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Wednesday, July 26, 2006

Diagnosis: Infertility Caused By Scar Tissue

Diagnosis: Infertility Caused by PID Scar Tissue
By: Carolyn

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.

Diagnostic Process

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.

Treatment Options

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.

Personal Experience

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.


Anonymous said...

Thankyou for providing this article. I have been diagnosed with chlamydia, and have been made aware it may have scarred my tubes. I am terrified and there seems to be little information around on what I can do. My GP isn't too concerned as we have only been trying for 3months, but as I am sure you are aware being told even you are possibly infertile is stressful enough. Thanks again!

Anonymous said...

How much does the lap test cost? My situation, after trying 3 years:

1) Clomid challenge--ok
2) H's sperm--ok
3) 1st HSG--blocked
4) IVF --> failed
5) 2nd HSG--one side open (WTF?)
6) 1st IUI --> low beta, then failed
7) 2nd IUI --> failed

I asked before the 2nd IUI if we needed more testing and was told no. But at over 2K per medicated IUI and around 15K per IVF, I feel like I need more answers. I don't think a lap has been brought up. Or, the doc may have said it wasn't worth it due to cost or something. I don't remember. But if one HSG showed blockage on both sides and the 2nd showed one side blocked....

Anonymous said...

My ex partner gave me chlamidya when i was just 22 years old. This resulted in an eptopic pregnancy as the left tube was full of puss. Doctors could not suggest why I was so poorly and in extreme pain and I eventually ended up having a laparoscopy to investigate, this is when they found the infection. They treated me and also told me I had PID, my womb was retrovert and the tubes had fallen behind my womb, also I know that my womb is substantially lower that it used to be with perhaps only 2 and a half inches of the vaginal entry befor I can feel my cervix. Ever since I have been in terrible pain, whilst running, during intercourse and it was getting worse. That is when I went back for a 2nd laparoscopy and they discovered severe adhesions that caused my womb to stick to my liver, they cut it off and removed adhesions and then did a tubular inslaflation 'dye test' when i opened my eyes from the op the doctor coldly told me I would never have children again and that a small trickle passed through the right tube and that if this did result in pregnancy it would cause another eptopic. I'm 26 now and still in pain when I have intercourse, some positions are worse than others but that feels like the position of my womb being tilted, i have various sharp pains and before periods can feel agonising pain in my tubes and ovaries. Does any one know what I can do, I so want children again, it has made me feel so depressed and the pain has ruined my sex life, my new partner and i are planning on getting married and i'm sick of pretending I'm too tired for intercourse that lasts over twenty mins its really affecting me and i don't know how long i can keep up he pretence

Anonymous said...

I found your article very interesting and informative. Thank you. I am 41 and have failed over the years to conceive. I did 2 mysmectomy and told that my womb is now malfigured. I was treated over a hundred times for STD that I contracted from my husband who claimed he has always been faithful. I would like for someone to tell me if I can still conceive after experiencing all this. I am now out of a relationship for the pasr 2 yrs and is dtill interested in having even 1 child. Please help.

Melinda said...

I was diagnoised with PID at 17, with three different STD tests coming back negative for everything. I am now 19 and still have reoccuring attacks, which make my periods super painful and sex with my husband, if I've recently had a bad attack, is almost non-existant because of the pain. I'm not interested in children, yet, but I know in the future, I'm going to want them. This article was very helpful to me, because I can suggest trying a lap test to see how bad the scarring is. Thank you for posting this article.

Anonymous said...

I would also like to thank you for this article. My husband and I had been on the TTC train for about two years before I found this blog site. After reading this, a red flag went up and I brought it up to my doctor. When I was young I had my appendix removed and six months later scar tissue had grown around my intestines blocking them. This resulted in another major surgery to remove several inches of my intesine.

I had my lap done two months ago and I'm so thankful for it. She found my abdomen full of scar tissue blocking my tubes, pulling them in different directions, and my uterus attached to my bowel wall. Luckily she was able to remove the adhesions and fix things and we are currently back in TTC-mode.

I wanted to add that if you have any suspicion at all you need to get checked. In my case, I had no pain from the scar tissue and pretty normal periods. No signs that there was a problem. You just never know what is going on inside your body.

GL to all..