Written by Shahin Ghadir, MD (Southern California Reproductive Center)
Los Angeles fertility specialists Mark Surrey, M.D. and Hal Danzer, M.D. often see women whose infertility is accompanied by significant pelvic pain. Of course, pelvic pain is a somewhat-general term that can be related to a wide range of medical conditions, which may or may not impact a woman’s fertility. However, Drs. Surrey and Danzer find that a very common cause of pelvic pain is pelvic adhesions.
TPelvic adhesions are bands of scar tissue that may cause internal organs to stick to one another. They may affect any of the organs in or near the pelvic region, including the:
There are many ways in which different types of adhesions cause the organs to stick together. For example, the uterus may be bound by adhesions to the ovaries, or the adhesions may be intrauterine (strictly within the uterus), in which case the myometrium (uterine muscle) is bound to the opposite uterine wall.
Pelvic adhesions may be caused by a number of factors, but previous pelvic surgery or infection is usually the culprit. Pelvic inflammatory disease, which is a complication of certain urogenital infections, often leads to adhesions in the fallopian tubes. Pelvic adhesions may also occur with severe cases of endometriosis.
If pelvic adhesions are present within the fallopian tubes, they prevent eggs from traveling freely through the tubes, which is necessary for a normal pregnancy. Therefore, we can see how infertility may result. Another possible complication that may occur is that the fertilized egg is trapped in the fallopian tubes; the embryo develops in the tubes instead of in the uterus. This is called an ectopic pregnancy. If intrauterine adhesions are present, the scar tissue causes parts of the uterine interior to be abnormally joined together; decreased fertility results from defective implantation.
The diagnosis of pelvic adhesions is by no means simple or obvious. Ordinary imaging tests, such as MRI, CT, and ultrasound often do not reveal their presence. It takes highly trained specialists, such as the fertility doctors at the Southern California Reproductive Center (SCRC), to arrive at a definitive diagnosis of pelvic adhesions. This is first accomplished by taking a detailed medical history and performing a thorough pelvic exam. In order to get a clear idea of the severity and extent of the pelvic adhesions, our fertility specialists will often need to perform a laparoscopy. If the problem is thought to be confined to the uterus (intrauterine adhesions) a hysteroscopy may be sufficient.
Once an accurate diagnosis has been obtained, your SCRC fertility specialists will proceed with the appropriate surgical treatment (non-surgical treatments will not work, as they do not remove the physical problem) to remove the adhesions.
Removal of pelvic adhesions is actually a very routine surgical infertility treatment at SCRC; our fertility doctors can perform this procedure in our on-site surgery center, which is specially equipped for most fertility-related surgical procedures. Often, we can perform this minimally invasive surgery at the same time as we are diagnosing the pelvic adhesions. That means once we have identified and characterized the adhesions, we can surgically remove them, either by burning them out (vaporizing the scar tissue) or by cutting them out; this is done by introducing surgical instruments into the laparoscope or hysteroscope we are using during diagnosis. In this manner, no additional surgical incisions are required, reducing post-surgical pain and healing time. The fertility specialists at SCRC are highly experienced in performing minimally invasive surgery for pelvic adhesions; in fact, this type of surgery can make the critical difference between fertility and infertility.
Call SCRC at (800) 600-9112 to speak to one of our helpful fertility consultants. They will be glad to give you more detailed information about diagnosing and treating pelvic adhesions, as well as information about surgical infertility treatment in general. They can also schedule a consultation for you with an SCRC fertility specialist. If you prefer, you may also click here to contact us.