparoscopy, then small instruments can be placed through the abdominal wall to treat tthems. The adhesions can be removed with scissors, cut with a laser, or burned with electrical current. Surgical correction of pelvic adhesions can improve pregnancy rates by freeing up the ovaries and fallopian tubes so that the egg is more likely to be picked up by the fallopian tube after ovulation.

Even following complete scar tissue removal, it is possible for the scar tissue to reform. Pelvic adhesions also increase the risk of an ectopic or tubal pregnancy even after treatment. Therefore, if a woman has a history of adhesions, every pregnancy should be monitored very closely to make sure that implantation has occurred in the uterus. If adhesions are significant, IVF may be required for pregnancy to occur.

Since IVF does not require normal fallopian tubes or a normal pelvis free of scar tissue, it is often the optimal fertility treatment for women with pelvic adhesions or severe endometriosis.

If you have any questions, please contact our San Antonio fertility center.