Scar tissue, known medically as adhesions, forms as a natural part of the body’s healing process following injury or inflammation. These fibrous bands of tissue are a common cause of infertility. Scar tissue can prevent pregnancy, with the severity depending on the location and extent of the scarring within the reproductive organs. When adhesions develop within the pelvis, they physically alter the reproductive anatomy, creating barriers that disrupt the complex journey required for conception.
How Scar Tissue Interferes with Conception
Scar tissue disrupts the reproductive process primarily by creating physical barriers and distorting the normal relationship between pelvic organs. These adhesions act as internal “glue,” causing organs like the ovaries and fallopian tubes to stick to each other or to the pelvic wall. This loss of mobility prevents the reproductive system from functioning efficiently. The most direct mechanism is physical blockage, which prevents the necessary movement of reproductive cells. This can stop sperm from reaching the egg or block the fertilized egg from traveling down the fallopian tube to the uterus.
Beyond creating blockages, scar tissue also alters the fundamental anatomy of the reproductive tract. The distortion of the pelvic structures can change the way the fallopian tubes interact with the ovaries. It can also reduce the functional space within the uterus. This anatomical change compromises the environment necessary for fertilization and the subsequent growth of a pregnancy.
Key Locations of Reproductive Scarring
Scarring within the fallopian tubes is a significant cause of infertility because it interferes with the path the egg must travel. Adhesions forming inside the tubes can cause a partial or complete tubal blockage. This damage substantially increases the risk of an ectopic pregnancy, where a fertilized egg implants within the scarred tube instead of reaching the uterus.
Intrauterine Adhesions (Asherman’s Syndrome)
Scar tissue forming inside the uterus is referred to as intrauterine adhesions, or Asherman’s Syndrome. This condition occurs when the inner lining, the endometrium, is damaged, leading to the formation of fibrous bands that connect the opposing uterine walls. The scarring reduces the size of the uterine cavity and compromises the quality of the endometrial lining. This damaged environment makes it difficult for a fertilized egg to implant, often resulting in implantation failure or recurrent miscarriage.
Pelvic and Ovarian Adhesions
Adhesions can also form around the ovaries and the rest of the pelvic cavity, restricting the normal functions of these organs. Scar tissue surrounding the ovary can impede the release of the egg. It can also prevent the fimbriae—the finger-like projections at the end of the fallopian tube—from capturing the egg after ovulation. When the entire pelvic structure is bound by adhesions, the fallopian tube can be pulled away from the ovary, physically separating the two organs.
Conditions That Lead to Reproductive Scarring
Pelvic infections are a major catalyst for the formation of scar tissue in the reproductive tract. Pelvic Inflammatory Disease (PID), often resulting from untreated sexually transmitted infections, causes widespread inflammation. This inflammation leads to scarring of the fallopian tubes and surrounding tissues, resulting in tubal damage or complete blockage.
Prior surgical procedures within the abdominal or pelvic area are another common cause of adhesions. Any surgery on or near the reproductive organs, such as a C-section, myomectomy, or appendectomy, carries a risk of adhesion formation as the body attempts to heal. Procedures like dilation and curettage (D&C) are the most common cause of intrauterine adhesions (Asherman’s Syndrome). This is because D&C, especially when performed after pregnancy complications, can traumatize the delicate basal layer of the endometrium.
Endometriosis, a chronic condition where tissue similar to the uterine lining grows outside the uterus, is a powerful driver of pelvic scarring. This misplaced tissue causes chronic inflammation and internal bleeding. This process leads to the development of deep, fibrotic adhesions throughout the pelvis. Endometriosis-related scarring can bind together organs and severely distort the anatomy, compounding the difficulty in conceiving.
Diagnosing and Managing Scar-Related Infertility
Diagnosing scar-related infertility begins with specialized imaging and diagnostic procedures designed to visualize the internal anatomy. Hysterosalpingography (HSG) is a common initial test that involves injecting a contrast dye through the cervix while taking X-ray images. This allows clinicians to assess the shape of the uterine cavity and determine if the fallopian tubes are open or blocked by scar tissue.
To gain a more direct and detailed view, diagnostic laparoscopy and hysteroscopy are often used. A hysteroscopy involves inserting a thin, lighted camera through the cervix to examine the inside of the uterus, allowing for the direct visualization of intrauterine adhesions. Laparoscopy, a minimally invasive surgery, provides a view of the external reproductive organs and the overall pelvic cavity to identify external adhesions.
For management, surgical removal of the scar tissue, known as adhesiolysis, can be performed using hysteroscopy for uterine adhesions or laparoscopy for pelvic adhesions. Success rates following adhesiolysis vary widely, depending heavily on the initial severity and location of the scarring. Mild to moderate cases often have better outcomes.
When tubal damage is severe or irreparable, assisted reproductive technology (ART) often becomes the primary treatment path. In Vitro Fertilization (IVF) bypasses the need for open fallopian tubes entirely. This is achieved by fertilizing the egg outside the body and transferring the embryo directly into the uterus.