Pelvic Adhesions & Their Impact on Female Fertility!

• What are Pelvic Adhesions?
• What causes Pelvic Adhesions?
• Symptoms
• How do pelvic adhesions cause infertility?
• How adhesions are diagnosed?
• Fertility Treatment

Do you know that adhesions can be a significant factor in as much as 40% of infertility? Also thought to be responsible for up to 50% of chronic pelvic pain and are typically responsible for 50-75% of bowel obstruction cases. 

Fertility specialists state that they often see women patients whose infertility is accompanied by significant pelvic pain. Certainly, pelvic pain is a general term that could be related to a wide variety of medical conditions, which may or may not affect a woman’s fertility. However, it is found that a very common cause of chronic pelvic pain is pelvic adhesions.

Pelvic/uterine adhesions or scar tissue or Asherman’s syndrome commonly can cause infertility by preventing implantation.

This article discusses what are pelvic adhesions, how they are related to your fertility, treatments, and more details. 

What are pelvic adhesions?

Pelvic adhesions areas of scar tissue that form between internal organs causing them to stick to one another that are not generally joined together. They can affect any of the internal organs near pelvic regions, including:

• Uterus
• Fallopian tubes
• Ovaries
• Bladder
• Intestines

Anything that leads to an inflammatory response such as infection, or surgery, or some diseases can trigger adhesion formation. Adhesions can cause infertility by:

• Interfering with ovulation
• Preventing the egg & sperm from coming together
• Making the uterus inhospitable to a fertilized egg.

Uterine adhesions are one of the possible causes of blocked fallopian tubes, endometriosis. Also, PID-Pelvic Inflammatory Diseases can cause adhesions that interface with your ability of conception.

Asherman’s syndrome/uterine synechiae are conditions when adhesions form inside the uterus. It might cause infertility or recurrent miscarriages. 

What causes Pelvic Adhesions?

Adhesions can occur as a result of inflammation and when the body’s natural healing process goes a little awry. 

Usually, the surfaces of the uterus, abdominal cavity, & fallopian tubes are slippery. This enables organs to move around each other easily. 

• Tubal surgery
• Myomectomy
• Ovarian surgery
• Surgery for endometriosis
• Even surgeries to remove adhesions can lead to the formation of new adhesions.

However, when there is an injury from infection, endometrial deposit, or previous surgery, the surface could become sticky and cause organs to get stuck together. Scar tissue may hold the internal organs in an abnormal position and may also create web-like attachments between organs. 

These adhesions are usually thick and strong where your organs may unnaturally pull on each other. This can do cause pain, especially during menstruation or during intercourse.

Symptoms

Most women who have pelvic adhesions don’t have any symptoms and others may experience:

• Infertility
• Pelvic pain/Abdominal Cramping
• Bloating
• Nausea
• Bowel obstruction

How do pelvic adhesions cause infertility?

Infertility is caused when the adhesions interrupt gamete or egg transport & prevent them from coming together or implanting or distort the reproductive organs.  The finger-like projections of the fallopian tube called fimbriae have difficulty receiving the egg after ovulation, if adhesions block the entry point or pull the fallopian tube too far away from the ovaries and preventing fertilization and implantation. 

In the case of Asherman’s syndrome, adhesions occur within the uterus and in a few or in severe cases, they could cause uterine walls to stick together completely.  

Uterine adhesions prevent a healthy endometrial lining from being formed further preventing implantation of an embryo. Or even if implantation of an embryo does happen, the miscarriage risk may be higher.

In cases of PID, or any other infections of the reproductive tract, the fallopian tubes can become inflamed which can develop into scar tissues within the tubes. Adhesions caused due to endometriosis usually occur in the pelvic cavity. They even might present near fallopian tubes /ovaries and these endometrial adhesions can interface with ovulation.

If adhesions interface with the natural movement of fallopian tubes, an egg may not make it into the tubes, therefore, decreases one’s fertility. 

Women with adhesions are at higher risk for having recurrent pregnancy loss, & ectopic pregnancy.

How adhesions are diagnosed?

Pelvic adhesions can be diagnosed using:

HSG-Hysterosalpingogram—It is a test in which the uterus is visualized through x-ray and a special dye is introduced into the uterus passing through the cervix and fallopian tubes. This examination is used to determine whether your fallopian tubes are open

Hysteroscopy—A small-diameter device called a hysteroscope (a telescope-like device attached with a miniature camera) is inserted into the vagina to examine the cervix & also used to diagnose or treat uterine problems. 

Laparoscopy—In diagnostic pelvic laparoscopy, doctors use an instrument called a laparoscope (a long thin tube with a high-resolution camera & light) to examine reproductive organs. 

It is suggested where X-ray and ultrasound cannot find the cause of the condition. Used to determine the cause of pelvic pain, screen abdominal regions and to examine an abnormality like tissue mass, ovarian cyst or tumor, to examine obstructions, etc.

Fertility Treatment

Surgical repair can be possible through an operative hysteroscopy or laparoscopy depending on the severity and location. However, IVF treatment might be a more successful and cost-effective option for women who are suffering from infertility due to adhesions.

If Asherman’s syndrome is the cause of fertility issues then adhesions can be removed with the help of operative hysteroscopy. After hysteroscopy, you might be able to conceive naturally or you may require fertility treatment in addition to surgery.

In the case of endometriosis or pelvic adhesions, removal of the scar tissues/adhesions might reduce pain and improve the odds of a successful pregnancy. However, based on the severity of the condition, one may still need IVF or other fertility treatment after surgery. 

MotherToBe’s experienced and highly skilled surgeons are able to detect and remove adhesions, thus improving patients’ fertility by reducing discomfort.  Our fertility specialists are expertise in performing minimally invasive surgery for pelvic adhesions that hinder one’s fertility potential.

It is best to consult a fertility doctor at the earliest stage of any condition for an accurate diagnosis and effective treatment. Reach out to your nearest MotherToBe fertility center in Hyderabad to assist you through your journey to conception.  

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