For many couples, becoming a mother or father is one of life’s most exciting and rewarding moments. But when fertility issues arise, that dream can feel increasingly distant.
A common cause of infertility in women is pelvic adhesions, also called scar tissue. They develop after abdominal or pelvic surgeries, infections, endometriosis, or trauma in the area, and can hinder both conception and proper pregnancy development.
In this article we explore what pelvic adhesions are and how they affect fertility.
What are pelvic adhesions and why do they form?
Pelvic adhesions are bands of scar tissue that bind organs—ovaries, tubes, uterus, bladder, and intestines—causing loss of mobility and normal function. They form when the body repairs inflammation or injury after surgery, infection, or endometriosis.
- Ovaries can become stuck to other structures, making egg release difficult.
- Blockage or distortion of the tubes prevents the egg and sperm from meeting.
- The risk of ectopic pregnancy increases if the tubes are compromised.
- Pain during intercourse can lead to avoiding it during fertile days.
How do pelvic adhesions affect fertility and pregnancy?
They interfere with gamete transport, tubal patency, and embryo migration. If the tubes are blocked or twisted, sperm cannot reach the egg, and the embryo cannot implant properly in the uterus. They also increase the risk of ectopic pregnancy (learn more about ectopic pregnancies).
Assisted reproduction techniques, such as IVF, bypass these issues by retrieving eggs directly from the ovaries and transferring healthy embryos to the uterus.
What symptoms may suggest the presence of adhesions?
- Chronic pelvic pain
- Very painful periods
- Pain during sex
- Difficulty conceiving
- Sometimes intestinal obstruction
- Higher risk of ectopic pregnancy
Risk factors for pelvic adhesions
- C-section or ovarian cyst removal
- Myomectomy (fibroid removal)
- Endometriosis surgery (What is endometriosis and how does it affect fertility?)
- Appendicitis or pelvic inflammatory disease (from STIs like chlamydia)
- Infections such as hydrosalpinx
Between 60% and 90% of women who undergo gynecological surgeries develop adhesions. Laparoscopy reduces the risk but does not eliminate it.
How are adhesions safely diagnosed?
Laparoscopy is the gold-standard test but can create new adhesions. At Ingenes we prefer a non-invasive transvaginal ultrasound (TVUS) first and sometimes a hysterosalpingography (HSG) with contrast (10–20 mL), which only causes mild discomfort.
Treatments to conceive with pelvic adhesions
IVF is the most effective option since it bypasses the tubes. Eggs are retrieved from the ovaries, fertilized in the lab, and the highest-quality embryos are transferred to the uterus, increasing pregnancy chances.
Do not self-medicate: always consult a fertility specialist to design a personalized plan that maximizes your chances.
What to do if you suspect you have pelvic adhesions?
See a reproductive endocrinologist for a comprehensive evaluation. With your medical history, imaging tests, and personalized advice, you can choose the most appropriate treatment.
At Ingenes, we support you with empathy and professionalism every step of the way toward motherhood or fatherhood. Remember to always consult a specialist before making any decisions or starting any treatment.
Frequently Asked Questions
1. Can pelvic physiotherapy prevent or treat adhesions?
Specialized pelvic physiotherapy improves circulation and tissue mobility, relieving pain and stiffness, but does not eliminate fibrosis. It is usually combined with medical treatments under specialist supervision.
2. Is laparoscopy safe for treating adhesions if I want to get pregnant?
Laparoscopy minimizes risk compared to open surgery, using 5–10 mm incisions. However, there is still a chance of forming new adhesions. Your doctor will weigh benefits and risks based on your history and reproductive goals.
3. How long should I wait after surgery before trying to conceive?
It is recommended to wait between 3 and 6 months for tissues to regenerate and inflammation to subside, although the exact time depends on the type of surgery and your recovery. Always follow your specialist’s guidance.
4. What is the success rate of IVF in women with pelvic adhesions?
It depends on factors such as age, egg quality, and severity of adhesions. Generally, women under 35 can achieve over a 50% chance of clinical pregnancy per cycle. A personalized assessment will provide more precise figures.
References
- American Society for Reproductive Medicine. Adhesion Prevention and Management. Fertility and Sterility, 113(2), 443–455 (2020).
- MedlinePlus. Pelvic Adhesions. U.S. National Library of Medicine (2023).
- Chapron C., Souza C., Gonzalez F. Adhesion Formation After Endometriosis Surgery: A Multicenter Trial. Journal of Minimally Invasive Gynecology, 25(5), 805–812 (2018).
- Stratton P., MacLean A. Pelvic Adhesions: Impact on Fertility and Role of Laparoscopy. Human Reproduction Update, 25(4), 457–471 (2019).