What is Adhesions?
💡 Pelvic adhesions = fibrous scar tissue bands between pelvic organs. Causes: endometriosis, PID, prior surgery (appendicectomy, myomectomy, caesarean section). Fertility impact: tube-ovary distortion, impaired egg pickup, tubal blockage, reduced ovarian accessibility. Diagnosed at laparoscopy. Treatment: laparoscopic adhesiolysis. Does not always improve fertility — evidence mixed for mild adhesions.
Pelvic adhesions are abnormal fibrous bands of scar tissue that form between pelvic organs — the uterus, ovaries, fallopian tubes, bowel, and peritoneum — following inflammation, infection, endometriosis, or surgery. Adhesions distort normal pelvic anatomy, restrict organ movement, trap the ovaries or tubes, and impair egg pickup at ovulation. They are a significant cause of pelvic pain, tubal factor infertility, and poor IVF response.
🇮🇳 India Context: Adhesions is widely assessed and treated across major Indian fertility centres including Chennai, Mumbai, Bangalore, Delhi, and Hyderabad.
What are the key characteristics of Adhesions?
- Types: filmy adhesions (thin, avascular, translucent — easily divided); dense/vascular adhesions (thick, fibrous, contain blood vessels — more complex to divide, higher bleeding risk)
- Location and fertility impact: periovarian adhesions (ovary encased in adhesions — impairs egg pickup at ovulation; ovary inaccessible for egg retrieval in IVF); peritubal adhesions (tube kinked or encased — blocks egg transport even if tube is patent); cul-de-sac (pouch of Douglas) obliteration — characteristic of Stage IV endometriosis
- Causes: endometriosis (most common — retrograde blood causes intense peritoneal inflammatory response → dense adhesion formation); PID/salpingitis (infection → peritoneal inflammation → adhesions); previous pelvic surgery (appendicectomy, myomectomy, ovarian cystectomy — cutting peritoneum triggers adhesion formation); caesarean section (anterior uterine adhesions to bladder/anterior abdominal wall)
- IVF and adhesions: ovarian adhesions may prevent transvaginal egg retrieval if ovary is not accessible to the retrieval needle; laparoscopic adhesiolysis before IVF improves ovarian accessibility; dense cul-de-sac adhesions may make egg retrieval dangerous (bowel injury risk)
- Diagnosis: laparoscopy — only reliable diagnostic method; adhesions cannot be reliably detected by TVS, MRI, or HSG (periovarian adhesions invisible to HSG)
- Adhesiolysis (surgical division): laparoscopic sharp dissection of adhesion bands; filmy adhesions divided easily; dense adhesions require careful sharp dissection between tissue planes; anti-adhesion barriers (Interceed, Seprafilm) placed over raw surfaces to prevent reformation
- Recurrence: adhesions reform after adhesiolysis in 30–80% of cases within 12 months; the more extensive the adhesions and the more surgery performed, the higher the recurrence; pregnancy (if achieved) may prevent recurrence by stretching adhesions
- Evidence for adhesiolysis improving fertility: strong evidence for tubo-ovarian adhesions (improving tube-ovary relationship); weak evidence for mild peritubal adhesions (no proven benefit of adhesiolysis over expectant management in mild adhesions)
How does Adhesions work?
Why does Adhesions matter in fertility?
Pelvic adhesions are a silent cause of infertility — they are invisible to standard non-invasive testing and are only diagnosed at laparoscopy. For women with a history of endometriosis, PID, appendicitis, or prior pelvic surgery who have unexplained infertility or poor IVF access to ovaries, diagnostic laparoscopy should be strongly considered to assess and treat adhesions. The most impactful benefit of adhesiolysis is restoring normal tube-ovary anatomy for egg pickup and ensuring ovarian accessibility for IVF egg retrieval.
What are related terms to Adhesions?
Asherman Syndrome
Asherman syndrome (intrauterine adhesions or synechiae) is a condition in which …
Laparoscopy (Keyhole Surgery)
Laparoscopy is a minimally invasive surgery, also called keyhole surgery. A thin…
Hysteroscopy
Hysteroscopy is a procedure used to examine the inside of the uterus. A thin, li…
Endometriosis
Endometriosis is a chronic condition. Tissue similar to the uterine lining grows…
Secondary Infertility
Secondary infertility is defined as the inability to achieve a clinical pregnanc…
FAQs about Adhesions
What are pelvic adhesions?
Pelvic adhesions are abnormal fibrous scar tissue bands that form between pelvic organs — sticking the uterus, ovaries, fallopian tubes, bowel, and peritoneum to each other or to the pelvic wall. They develop as a result of inflammation, infection (PID), endometriosis, or previous surgery. Adhesions distort normal pelvic anatomy, restrict organ movement, kinked tubes, trap ovaries, and impair the natural egg pickup process at ovulation.
How do pelvic adhesions affect fertility?
Pelvic adhesions impair fertility through several mechanisms: (1) Peritubal adhesions — surround and kink the tube, blocking egg transport even if the tube itself is internally patent; (2) Periovarian adhesions — encase the ovary, preventing the fimbria (tube opening) from picking up the egg at ovulation; (3) Tubo-ovarian adhesions — stuck tube and ovary together in a distorted mass — most common in severe endometriosis and PID; (4) For IVF: adhesed ovaries may not be accessible to the transvaginal retrieval needle, making egg collection difficult or impossible.
Can pelvic adhesions be detected on ultrasound or MRI?
Pelvic adhesions are generally not reliably detected by non-invasive tests. TVS and MRI can occasionally suggest adhesions indirectly — a fixed, non-mobile ovary on TVS ("kissing ovaries" in severe endometriosis), or restricted organ mobility — but cannot directly visualise adhesion bands. HSG assesses tubal patency but cannot detect periovarian or peritoneal adhesions. Laparoscopy is the only reliable diagnostic method — the pelvis is directly visualised under magnification, and adhesion bands can be graded and treated in the same procedure.
What is adhesiolysis and does it improve fertility?
Adhesiolysis is the surgical division of adhesion bands, performed laparoscopically. Thin filmy adhesions are divided easily. Dense fibrous adhesions require careful sharp dissection to avoid injury to underlying bowel, ureter, or vessels. Whether adhesiolysis improves fertility depends on the type and severity: Tubo-ovarian adhesions (tube stuck to ovary) → strong evidence for benefit — restores natural egg pickup anatomy; Mild peritubal adhesions → weak evidence — no proven benefit over expectant management; Periovarian adhesions preventing IVF egg access → improves egg retrieval; All → risk of adhesion reformation (30–80% at 12 months).
Can adhesions come back after surgery?
Yes — adhesion reformation (recurrence) is one of the most frustrating aspects of adhesiolysis. Studies show 30–80% of divided adhesions reform within 12 months. Factors increasing recurrence: more extensive original adhesions; more peritoneal surfaces cut or cauterised during surgery; prior adhesiolysis history. Strategies to reduce recurrence: anti-adhesion barriers (Interceed, Seprafilm gel) placed over raw surfaces; careful surgical technique (sharp dissection, minimal bleeding, no unnecessary peritoneal disruption); early mobilisation post-surgery. Pregnancy after adhesiolysis may prevent recurrence by physically stretching the adhesion-prone surfaces.
🏥 Find Specialists for Adhesions in India
Connect with verified fertility specialists who can guide you through adhesions.