Infertility caused by Adhesions?

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I have this little sister, funny witty and very hard working. I will name her Adeola here for the sake of privacy. I have known her for about six years now and I love her resilience, her determination to succeed and hard work. She always came to me when she had major decisions, we spoke and prayed when she wanted to get married and no man was in the horizon, we did the same as per her career and how she started her business which is fantastic now because she is focused and hard working. She finally got married and a year now, she is not pregnant yet and she is worried.

When she came to me I laughed at her as her marriage was not even up to a year and her husband is not often around. So to alleviate her fears I sent her to the only Doctor I knew who will do the proper thing and give her a truthful diagnosis. She did that and called me after seeing him for two days and doing all the tests; I knew immediately that she needed to talk as she asked me frantically if I was home and I said yes.

She got here armed with a very good result however, due to some factors she had adhesions and also had fibroids which the doctors say got to go! There was the apprehension and tension! In her desperation, she asked what adhesions were and I decided to get some great info on this as it is also another common cause of infertility. Like my Doctor said, I love to read. Yes I do, as I have also been deceived by Doctors with medical jargons so I like researching stuff so I am fully armed with good information, then I know no Doctor will intimidate me.

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So… Pelvic adhesions also commonly referred to as scar tissue are areas of fibrous tissue that form as a result of the healing process which remain after the original inflammation or trauma has healed. Adhesions can cause different organs in the abdomen or pelvis to become stuck together. As a result, adhesions can distort the normal pelvic anatomy or cause decreased mobility and function. Therefore, pelvic adhesions can be a cause of infertility. Adhesions can result from a number of different causes. Common causes of adhesions are infections, previous surgery, abdominal trauma, endometriosis, and appendicitis. Essentially, anything that causes inflammation in the abdomen can cause adhesions. In some cases, women are found to have adhesions even without a history of any of the above conditions. In some of these women, adhesions might have resulted from a previous pelvic infection. Since not all pelvic infections in women may have conspicuous symptoms, the woman might not have realized that she had the infection; however, adhesions may have formed as her body worked to get rid of the infection. Hmmm, now isn’t that something! Reading here, my mind went to the verse of the bible that says we are fearfully and wonderfully made.

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Now how does this Adhesion thing work? Generally, the ovaries and fallopian tubes are mobile and can easily intermingle with each other. Abdominal adhesions cause female infertility by preventing fertilized eggs from reaching the uterus, where fetal development takes place. Adhesions can kink, twist, or pull out of place the fallopian tubes, which carry eggs from the ovaries – where eggs are stored and released – to the uterus. There are cases in which a woman may have adhesions in her abdomen or pelvis that don’t affect the tubes or ovaries. These adhesions may cause pain or other health problems but they will not impair her ability to become pregnant.

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Over the years, physicians have tried classifying adhesions so that more uniform descriptions can be given for adhesions. This allows for more easy comparisons between patients and allows fertility doctors to more easily assess the potential benefits of treatments to remove or prevent adhesions. Filmy adhesions are very thin and can usually be broken apart easily with gentle pressure or tugging. Thick adhesions often are vascular (contain blood vessels) and require disruption via mechanical mean or with energy (such as electrical or laser) to be removed. Band adhesions may connect two structures by forming a “band” or string-like structure between them. Flat adhesions result when two structures are “stuck” together. Although most abdominal adhesions go unnoticed, the most common symptom is chronic abdominal or pelvic pain. The pain often mimics that of other conditions, including appendicitis, endometriosis, and diverticulitis

 

When I read this particular paragraph below, I never knew you could actually treat adhesions! The only snag is the method of treatment as stated here: Surgery is the only effective treatment for pelvic adhesions. Fertility doctors will use the term “lysis of adhesions” to describe the surgical procedure to cut away adhesions and restore the normal pelvic anatomy. As a general rule, the less adhesions that are present, the more it is likely that surgery will be effective at producing a pregnancy. Why aren’t all surgeries to remove adhesions successful? One reason is that adhesions can recur after a surgery. In addition, new adhesions may form after a surgery is performed, even if the purpose of the surgery was to remove adhesions. Fertility doctors will try to use many techniques to prevent adhesions from returning or to prevent new adhesions from forming. Often, this involves putting absorbable “barriers” in the pelvis to prevent different structures from getting stuck together. Another method is to place various types of fluid in the abdomen after the surgery. Currently, there is one type of fluid that is approved by the FDA during gynecologic surgery to prevent adhesions. Or a special filmlike material (Seprafilm) or Adept can be inserted between organs or between the organs and the abdominal incision at the end of surgery. Other steps during surgery to reduce adhesion formation include using starch- and latex-free gloves, handling tissues and organs gently, shortening surgery time, and not allowing tissues to dry out. However, if the adhesions do not cause any problems such as infertility, treatment is usually not necessary.

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Are there any prevention methods? Hmm, let’s see, can you prevent a child from scraping his knee? No! You cannot bind him to a chair forever to avoid a scraped knee thus Abdominal adhesions are difficult to prevent; however, surgical technique can minimize adhesions. Laparoscopic surgery avoids opening up the abdomen with a large incision. Instead, the abdomen is inflated with gas while special surgical tools and a video camera are threaded through a few, small abdominal incisions. Inflating the abdomen gives the surgeon room to operate. Sadly, most hospitals in Nigeria do not offer this and the few who do, their prices are cut-throat! Arghhh!!! When will our Government provide us with good medical insurance?

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Adeola was so happy and less stressed by the time she was leaving as we discussed at length; sharing my experiences with her was also therapeutic for me as I felt I had a purpose, to be a source of support and help for others; it made me feel good. Never underestimate the place of good communication amongst the ‘right friends’ as even the bible says confessing to one another and praying for one another helps as the prayer of the righteous has great power as it is working.  I believe Adeola will be pregnant before the end of year 2014.

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