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Pelvic Adhesions: Impact on Your Fertility

Did you know that adhesions can lead to infertility or increase the chance of an ectopic pregnancy?

What are Adhesions?
Adhesions, which are also called scar tissue, can block or distort the fallopian tubes. Anything which leads to an inflammatory response such as surgery, endometriosis, or infection (including Pelvic Inflammatory Disease or ruptured appendix) can initiate adhesion formation.

Where can Adhesions form?
Pelvic adhesions can be found between any two tissue surfaces in the pelvic cavity. These include the uterus, fallopian tubes, ovaries, bowel, and bladder. Adhesions may also be found inside the fallopian tubes. Endometriosis or tubal surgery may cause adhesions to form inside the fallopian tube, on the outer surface of the tube, or even on the ends of the fallopian tube called the “fimbria”. These fimbria, which act like fingers to sweep the egg into the tube, become stuck together and can’t move to get the egg into the tube when it is released during ovulation. Any tubal adhesions which block or distort the tube can lead to infertility or increase the chance of an ectopic pregnancy.

Can adhesions be removed?
Removal (also called ”lysis”) of adhesions can be accomplished using laparoscopy or laparotomy with traditional or microsurgical techniques. Studies have shown that removal of adhesions can reduce pain and can potentially improve the possibility of conceiving, versus no treatment at all. However adhesions may reform after they have been removed.

What types of surgeries can increase the risk of adhesion formation?
Adhesions form in the majority of women after gynecologic pelvic surgery. Studies have shown that adhesions formed in 55-100% of patients who had reproductive pelvic surgery, whether open or aparoscopic. For example, myomectomy (surgery to remove fibroids), tubal surgery (to remove an ectopic pregnancy), surgery on the ovary (to remove cysts) and surgery for endometriosis can cause adhesions. Even surgery to remove adhesions can lead to new adhesions. Laparoscopic surgery (surgery done through several small incisions using a camera) causes less adhesion formation than laparotomy (surgery through one larger incision without use of a camera). Microsurgery (surgery using a microscope or magnifying glass, and special surgical technique) leads to less tissue damage and has a lower incidence of adhesion development than the traditional approach. Diagnostic procedures, which only involve a visual inspection of the organ(s), such as a diagnostic hysteroscopy or diagnostic laparoscopy, rarely lead to adhesions.

How can the risk of developing adhesions be reduced?
There are techniques which can be used at the time of surgery to reduce the risk of developing adhesions. In addition to using microsurgery or laparoscopic techniques, prevention of infection is essential. During surgery, various products are used to inhibit adhesion formation, known as adhesion barriers. These include gauze-like materials placed over the tissue which dissolve to become a gelatinous layer to reduce the incidence of post-operative adhesions. This material is eventually absorbed by the body.

Be informed. Ask Questions.
Patients should be aware of the type of procedure (laparotomy vs laparoscopy), and the type of techniques to be used during their surgery. Here are some questions to ask your doctor:

  • What type of surgery will I have? (Laparotomy? Laparoscopy?)
  • Will pre-operative antibiotics be given to reduce any risk of infection?
  • What are the risks of adhesions with my surgery?
  • What is the potential impact of adhesions on fertility?
  • What will be done at the time of surgery to minimize the risks of developing adhesions?