Pelvic Adhesive Disease

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Whenever a person has pelvic or abdominal surgery, a potential side effect is the formation of scar tissue. The only visible scar the patient sees is on the outside where the incisions may have been made, but there are healing phenomena at work on the inside as well, resulting in internal scarring, called adhesions. Adhesions can also develop in patients that have not had surgery. Any inflammatory process, whether it be normal post-operative healing, internal trauma and bleeding (eg. ruptured ovarian cysts), endometriosis, or infections (i.e. results of a ruptured appendix, Chlamydia, gonorrhea, and pelvic inflammatory disease “PID”) can result in the formation of adhesions inside the body.

Adhesions cause the surface of the organs to stick together. Normally, with no scar tissue present, organs are slippery and they glide against each other. Adhesions may contribute to infertility if they form around the ovaries, uterus, or fallopian tubes.

How Do Adhesions Cause Infertility?

If the fallopian tubes have adhesions or scar tissue around them, it can block an egg from entering the fallopian tube and therefore not be able to be fertilized by a sperm. If the tubes are partially blocked by adhesions, the egg may enter the fallopian tube and be fertilized by the sperm, however, may not adequately be able to make its way into the uterus; in this case an ectopic pregnancy (pregnancy outside the uterus) may occur and could result in a life threatening situation. Furthermore, adhesions around the ovary may disrupt ovulation.

Another form of pelvic adhesions are those that occur inside the uterus. These adhesions, called synechiae, may prevent an embryo from implanting into the uterine wall. The most common cause of intrauterine adhesions is due to previous uterine surgeries such as D&Cs either for abortions, miscarriages, or excessive bleeding. In addition, adhesions may be related to child birth when there are uterine infections or bleeding associated from childbirth, or if a Cesarean Section is performed. The most severe form of uterine adhesion is called “Asherman’s Syndrome”, and occurs when much of the inside of the uterine lining is abnormal.

What Are the Symptoms of Pelvic Adhesive Disease?

Often times, infertility is the only symptom of Pelvic Adhesive Disease. Some women may feel abdominal or pelvic pain, have pain during intercourse, strong menstrual cramps or pain during bowel movements. Uterine adhesions may also present as very light or absent menstrual flow.

How is Pelvic Adhesive Disease Diagnosed?

Pelvic adhesive disease is usually diagnosed with one of several diagnostic/surgical procedures:

• Sonohysterogram – an ultrasound based procedure in which sterile fluid is used to separate the layers of the uterus in order to determine if any abnormalities are present, including scar tissue.
• Diagnostic or Operative Hysteroscopy – a procedure in which a narrow fiber-optic telescope, a hysteroscope, is inserted into the uterine cavity to look for and potentially remove uterine adhesions
• Diagnostic or Operative Laparoscopy – a procedure in which a thin lighted telescope, called a laparoscope, is inserted into the abdominal cavity through a small incision in or near the belly button. Through the laparoscope, Dr. Zoneraich or your Ob/Gyn can see the surface of the uterus, fallopian tubes, ovaries and other pelvic organs to visually confirm the presence and extent of any adhesions. During this same procedure, Dr. Zoneraich or your Ob/Gyn is frequently able to remove the scar tissue attached to other organs.

How is Pelvic Adhesive Disease Treated?

In many cases, surgical removal of abdominal, tubal or ovarian scar tissue may be the optimal treatment for pelvic adhesive disease, especially if the woman is experiencing pain or discomfort secondary to the scar tissue. However, from the fertility standpoint, in many cases, choosing to proceed with In-Vitro fertilization (IVF) may provide the best opportunity to achieve pregnancy without undergoing surgery. Dr. Zoneraich will discuss the specifics of your case and his recommendations on the most appropriate course of action once he has had a chance to meet with you and evaluate your situation.

As for uterine adhesions, Dr. Zoneraich will evaluate the cause and extent of the adhesions, and then discuss the appropriate approach to addressing the adhesions. In many cases, a simple outpatient surgical procedure called an operative hysteroscopy will be all that is required to do so. Regardless of the cause, it is essential to restore the uterine cavity to normal prior to undergoing any fertility treatments.

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