A number of physical abnormalities in a woman’s pelvis may lead to infertility.
- Endometriosis, a condition in which tissue similar to the uterine lining is found in abnormal locations, such as on the surface of the uterus, ovaries or fallopian tubes and in the abdominal cavity
- Pelvic adhesions, which may occur from surgical scarring or infection.
- Diseases of the fallopian tubes, including blocked fallopian tubes (hydrosalpinges), which may prevent an egg from entering the tube for fertilization.
- Fibroid tumors (also known as uterin fibroids), benign uterine growths that may interfere with conception and maintenance of pregnancy.
Diagnosing physical abnormalities in a woman’s pelvis may involve one or more of the following medical procedures:
- Hysterosalpingogram (HSG) — A liquid contrast medium is injected into the cervix to fill the uterine cavity and fallopian tubes while X-rays are taken. HSGs are performed early in the menstrual cycle, after blood flow has ceased and no later than the 10th day of the cycle.
- Sonohysterography – The uterine cavity is infused with saline (saltwater) while a vaginal ultrasound is performed. Sonohysterography provides easy and accurate visualization of the uterine cavity. It is performed early in the menstrual cycle, after blood flow has ceased.
- Hysteroscopy — The hysteroscope, (a small telescope device) is inserted through the cervix and into the uterus to provide the physician with a direct view of the uterine cavity. Hysteroscopy is performed early in the menstrual cycle, after blood flow has ceased.
- Laparoscopy — The laparoscope, a slender, light-transmitting telescope device, is inserted into the abdominal cavity through a tiny incision in the navel. One to three other small incisions may be created for the insertion of other instruments. Laparoscopy allows the physician to view the pelvic organs, including the uterus, ovaries and fallopian tubes. When appropriate, the physician may perform a number of surgical procedures through the small incisions. Laparoscopy is usually performed early in the menstrual cycle.
Surgery may be performed during hysteroscopy to treat abnormalities such as fibroid tumors, polyps, uterine septa or scar tissue within the uterine cavity. Abnormalities such as endometriosis and pelvic adhesions may be treated during laparoscopy. When appropriate, blocked fallopian tubes also may be treated or removed during laparoscopy.
Both endometriosis and fibroid tumors may be treated with drug therapies in addition to surgery, although there are no medications available that will permanently treat uterine fibroids. In patients who are no longer interested in pregnancy, fibroids may be treated through a radiological procedure called embolization. Many times, surgery to correct problems is not the best procedure, and patients are advised to proceed with IVF.
See Treatment Options for more details on diagnosis and procedures.