Pelvic adhesions or scar tissue formation in the pelvis can lead to infertility. Many triggers can lead to adhesion formation including: endometriosis, previous surgery, pelvic infections, gonorrhea, chlamydia, pelvic inflammatory disease (PID), etc. When a women ovulates the oocyte or egg is released from the ovary. The egg is then picked up by the Fallopian tube. If there are adhesions in the pelvis the adhesions can interfere with the transport of the egg into the Fallopian tube. This transport interference can lead to infertility. It can also lead to an ectopic pregnancy if the egg is fertilized but then becomes trapped in the pelvis. An ectopic pregnancy results when a fertilized egg (embryo) implants and grows outside of the uterus.
Endometriosis is one of the leading causes of pelvic adhesions and pelvic pain. The endometrial layer of the uterus is the layer which lines the inside of the uterus (womb). It is the layer that grows every month during the menstrual cycle and then bleeds off with a period. This tissue can become misplaced and implant into the pelvis or nearby organs such as the bladder, bowel, ovaries, Fallopian tubes etc. The misplaced endometrial tissue then grows during the menstrual cycle and can bleed during the period. This can causes significant pelvic inflammation, pain and adhesions.
What causes endometriosis?
There are many theories as to the cause of endometriosis, but the exact cause is not known for sure. In most patients the most likely cause is retrograde menstruation. Retrograde menstruation is when some of the fluid from a women’s menstrual bleed goes up through the Fallopian tubes (retrograde) rather than exiting out of the body through the vagina. This fluid travels though the Fallopian tubes and is then released into the pelvis. The fluid contains endometrial cells which can implant and grown in the pelvis, resulting in endometriosis.
How is endometriosis diagnosed?
Sometimes endometriosis can be seen or hinted at by imaging studies such as ultrasound or MRI. Officially endometriosis can only be diagnosed by performing surgery and biopsying (removing) some of the tissue that is thought to contain endometriosis. The tissue is then viewed under the microscope and if endometrial tissue is seen the diagnosis of endometriosis is made. While this method is the only official method to diagnosis endometriosis it is very invasive. Therefore, we rarely perform surgery just to determine whether or not someone has endometriosis.
How does endometriosis affect fertility?
Endometriosis can affect fertility in several ways. The most obvious way is that endometriosis can lead to scar tissue or adhesions in the pelvic. If the adhesions inhibit the transport of the egg, infertility will result. Endometriosis also causes inflammation in the pelvis. This inflammatory reaction can create an inhospitable environment for the egg and or embryo to grow and develop. This too will result in infertility.
What can be done to improve fertility in people with endometriosis?
There are many different treatment options for women with endometriosis who are trying to conceive. Over time the options have changed considerably. One of the older standard options was surgery. More recent studies have indicated that while there may be some benefit to surgery the overall improvement in pregnancy rates is small. Therefore, surgery is not usually considered a first line treatment option in women with endometriosis and infertility. Women with severe endometriosis and adhesions can benefit from in vitro fertilization (IVF) instead of surgery. IVF essentially bypasses the pelvis and Fallopian tubes. Therefore, severe adhesions will have no impact on overall success rates with IVF. In less severe cases of endometriosis less invasive fertility treatment can be done. This includes options such as oral medications (eg Clomid), injectable gonadotropins, and/or inseminations (IUI). At the Advanced Reproductive Center we customize the treatment plan based upon each unique patient’s situation.
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To learn more about endometriosis and pelvic adhesions, contact the Advanced Reproductive Center. To schedule an appointment call us at 815-229-1700, or fill out the form below and we will contact you.