Testing and Treatment for Pelvic Factor Infertility and Pelvic Adhesions
Background information on pelvic scarring and adhesions is on the pelvic scar tissue page
Ultrasound Evaluation of the Pelvis
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).
Sometimes we see that the ovary is fixed in an abnormal location, indicating that adhesions that have "glued" it in place. Occasionally, fluid filled pockets of pelvic scar tissue are seen with ultrasound.
Ultrasound of uterus with ovary stuck on top in scar tissue
Uterus outlined in pink, uterine lining yellow, ovary green
Ultrasound picture showing a hydrosalpinx - blocked and dilated fallopian tube Black, sausage-shaped area at the bottom is fluid in the tube
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 dye collecting in adhesions around the left tubeExample of a normal HSG
Laparoscopycan 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 Success rates are low with surgery for pelvic scarring, but some women do the surgery If the surgery does not lead to a successful pregnancy, they can do IVFLaparoscopy 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, IUI, or in vitro fertilization (IVF) - depending on the degree of pelvic damage and the couple's preferences.
The decision as to what treatment is 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 the particular couple's situation.
However, IUI success rates with pelvic factor infertility is not very good.
IVF, 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 success 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.