Testing for pelvic infertility
Treatment options for infertility caused by scar tissue, and pelvic or tubal 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.
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.
Treatment of pelvic factor infertility
The treatment is usually either tubal surgery to repair some of the damage, or ovarian stimuluation with intrauterine insemination, or in vitro fretilization (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 repair.
With IVF, sperm and eggs are mixed together in the laboratory and then the resulting embryos are transferred to the womans uterus.
Pregnancy rates with in vitro fertilization for pelvic factor infertility in women under 40 years old are usually relatively good because these women are relatively unlikely to have additional infertility problems.
