Uterine Trauma
What is it?
Whenever there’s trauma to the uterus, intrauterine (inside the uterus) scarring can result. Some doctors refer to uterine scarring as Asherman’s Syndrome. Although the strict definition of Asherman’s is scarring due to a dilation and curettage (D&C) performed after a miscarriage or retained placenta (where all or part of the placenta is left in the uterus after birth), the definition has been expanded by some to include all cases of uterine scarring, such as that potentially caused by fibroid surgery. Whatever the cause, uterine scarring can diminish the surface area of the endometrium. “So the likelihood that an embryo will get in there and find it a healthy environment to implant is reduced,” says Dr. Herbert. In other words, the scarring can cause infertility.
How will I know I have it?
Many women with uterine scarring have light periods, or no periods at all. Some women feel period pain without the actual period, which may indicate that menstruation is occurring, but the blood is trapped in the uterus. Recurrent miscarriage and infertility could also be considered symptoms.
Diagnosis and treatment:
Intrauterine scarring is usually detected with a hysteroscopy, a procedure where a small, thin telescope is inserted through the cervix. “The good news is, for milder cases we can go in and cut [apart] those areas that are stuck together,” says Dr. Herbert. The trick with Asherman’s surgery is not to cause more scarring, (a natural byproduct of surgery), so doctors leave a small balloon in the uterine cavity to keep it open while it heals. According to the National Institutes of Health, approximately 70 to 80 percent of women who are infertile because of mild to moderate Asherman's syndrome will be able to get pregnant and carry the pregnancy to term after treatment. For those with severe adhesions, full-term pregnancy rates are closer to 20 to 40 percent.
Pelvic Inflammatory Disease (PID)
What is it?
Infection of the uterus, fallopian tubes, and other reproductive organs, which usually results from sexually transmitted diseases (STDs), most often chlamydia and gonorrhea. “Bacteria come up from the vagina, the cervix, and the fallopian tube and on their way they create serious damage,” says Dr. Adamson. The scar tissue that PID leaves behind blocks the normal movement of the eggs into the uterus, hindering fertilization. A partially blocked tube may also cause a fertilized egg to remain in the fallopian tube, causing an ectopic—or tubal—pregnancy. According to the Centers for Disease Control and Prevention, more than 100,000 women become infertile each year as a result of PID.
How will I know I have it?
The symptoms of early pelvic infection can be mild, which is why the disease often goes undetected for a while. Some women do have pain and abdominal tenderness. If you’ve been treated for an STD in the past you may have scarring left over from the infection, but you probably won’t be aware of it until you try to conceive. “You may have had chlamydia when you were 17 and gotten rid of the bacteria, but the scar tissue is there for life,” says Dr. Herbert.
Diagnosis and treatment:
Doctors can usually diagnose active PID with a physical exam and patient history. “The things we look for are pelvic pain and signs of tenderness on a pelvic exam,” says Dr. Adamson. If a test for gonorrhea or chlamydia comes up positive, you and your partner will be put on antibiotics to clear up the infection. If you’re trying to conceive, a doctor can diagnose scarring in and around the tubes with either a laparoscopy or a hysterosalpingogram, (HSG), an x-ray of the uterus and fallopian tubes.
If you have relatively minor scarring from a previous bout (or bouts) with PID, laparoscopic surgery (where a tiny camera mounted on a telescope is inserted through a patient’s navel) can remove the scar tissue and restore fertility. If the tubes are severely damaged, you’ll most likely need IVF to get pregnant.
Previous Surgeries
What is it?
Any type of surgery in the pelvis or abdomen—even an appendectomy—can cause scarring around the pelvis. Adhesions between the ovaries, tubes, or pelvic walls can inhibit or block the fallopian tube from properly picking up an egg from the ovary, preventing conception. Adhesions or damage inside the tubes can make it difficult for the sperm to reach the egg, making pregnancy less likely.
How will I know I have it?
You might have pelvic pain or pain with intercourse, but you probably won’t know about the scarring until you try to get pregnant.
Diagnosis and treatment:
HSG can reveal both tubal and uterine blockages, as can laparoscopy and hysteroscopy, which can be used to both diagnose and treat scarring in those areas from past surgeries. In many cases, conception and pregnancy can occur normally afterwards. In severe cases, IVF might be needed for a successful pregnancy.
A version of this article originally appeared in the Spring 2007 issue of Conceive Magazine.
Related Topics: Endometriosis and Fertility; Fibroids and Fertility; Stress and Fertility
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