Whether they’re a recent acquisition or left over from years ago, internal scars that you probably don’t even know are there may be threatening your fertility.
During college, Heather was rushed to the hospital for an emergency appendectomy. A few years later, a painful fibroid forced her to go under the knife again. Years later, when she and her husband decided they wanted to get pregnant, they tried to conceive without success for nine months, then visited a fertility specialist. Five IVFs (in vitro fertilizations) later, Heather still wasn’t able to conceive. “I made a ton of eggs, they fertilized, I just couldn’t get pregnant,” she says.
Frustrated but not foiled, Heather and her husband decided to try getting pregnant one more time. “We went to another doctor who said we must be missing something. He did a laparoscopy, and found a ton of scarring around my uterus and in my pelvis,” Heather says. The scarring may have been a result of her previous surgeries, or of the endometriosis she was also found to have. Heather had surgery once again—this time to clear out the scarring—and the couple tried another IVF cycle. This time Heather got pregnant; her baby girl was born last June.
Scar tissue forms when the body needs to repair itself or guard against a foreign substance. Most of the time these adhesions help with healing, but problems can occur because the repair cells can’t differentiate between one organ and another. “So instead of putting the two pieces of the same organ back together, sometimes two different pelvic organs will adhere to each other,” says Charles March, M.D., a reproductive endocrinologist at California Fertility Partners in Los Angeles, California, and professor of obstetrics and gynecology at the Keck School of Medicine, University of Southern California. When it occurs in the pelvis, the scarring can limit the interaction between the tubes and ovaries, and/or block the fallopian tubes, making it difficult or impossible to get pregnant.
Here are some of the most common reasons you may have scar tissue in places you don’t want it. And what to do about it to restore your fertility in order to have a baby.
What is it?
A chronic disease that affects at least five and a half million women in North America, causing fertility problems for 30 to 40 percent of them. With endometriosis, the tissue lining the uterus–called the endometrium—migrates to other pelvic structures, including the ovaries and fallopian tubes. This tissue responds to menstrual cycle hormones, building up and breaking down each month. But unlike the endometrium tissue that lines the uterus, which is shed from the body during menstruation, the tissue that’s gone astray in endometriosis has no way out, so it continues to build every month. “This misplaced tissue is something the body doesn’t like, and scar tissue sometimes forms as part of the body’s reaction,” says Carl Herbert, M.D., associate medical director of Pacific Fertility Center in San Francisco. “Because of the scar tissue, the tubes can’t move in their normal way. They won’t be able to tease the egg out of the ovary, won’t be able to pick it up, and fertilization won’t occur.”
How will I know I have it?
Symptoms can include excessive pain before and during menstrual periods that doesn’t get better with non-steroidal anti-inflammatory medication (such as ibuprofen). There may also be pain during sex. “An ache in the pelvis after intercourse is almost a sure sign of endometriosis,” says David Adamson, M.D., director of Fertility Physicians of Northern California in San Jose and Palo Alto.
Diagnosis and treatment:
Endometriosis can be diagnosed with a laparoscopy, which involves inserting a small lighted wire through an incision, usually near the navel. Laparoscopy can also remove or vaporize the growths, which some studies show can double the pregnancy rate. With more severe cases, IVF can be helpful because it creates a pregnancy by bypassing the tubes altogether.