A severe pelvic fracture can lead to infertility, but this outcome is not common and depends heavily on the injury’s location and the extent of associated soft tissue damage. Infertility is not a direct result of the broken bone itself, but rather a consequence of bone fragments or massive impact damaging the reproductive, vascular, and neurological structures housed within the bony ring. Pelvic fractures are typically the result of high-impact trauma, meaning a significant force is transmitted through the body, potentially compromising multiple organ systems. While many patients fully recover their reproductive function, the potential for long-term complications makes a detailed assessment necessary.
The Pelvis: Anatomical Proximity to Reproductive Organs
The pelvic girdle cradles the reproductive and urinary organs, positioning them directly in the path of traumatic force. In women, the uterus, ovaries, and fallopian tubes reside within this enclosure, making them vulnerable to displacement or injury from a fractured bone. The ovaries, suspended within the pelvic cavity, can be bruised or suffer vascular compromise from the trauma.
For men, the prostate gland and seminal vesicles are positioned in the deep pelvis, closely fixed to surrounding structures. The prostate sits just behind the pubic bones. Fracture displacement, especially near the pubic symphysis, can cause a shearing force that tears the urethra as it passes through the prostate. The seminal vesicles are also at risk of damage from displaced bone fragments or massive hematoma formation.
Direct Structural Damage and Scar Tissue Formation
The most direct mechanical pathway to female infertility is the laceration of reproductive organs by sharp bone fragments. High-energy trauma can cause movement of bone edges that lacerates the uterus or vagina. More commonly, the massive internal bleeding and inflammation following a severe fracture trigger the body’s healing response, leading to the formation of internal scar tissue, known as adhesions.
These adhesions can physically bind the fallopian tubes to surrounding tissues, preventing the wave-like movement necessary to capture an egg after ovulation. Scar tissue can also obstruct the fallopian tubes, blocking the path for sperm to meet the egg, resulting in tubal factor infertility. Since fertilization occurs within the fallopian tube, any physical blockage or distortion significantly lowers the chance of conception. In men, severe fractures can directly injure the urethra near the prostate, and subsequent scarring can lead to a urethral stricture, which may impede ejaculation.
Impact of Vascular and Neurological Injury
Beyond direct physical damage, a pelvic fracture can cause infertility by disrupting the vascular and neurological supply to the reproductive organs. The pelvis contains major arteries, including branches of the internal iliac artery, which supply blood to the uterus, vagina, and prostate. Damage to these vessels can lead to life-threatening hemorrhage often treated with pelvic angiographic embolization (PAE).
While PAE saves lives, it can carry a risk of long-term complication, especially in women, due to the high radiation exposure required. This radiation can affect the ovarian reserve, potentially accelerating the loss of viable eggs. Neurological injury is also a concern, as the sacral plexus and pudendal nerve, which control sexual and urinary function, run through the pelvis. Damage to these nerves can result in functional issues, such as erectile dysfunction or ejaculatory failure in men, even if the reproductive organs are structurally intact.
Assessing Fertility Risk After Fracture
Because the link between a pelvic fracture and infertility is not always straightforward, a multidisciplinary assessment is necessary after recovery, typically involving an orthopedic surgeon, a urologist, and a reproductive endocrinologist. For men, a semen analysis is the primary diagnostic tool, evaluating the quantity, motility, and morphology of the sperm. In cases of ejaculatory failure, this test helps determine if the issue is a lack of sperm production or a mechanical obstruction.
For women, a hysterosalpingogram (HSG) is often performed, using an X-ray and contrast dye to check for blockages or scarring within the fallopian tubes and uterine cavity. Hormone panels, including tests for Anti-Müllerian Hormone (AMH), Follicle-Stimulating Hormone (FSH), and Estradiol, are used to assess ovarian reserve and function. Early diagnosis of structural or functional damage allows for timely fertility preservation or treatment options, such as in vitro fertilization (IVF).