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Testing and treatment for pelvic factor infertility and pelvic adhesions

Advanced Fertility Center of Chicago
IVF Specialist Clinic
Gurnee & Crystal Lake, Illinois

Treatment options for infertility caused by scar tissue, and pelvic or tubal scarring and adhesions

Background information on pelvic scarring and adhesions is on the pelvic scar tissue page

Ultrasound

Pelvic ultrasound can sometimes give us evidence of pelvic scarring and tubal damage. We can see blocked tubes that are full of fluid - called a hydrosalpinx (plural is hydrosalpinges). At times we can see that the ovary is fixed in an abnormal location, which indicates adhesions that have glued it in place.

Ultrasound of uterus with ovary stuck on top in scar tissue	Uterus outlined in pink, uterine lining yellow, ovary green

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Ultrasound picture showing a hydrosalpinx - blocked and dilated fallopian tube
Black, sausage-shaped area at the bottom is fluid in the tube

Hysterosalpingogram HSG

The diagnosis of pelvic factor infertility can be made sometimes with a hysterosalpingogram. This is an x-ray examination performed in the radiology department of the hospital in which contrast material (dye) is injected through the cervix to the uterine cavity. If the fallopian tubes are open the dye flows into the tubes and then spills out to the abdominal cavity. This is documented in a series of x-ray images during the procedure.

Open but scarred tubes may not be able to perform the necessary functions to result in establishment of a normal intrauterine pregnancy. Proper tubal function allows egg pickup and transport, fertilization, and subsequent embryo transport from the fallopian tube down into the uterus where the embryo would implant.

If egg pickup, transport, and fertilization occur properly, but the internal tubal damage does not allow proper transport of the embryo to the uterus, implantation may occur in the tube resulting in a tubal pregnancy.

Pockets of pelvic scar tissue can sometimes be identified on the HSG

Hysterosalpingogram x-ray showing an area of dye collection in adhesions around the left fallopian tube

Example of a normal HSG

Laparoscopy can be performed to look for pelvic scar tissue and endometriosis

Hydrosalpinx, blocked and dilated fallopian tube
Pelvic scar tissue and adhesions being cut at laparoscopy
Although success rates are low with surgical "correction" of pelvic scarring and tubal damage, some women have surgery first
If the surgery does not lead to a successful pregnancy, they can do IVF later

Laparoscopy photo pages

Treatment of pelvic factor infertility

The treatment is usually either tubal surgery to repair some of the damage, or ovarian stimulation with intrauterine insemination, or in vitro fertilization (IVF) - depending on the degree of pelvic damage and the wishes of the woman. The decision as to what treatment is most appropriate for the couple requires a detailed discussion with the Reproductive Endocrinology and Infertility specialist of the risks and benefits of the available options in that particular couple's situation.

In vitro fertilization for pelvic factor infertility:

In vitro fertilization is a treatment option that bypasses the pelvic problem instead of attempting to fix it.

With IVF, sperm and eggs are mixed together in the laboratory and then the resulting embryos are transferred to the woman's uterus. This gets the sperm and eggs together outside the woman's body, then the pelvic scar tissue doesn't affect fertility.

Pregnancy rates with in vitro fertilization for pelvic factor infertility in women under 40 years old are usually excellent because these women are less likely to have additional fertility problems.