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Adhesions and Infertility

Pelvic adhesions are also commonly referred to as scar tissue. Adhesions are areas of fibrous tissue that form as a result of the healing process which remain after the original inflammation or trauma has healed. Adhesions can cause different organs in the abdomen or pelvis to become stuck together. As a result, adhesions can distort the normal pelvic anatomy or cause decreased mobility and function. Therefore, pelvic adhesions can be a cause of infertility.

Adhesions can result from a number of different causes. Common causes of adhesions are infections, previous surgery, abdominal trauma, endometriosis , and appendicitis. Essentially, anything that causes inflammation in the abdomen can cause adhesions. In some cases, women are found to have adhesions even without a history of any of the above conditions. In some of these women, adhesions might have resulted from a previous pelvic infection. Since not all pelvic infections in women may have noticeable symptoms, the woman might not have realized that she had the infection. Nonetheless, adhesions may have formed as her body worked to get rid of the infection.

Tube and ovary interaction

Normally, the ovaries and fallopian tubes are mobile and can easily interact with each other. At the time of ovulation, the developing egg starts to bulge outward causing a bump on the surface of the ovary called the “stigma”. The ends of the fallopian tubes have fine fingers or “fimbriae” which can capture the egg. At the time of egg release, the stigma becomes sticky. The fallopian tube, which normally can sweep the fimbriae over the surface of the ovary, will stick to the area of the stigma so that the egg is released directly into the fallopian tube.

Adhesions may affect the chances for a woman to get pregnant if it becomes more difficult for the egg to enter the fallopian tube at the time of ovulation. Adhesions will sometimes form a barrier between the ovary and the fallopian tube. Think of a sheet with the ovary on one side and the tube on the other. When the egg is release from the ovary, the tube cannot get to it. Other types of adhesions may pull the tube and ovary apart so that the fimbriae cannot reach the egg at ovulation.

There are cases in which a woman may have adhesions in her abdomen or pelvis that don’t affect the tubes or ovaries. These adhesions may cause pain or other health problems but they will not impair her ability to become pregnant.

Tubal blockage versus adhesions

It is important to distinguish between fallopian tubes that are “blocked” from those that are “open” but affected by adhesions. Blocked fallopian tubes occur when there is an actual obstruction within the fallopian tube. The tube itself may have normal mobility. A blocked fallopian tube can be diagnosed using a hysterosalpingogram . Pelvic adhesions can only be diagnosed with surgery to look inside the abdomen.

Categories of pelvic adhesions

Over the years, physicians have tried classifying adhesions so that more uniform descriptions can be given for adhesions. This allows for more easy comparisons between patients and allows fertility doctors to more easily assess the potential benefits of treatments to remove or prevent adhesions.

Filmy adhesions are very thin and can usually be broken apart easily with gentle pressure or tugging. Thick adhesions often are vascular (contain blood vessels) and require disruption via mechanical mean or with energy (such as electrical or laser) to be removed. Band adhesions may connect two structures by forming a “band” or string-like structure between them. Flat adhesions result when two structures are “stuck” together.

Treatment of adhesions to improve fertility

Surgery is the only effective treatment for pelvic adhesions. Fertility doctors will use the term “lysis of adhesions” to describe the surgical procedure to cut away adhesions and restore the normal pelvic anatomy. As a general rule, the less adhesions that are present, the more it is likely that surgery will be effective at producing a pregnancy. Why aren’t all surgeries to remove adhesions successful? One reason is that adhesions can recur after a surgery. In addition, new adhesions may form after a surgery is performed, even if the purpose of the surgery was to remove adhesions.

Fertility doctors will try to use many techniques to prevent adhesions from returning or to prevent new adhesions from forming. Often, this involves putting absorbable “barriers” in the pelvis to prevent different structures from getting stuck together. Another method is to place various types of fluid in the abdomen after the surgery. currently, there is one type of fluid that is approved by the FDA during gynecologic surgery to prevent adhesions. It is called Adept.

Beware the “snake oil” salesman

Snake oil salesman is a derogatory term for those who offer for purchase treatments which are fake, fraudulent, quackish, or ineffective. Snake oil salesman typically thrive in those areas of medicine in which there is no proven highly successful therapies. The area of pelvic adhesions is just such an area.

On the internet, there have been heavily advertised websites promoting the use of various types of abdominal massages to improve the fertility of women with pelvic adhesions. By mixing in a little bit of science and preying on the hopes of desperate couples with infertility, these quacks have been successful at separating couples from thousands of dollars of their hard earned money for “treatments” that lack any proven benefit.

The pelvis is protected on all sides by several bones. The very top of the pelvis is below the pubic hair. Massaging someone’s abdomen does not even come close to manipulating the pelvic organs. Do not fall prey to these criminals!