How Adhesions Can Harm Your Fertility

Definition + Symptoms + Diagnosis and Treatment

Woman standing at a window, light coming in, in pain from adhesions
Adhesions may cause back or pelvic pain. They can also make sexual intercourse painful. However, sometimes, there are no obvious symptoms.. Cultura RM/Steve Prezant / Cultura / Getty Images

Quick definition: adhesions are abnormal bands of scar tissue that join together organs or parts of organs that are not normally joined together. They can be caused by infection, some diseases, or previous surgery.

Adhesions may cause infertility by...

  • preventing the egg and sperm from meeting
  • by interfering with ovulation
  • by making the uterus inhospitable to a fertilized embryo

Adhesions are one possible cause of blocked fallopian tubes.

Endometriosis and pelvic inflammatory disease (PID) can cause adhesions that interfere with your ability to get pregnant.

Asherman’s syndrome, or uterine synechiae, are when adhesions form inside the uterus. It may cause infertility or recurrent miscarriage.

Adhesions may cause pain, including painful menstrual cramps or pain during sex. Adhesions may cause abnormal menstrual bleeding, very light menstrual periods, or a complete lack of menstrual bleeding.  

However, it’s also possible to have no obvious symptoms.

What Causes Adhesions? How Do Adhesions Cause Infertility?

Adhesions can occur when the body’s natural healing process goes a little awry.

Usually, the surfaces of the uterus, abdominal cavity, and fallopian tubes are slippery. This enables organs to move around each other easily.

However, when there is injury – whether from an infection, previous surgery, or an endometrial deposit – the surface can become “sticky.” This can cause organs getting stuck together.

Scar tissue may form and hold the organs in an abnormal position. Scar tissue may also create web-like attachments between organs.

These adhesions can be thick and strong. Your organs may unnaturally pull on each other. This can cause pain, especially during sexual intercourse or during menstruation.

In the case of Asherman’s syndrome, adhesions occur within the uterus.

The adhesions may be few, or, in severe cases, they can cause the uterine walls to stick together almost completely.

Intrauterine adhesions prevent a healthy endometrium from being formed. This may prevent healthy implantation of an embryo.

Or, if implantation of an embryo does occur, the risk of miscarriage may be higher.

In the case of pelvic inflammatory disease, or some any other infection of the reproductive tract, the fallopian tubes can become inflamed. The inflamed surfaces can develop scar tissue or adhesions within the tubes.

These adhesions prevent egg and sperm from coming together.

Adhesions caused by endometriosis usually occur in the pelvic cavity. They may be present near the fallopian tubes or ovaries. Endometrial adhesions may interfere with ovulation.

Sometimes, endometrial adhesions prevent the fallopian tube from moving naturally.

The ovary is not attached directly to the fallopian tubes. During ovulation, when an egg is released from the ovary, it must find its way into the fallopian tube.

If adhesions interfere with the fallopian tubes natural movement, an egg may not make it into the fallopian tube. This decreases fertility.

How Are Adhesions Diagnosed?

There are three primary ways to diagnosis adhesions:

An HSG is a special kind of x-ray that can be used to get an idea of the uterine shape and whether the fallopian tubes are clear. Blocked fallopian tubes may be diagnosed with a HSG.

With a hysteroscopy, a thin, lighted tube called a hysteroscope is inserted into the uterus via the cervix. This enables the doctor to see the inside of the uterine cavity and the openings to the fallopian tubes. 

A hysteroscope can be used to diagnosis problems with the uterine cavity, including Asherman’s Syndrome. The same procedure may be used to remove and heal intrauterine adhesions.

A laparoscopy is a procedure where a small incision is made in the abdomen. Then, a small, lighted tube with a camera device is inserted, along with instruments.

Laparoscopic surgery is the only way to diagnosis endometriosis.

You can get normal results on an HSG and hysteroscopy, but still have mild to severe endometriosis.

About 50% of otherwise normal infertile patients may be diagnosed with pelvic adhesions or endometriosis after a laparoscopy. Sometimes, “unexplained” infertility is really just undiagnosed pelvic adhesions or endo.

The same surgery that is used to diagnosis endometriosis or pelvic adhesions can be used to treat and remove the adhesions. That way, you don’t have to go through surgery twice.

Talk to your doctor before you have the procedure.

Fertility Treatment and Adhesions

If the adhesions are within the fallopian tubes, surgical repair may be possible. However, IVF treatment may be more successful and cost effective.

If Asherman’s syndrome is the cause of infertility, the adhesions may be removed during an operative hysteroscopy. You may be able to conceive naturally afterwards, or you may require fertility treatment in addition to surgery.

In the case of pelvic adhesions or endometriosis, removal of the adhesions may reduce pain and may improve the odds of pregnancy success. However, depending on the situation, you may still need IVF or fertility treatment after surgery.

Always talk to your doctor about all your options. Ask what can be expected after surgery.

More on infertility and fertility treatment:


Adhesions: What Are They and How Can They Be Prevented? American Society for Reproductive Medicine. Accessed February 22, 2016.

What is Hysteroscopy? Treatment & Procedures. Cleveland Clinic.  Accessed February 22, 2016.

Tsui KH1, Lin LT2, Cheng JT3, Teng SW4, Wang PH5. “Comprehensive treatment for infertile women with severe Asherman syndrome.” Taiwan J Obstet Gynecol. 2014 Sep;53(3):372-5. doi: 10.1016/j.tjog.2014.04.022.

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