Adhesions

The cause of infertility can sometimes be traced to adhesions in a woman's pelvic cavity or uterus. Adhesions, also known as scar tissue, may occur in the majority of women following pelvic surgery and lead to such problems as pelvic pain in addition to infertility. Adhesions can also form in the uterus (intrauterine adhesions) and can be associated with menstrual dysfunction and infertility, despite the fact that some women may not experience any symptoms.

The cause of adhesions.

Adhesions in the pelvic cavity may occur following pelvic surgery for treatment of fibroids, ovarian cysts, or anatomical problems with reproductive organs. Adhesions can also be associated with endometriosis.

Intrauterine adhesions may be caused by trauma to the uterine cavity, such as dilation and curettage (scraping away of tissue or growth). They may also be caused by prolonged use of an IUD and infections of the endometrium, although these causes are less common.

Diagnosis and surgical treatment of adhesions.

Adhesions are often diagnosed and treated with laparoscopy, a surgical procedure that allows a healthcare provider to visualize a women's internal pelvic cavity and reproductive organs. During this procedure, a telescope-like instrument with a camera, called a laparoscope, is inserted into the pelvic cavity through a tiny incision made just below the woman's navel. Other instruments, such as laser or electrocautery, may also be used to remove the adhesions during the surgical procedure. They, too, are inserted through small incisions.

To diagnose intrauterine adhesions, a healthcare provider may use an x-ray procedure called hysterosalpingography (HSG). A more accurate method for diagnosis, however, is hysteroscopy. During this procedure, a hysteroscope (also a thin telescope-like instrument) is inserted through the cervix in order to visualize the uterine cavity. Generally, intrauterine adhesions are removed with hysteroscopic guidance using instruments such as a laser, electrocautery, or scissors.