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Pelvic Factor

Several conditions that affect the uterus, fallopian tubes and ovaries may lead to infertility. 

Endometriosis is a condition in which the lining of the uterus implants outside the uterus to involve the female pelvic organs. 

Pelvic adhesions (scar tissue) also can be a cause of infertility and can be caused by previous infection, previous surgery or endometriosis. 

If the fallopian tubes are blocked or severely scarred, this may prevent the tube from picking up the egg, or in some cases, lead to an ectopic pregnancy (implantation of the embryo into the fallopian tube). 

Uterine fibroids are benign tumors of the uterus that can interfere with conception (if the tubes are blocked, for example) or maintenance of the pregnancy (if the fibroid tumor is inside the uterine cavity, for example).

Tests and Treatment

Many tests can be used to diagnose or treat abnormalities of the female pelvis. These tests and treatments are usually performed early in the menstrual cycle, after blood flow has stopped.

Hysterosalpingogram (HSG)

HSG is a test in which dye is injected through the cervix (opening to the uterus) while X-ray pictures are taken, which can determine if the uterine cavity is normal, and whether the fallopian tubes are open.

Saline Infusion Sonography, also called Hysterosonography

During vaginal ultrasound, a small amount of saline solution is injected into the uterine cavity through the cervix to determine if the uterine cavity is normal. This test also may help determine if at least one fallopian tube is open.

Hysteroscopy 

A small telescope is inserted through the cervix and into the uterine cavity while saline solution is infused. An attached camera allows direct visualization of the uterine cavity. Larger telescopes with an operating channel can be used to remove fibroids, polyps, uterine septa and scar tissue, allowing not only diagnosis but also treatment. The operative portion of the procedure usually requires anesthesia. This can typically be performed under minimal sedation as an outpatient procedure in our clinic.

Laparoscopy

This test involves a telescope that is inserted through a small incision in the umbilicus (belly button) and allows direct visualization of the pelvic organs. It is performed as an outpatient procedure and requires general anesthesia. Placing one to three additional ports through small (1/2 cm) incisions allows for surgical procedures to be performed. This usually includes laser or cautery of endometriosis or adhesiolysis (cutting scar tissue). 

Repair of some tubal blockage also can be performed but is only successful if the fimbria (“fingers” on the end of the tubes) are normal. If the tubes are completely destroyed at the ends and are swollen (hydrosalpinges), removal of the tubes or tubal ligation is recommended before to undergoing IVF and can be performed at the time of laparoscopy.

Other Fibroid Treatment 

Laparotomy involves an open surgical procedure requiring a regular abdominal incision and is performed using general anesthesia. This procedure is primarily performed to remove large fibroids from the uterus that make the cavity abnormal. 

Injectable medications may be used to “shrink” the fibroids before surgery, although there are no medications that can permanently treat fibroids. 

Fibroid embolization is a radiology procedure in which particles are injected to “cut off” the blood supply to the fibroid(s). Currently, this procedure is not recommended for patients who wish to conceive in the future.

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