Can Scar Tissue Affect Fertility?

Question:
I have never been pregnant or on birth control pills or had surgery but I have scar tissue so bad they can't see my reproductive system. Will I ever be able to conceive? Is this fixable?

Answer:
Hello Sarah from Canada,
　
I am not sure how your diagnosis was made without having had surgery. Scar tissue is usually only diagnosed by a surgery called a laparoscopy.

But, assuming you have scar tissue, and it is bad, this could be caused from a previous pelvic infection, called PID, due to bacteria that ascends through the vagina, cervix and uterus, or it could be caused from a disease called endometriosis that causes severe inflammation of the pelvis. In either case, severe scar tissue is caused in the pelvis and obstructs the egg's ability to reach the Fallopian tube.

In some cases of pelvic scar tissue (adhesions), surgery can be performed to try to reduce the scar tissue, but this doesn't always work because scar tissue can form as a result of the surgery as well. The best option would be to do IVF (In Vitro Fertilization) whereby the eggs are removed directly from the ovaries and the pelvis is bypassed completely. The chances of pregnancy are age dependent but are very good and can be as high as 63% per attempt.

You don't need to worry about never getting pregnant. The technology has advanced quite a bit and we can get almost anyone pregnant. The only consideration is what has to be done to get you pregnant, and what you are willing to do to get pregnant.

Sincerely,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check me out on Facebook and Twitter with me at @montereybayivf

Permanent infertility from past infections?

Question:
I am 35 years old and have never achieved a pregnancy. In the past I have been diagnosed with chronic BV, trichomonas, HPV, PID, and endometriosis. I recently read that all of these conditions could be symptomatic of a unicellular microorganism called microplasma genitalium. What information do you know of this organism? I have been successfully treated for each of these infections. Is there a specific fertility treatment that I should try with these past issues? Is my infertility permanent? I have been symptom free since my divorce 3 years ago.

Answer:
Hello Lynn from the U.S.,

The main problem with this variety of infections, is that some of them could have led to tubal damage. That is, the bacteria ascend into the tubes leading to inflammation and scarring. Once the tubes are damaged, they do not function and so natural pregnancy cannot occur. The way that we currently check for this is using a test called the HSG (hysterosalpingogram) to see if the tubes are open. This still is not specific enough but if there is severe damage to the tubes, it will return showing the blockage. If one tube is blocked, you can assume that the other is damaged as well, although it may not be blocked. If the tubes are blocked there is no other alternative other than IVF for treatment of the infertility. IVF works by bypassing the tubes by extracting the eggs directly from the ovaries.

Endometriosis can also be a cause for infertility. Endometriosis is a pelvic disease that causes the pelvis to be inflamed. It is thought that this inflammation attacks and kills the egg at the time of ovulation. In addition, it can cause scar tissue formation in the pelvis that will prevent the egg from getting to the tube. Again, in cases of severe endometriosis, IVF is the treatment of choice.

At 35 years old, your age is now going to be a factor A woman's fertility decreases significantly after the age of 35. Therefore, if you are contemplating getting pregnant or having children, you might want to start aggressively trying with IVF. If you have never undergone an infertility evaluation, then you should start there. IVF may not be your only option.

Sincerely,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.blogger.com/www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com/ check me out on facebook and twitter with me at @montereybayivf