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Reproductive Endo/Infertility
Missouri Center for Reproductive Medicine and Fertility
Pelvic Factor

There are a number of conditions affecting the uterus, fallopian tubes, and ovaries which 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) can also 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 which can interfere with conception (i.e., if the tubes are blocked) or maintenance of the pregnancy (i.e., if the fibroid tumor is inside the uterine cavity).

There are a number of tests which can be used to diagnose and/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) - 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 may also help to 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 is a telescope which is inserted through a small incision in the umbilicus (belly-button) and allows direct visualization of the pelvic organs. It is performed as an out-patient procedure and requires general anesthesia. Placing 1-3 additional ports through small (1/2 cm) incisions allows surgical procedures to also be performed. This usually includes laser/cautery of endometriosis, or adhesiolysis (cutting scar tissue). Repair of some tubal blockage can also be performed, but this 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 prior 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 which are making the cavity abnormal. Injectable medications may be used to "shrink" the fibroids prior to 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.

Related Pages
Causes of Infertility
Infertility Evaluation
Ovulation Disorder and PCOS
Male Factor
Pelvic Factor
Unexplained Infertility
Tubal Reversal

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