If you have had an operation to the pelvis in the past, it can sometimes cause fertility problems later down the line. This can be due to direct damage to the reproductive organs, or damage resulting from the development of internal scar tissue, also known as adhesions. It is rare, but it may also have been necessary to remove one or more of the reproductive organs.
It is not only surgery to the pelvis which can cause adhesions to form. Surgery to the bowel (such as for appendicitis) can also result in scar tissue developing around the Fallopian tubes or ovaries.
The type of operation performed may also have an effect. Generally speaking, surgery which is performed laparoscopically (keyhole surgery) rather than by a laparotomy (cut across the abdomen) results in less scar tissue.
Surgery and the Cervix
Surgery to the cervix is sometimes performed as part of the treatment of cervical cancer. Small procedures are unlikely to cause fertility problems, but larger procedures may shorten the cervix or result in scar tissue. This can impair the passage of the sperm through the cervix, or affect how a fertilised egg can implant and start to develop in the uterus.
Surgery and the Fallopian Tubes
The fallopian tubes may become blocked as a result of previous surgery, as the scar tissue causes the tubes to stick together. This is similar to the blockages that can develop from previous infections such as pelvic inflammatory disease (PID). This blockage prevents the normal passage of the egg down the tube, as well as making it difficult for the sperm to travel up the tube to meet the egg for fertilisation.
Surgery and the Ovaries
Damage to the ovaries can affect their normal function and prevent normal ovulation. This may happen after recurrent operations to remove ovarian cysts. If only one ovary has been affected, then this does not usually cause problems. However, if one ovary has either been damaged significantly or removed altogether, it can affect the function of the remaining ovary. This ovary starts to work harder, and can become polycystic, which in turn affects its normal function.
How Do I Know If Surgery Has Affected My Fertility?
Without testing, there is no way to know if surgery you have had previously is affecting your fertility as there is unlikely to be any obvious symptoms. However, if you have had surgery to your abdomen, pelvis or bowel and have been trying for a baby unsuccessfully for more than six months, book an appointment to see your doctor who will be able to refer you for tests. For advice on your visit to your doctor, check out: What to Expect When Seeing Your Doctor About Problems Conceiving.
Is There Treatment for Damage Done by Surgery?
If there is internal scarring it is sometimes possible to remove this surgically. This does however require another operation, which in turn can produce new scar tissue. Therefore, this is generally only performed if there is extensive scarring, or if there is a specific area that is thought may respond well to treatment.
If surgery is not an option, then fertility treatment options depend upon the area which has been affected. Options may therefore include ovulation induction (for ovulation problems due to ovarian damage) or IVF if there has been damage to the Fallopian tubes.
There are various websites which advocate a special type of abdominal massage to break down adhesions, but there is no scientific evidence supporting this treatment, and it is not recommended by doctors.
Surgery Associated Fertility Problems
If you think you have damage done by surgery, then you may also want to read the sections on Pelvic Inflammatory Disease.