Preventing the egg and sperm from meetingInterfering with ovulationMaking the uterus inhospitable to a fertilized embryo
Adhesions are one possible cause of blocked fallopian tubes. Endometriosis and pelvic inflammatory disease (PID) can cause adhesions that interfere with your ability to get pregnant. Asherman’s syndrome, or uterine synechiae, are when adhesions form inside the uterus. It may cause infertility or recurrent miscarriage.
Causes
Adhesions can occur when the body’s natural healing process goes a little awry. Usually, the surfaces of the uterus, abdominal cavity, and fallopian tubes are slippery. This enables organs to move around each other easily. However, when there is injury – from an infection, previous surgery, or an endometrial deposit – the surface can become “sticky.” This can cause organs getting stuck together. Scar tissue may form and hold the organs in an abnormal position. Scar tissue may also create web-like attachments between organs. These adhesions can be thick and strong. Your organs may unnaturally pull on each other. This can cause pain, especially during sexual intercourse or during menstruation. In the case of Asherman’s syndrome, adhesions occur within the uterus. The adhesions may be few, or, in severe cases, they can cause the uterine walls to stick together almost completely. In the case of pelvic inflammatory disease, or any other infection of the reproductive tract, the fallopian tubes can become inflamed. The inflamed surfaces can develop scar tissue or adhesions within the tubes. These adhesions prevent egg and sperm from coming together. Adhesions caused by endometriosis usually occur in the pelvic cavity. They may be present near the fallopian tubes or ovaries. Endometrial adhesions may interfere with ovulation. Sometimes, endometrial adhesions prevent the fallopian tube from moving naturally. The ovary is not attached directly to the fallopian tubes. During ovulation, when an egg is released from the ovary, it must find its way into the fallopian tube.
Diagnosis
There are three primary ways to diagnosis adhesions:
HSG (hysterosalpingogram) Hysteroscopy Laparoscopy
An HSG is a special kind of x-ray that can be used to get an idea of the uterine shape and whether the fallopian tubes are clear. Blocked fallopian tubes may be diagnosed with an HSG. With a hysteroscopy, a thin, lighted tube called a hysteroscope is inserted into the uterus via the cervix. This enables the doctor to see the inside of the uterine cavity and the openings to the fallopian tubes. A hysteroscopy can be used to diagnose problems with the uterine cavity, including Asherman’s Syndrome. The same procedure may be used to remove and heal intrauterine adhesions. A laparoscopy is a procedure where a small incision is made in the abdomen. Then, a small, lighted tube with a camera device is inserted, along with instruments. Laparoscopic surgery is the only way to diagnose endometriosis. You can get normal results on an HSG and hysteroscopy, but still have mild to severe endometriosis. About 50% of otherwise normal infertile patients may be diagnosed with pelvic adhesions or endometriosis after a laparoscopy. Sometimes, “unexplained” infertility is really just undiagnosed pelvic adhesions or endo.
Fertility Treatment
If the adhesions are within the fallopian tubes, surgical repair may be possible. However, IVF treatment may be more successful and cost-effective. If Asherman’s syndrome is the cause of infertility, the adhesions may be removed during an operative hysteroscopy. You may be able to conceive naturally afterward, or you may require fertility treatment in addition to surgery. In the case of pelvic adhesions or endometriosis, removal of the adhesions may reduce pain and may improve the odds of pregnancy success. However, depending on the situation, you may still need IVF or fertility treatment after surgery. Always talk to your doctor about all your options. Ask what can be expected after surgery.
