Diagnosis: Infertility Caused by PID Scar Tissue
What PID Scarring Means and Its Impact on Fertility
Many women who have suffered an attack of pelvic inflammatory disease (PID) also suffer from infertility caused by the infection. PID can be caused either by a sexually transmitted disease or bacterial vaginosis. An infection can cause scarring in the fallopian tubes or in the abdomen. Blocked fallopian tubes hinder an egg’s ability to travel into the uterus to be fertilized, and scarring in the abdomen can effectively cement the fallopian tubes in place (making it nearly impossible for them to “catch” an egg) and completely separate them from the ovaries.
PID is frequently misdiagnosed, especially if the patient does not test positive for a sexually transmitted disease. A bad attack causes severe stomach/abdominal pain and an infection that must be treated with antibiotics. If you suspect you have had PID, inform your OB/GYN or RE so they can complete further testing.
It’s important to note that any kind of abdominal infection or abdominal surgery can cause scarring that may lead to infertility. You should inform your physician if you have any cause to suspect that you may have scar tissue.
Unfortunately, the only way to definitively diagnose infertility caused by PID scarring is through a laparoscopy. Your doctor may decide a lap is indicated if an HSG shows that your tubes are blocked, if you have a known history of PID or abdominal infection/surgery, or if an HSG shows that your uterus and/or tubes seem to be pulled into an awkward position. If scarring is found during a lap, your doctor will remove all that (s)he can.
Since many women who suffer from infertility caused by PID scarring (or scar tissue in general) have blocked tubes, unblocking them is frequently the first step. This is typically done during a laparoscopy. The best treatment for scar tissue is to remove it, however, because the nature of scar tissue is to grow back, removal may only result in a short window (usually 6 months to 1 year) of fertility. Aggressive scar tissue can grow back even more quickly.
IUI may not be recommended for a woman who suffers from PID scarring if she has blocked fallopian tubes or tubes that cannot retrieve an egg once ovulation has occurred. In those cases, or in the case of a woman whose scar tissue has grown back aggressively after removal, IVF is the only option.
I suffered from a bad attack of PID three years before my diagnosis. The initial infection was misdiagnosed by no fewer than three doctors, all of whom assumed that I had a burst ovarian cyst. My HSG was perfectly normal, though a later review of the films showed that one of my tubes was pulled in a suspicious direction. After 15 months of infertility, a new OB/GYN recommended an exploratory laparoscopy just to rule out any problems that could have been caused by the infection. Lo and behold, I had scar tissue everywhere. My fallopian tubes were thankfully clear, but my tubes and ovaries were completely cut off from one another, and my tubes were tied down by scar tissue.
Not every doctor thinks to perform a lap before labeling an infertile patient “unexplained.” I will forever be grateful that mine decided to take that step before we wasted time and money on IUIs that would not have worked. As grateful as I am to my doctor, however, I never would have found him if I hadn’t been determined to find a diagnosis for my infertility. In my case, getting aggressive was likely the only way for me to find a cause and to determine which treatment options were best for us.