Secondary Infertility: Are You Scarred?

Written By: Sharon Safdieh, DPT, BCB-PMD

When we think about fertility, there are three basic factors needed in order to conceive and carry a child. We need a healthy egg, healthy sperm and healthy female anatomy as the environment in which the fetus will live and grow. Most people are aware of procedures used to help couples increase egg quantity or sperm count. In this article we will focus on the last factor – a healthy mobile reproductive pathway including the ovaries, fallopian tubes and uterus.

Organs are mobile structures. They move in every direction, when we inhale and exhale. If the uterus, fallopian tubes or ovaries are not fluidly moving, then fertility may be limited. The egg may not be meeting the sperm or the fertilized egg may not be able to implant properly. One such cause of limited organ mobility is a previous Cesarean section (C-section) or abdominal surgery.

Let’s discuss how people heal from an abdominal surgery or C-section. When someone gets a wound, the body creates an inflammatory response in order to bring the healing agents in the blood to that area. After the body clears out the bacteria, it focuses on closing the wound. In order to do so, the body quickly lays down scar tissue in an unorganized fashion. When scar tissue is placed, it sticks to the organs in the area or anything around it. Time goes by and the scar tissue becomes solid, less mobile, and stays stuck to the objects on which it adhered. The best analogy for understanding this concept is comparing scar tissue to Laffy Taffy. If taffy was left out in the sun, it would be fairly sticky and mobile. You could mold it and shape it into any shape and it would probably stick to anything you placed it on. Once it cooled down, the taffy would get hard and immobile. Sometimes the scar tissue from a C-section can stick to intestines, the bladder or even the fallopian tubes. Once the scar tissue is stuck to those organs, they don’t have as much mobility as they may have had.

These pelvic adhesions from scar tissue may be contributing to secondary infertility. A recent study in 2018 found that couples suffering with unexplained infertility after cesareans have pelvic adhesions, or scar tissue that is stuck to organs. Previous C-section deliveries or abdominal surgeries can result in scar tissue that impairs reproduction.

Scar mobilization is an easy and manageable treatment for most patients. It can be treated soon after the patient heals from their C-section or abdominal surgery, with physician approval, or years later with pelvic floor physical therapy. Pelvic floor physical therapists are specialized therapists who work within the scope of women’s health. They treat bowel, bladder, intimacy, fertility and pregnancy-related issues. Some pelvic floor therapists are trained in scar mobilization, myofascial work and visceral mobilization. These techniques are used to increase flexibility in the scar tissue and restore mobility and proper function to the organs. With therapy, we “heat up” and loosen the scar tissue externally by manipulating it with our hands, reviving the natural organ mobility that existed. In early stages of recovery from surgery, loosening and “organizing” the scar tissue can help to limit where the scar tissue will adhere and promote greater mobility for the organs around the scar. If pelvic floor therapy is utilized years after a surgery, the scar mobilization will loosen the scar tissue, stretching it, finally allowing the organs to move again.

Pelvic floor physical therapy can help with what we call the biomechanical factors of fertility, giving mobility to the organs that need it if they are limited due to scarring, immobility or a trauma to the abdomen. A fertility specialist should be consulted when seeking such an approach, as results are improved when a multidisciplinary approach is taken.

Sharon Safdieh is a Physical Therapist specializing in Pelvic Health. If you would like to make an appointment with Sharon, please call 917-459-8072.

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