Adhesions: How They Impact Pelvic Health & Fertility
- Feb 19
- 5 min read
Pelvic adhesions are an often-overlooked contributor to fertility challenges and chronic pelvic symptoms. These sticky areas of scar tissue can develop not only after surgery, trauma, or infection, but also as a result of conditions such as endometriosis, adenomyosis, or ongoing pelvic and systemic inflammation. They can cause tubal blockages or hydrosalpinx, which can cause ectopic pregnancy because the egg cannot reach the uterus to implant. Even when imaging appears normal, adhesions can silently disrupt circulation, organ mobility, and reproductive function.
What Are Pelvic Adhesions?
Pelvic adhesions are fibrous bands of scar tissue that can develop in the pelvic cavity. They often involve organs such as the uterus, ovaries, fallopian tubes, or intestines. Adhesions can also form inside the uterus, which is called intrauterine adhesions or Asherman’s syndrome. Such adhesions can restrict the normal movement of these organs, leading to several complications.
Adhesions can develop due to various reasons, including:
Pelvic or abdominal surgeries: Procedures such as hernia repair, salpingectomy, cesarean section, appendectomy, cholecystectomy, and endometriosis excision or ablation frequently result in adhesion formation. Studies show that adhesions develop in up to 90–93% of patients following abdominal or pelvic surgery, making them one of the most common postoperative complications.
Pelvic infections: Infections can lead to inflammation, which can contribute to adhesion formation. Pelvic inflammatory disease (PID) and chronic endometritis can increase the risk of adhesions significantly
D&C procedures: Intrauterine adhesions can occur after dilation and curettage, particularly when performed after miscarriage or postpartum hemorrhage.
Trauma: Blunt force trauma to the pelvis, such as from a car accident where a seatbelt forcefully compresses the lower abdomen, a fall, or direct impact injuries, can trigger localized inflammation and internal tissue damage. As the body heals, scar tissue may form, and in some cases, this healing response can contribute to the development of pelvic adhesions.
Chronic inflammation: Conditions such as endometriosis or gut issues can lead to long-term inflammation and contribute to adhesions.
How Do Adhesions Affect Fertility?
Pelvic adhesions can greatly impact fertility in several ways:
Limited organ mobility: Normal reproductive function depends on coordinated movement of pelvic organs. Adhesions can tether structures together and disrupt normal tubo-ovarian interaction.
Restricted fallopian tube function: Adhesions can block or distort fallopian tubes, contributing to tubal factor infertility. Tubal disease accounts for approximately 25–35% of female infertility cases worldwide.
Increased risk of ectopic pregnancy: Tubal blocakges and hydrosalpinx significantly increase the risk of ectopic pregnancy due to impaired embryo transport.
Disrupted implantation: Intrauterine adhesions (Asherman’s syndrome) are associated with implantation failure, recurrent miscarriage, and menstrual abnormalities. Adhesions around the uterus can impair blood supply, leading to thin endometrial lining and reduce the chance of implantation.
Chronic inflammation & infertility: Inflammatory processes contribute to an estimated 30–50% of infertility cases, particularly in the context of tubal disease and endometriosis.
Pelvic adhesions may cause symptoms like painful ovulation, pelvic pain, painful intercourse, or discomfort during menstrual cycles—issues often mistaken for normal menstrual symptoms. Recognizing these signs can be vital for women experiencing fertility challenges.
Non-Surgical Approaches to Address Pelvic Adhesions
We offer gentle, non-surgical approaches to help the body naturally soften adhesions, restore circulation, and reduce inflammation. Here are some effective methods used to promote healing:
Mercier Pelvic Therapy
Mercier Pelvic Therapy is a specialized approach designed to gently mobilize the uterus and ovaries, aiming to improve their alignment and overall function. This technique involves careful manipulation to encourage the body to release adhesions, ultimately restoring normal organ mobility and function.
Visceral Manipulation
Visceral manipulation uses targeted organ mobilization to release restrictions in the body's connective tissue that can hinder mobility, function and disrupt the nervous system. By resolving these restrictions, this therapy optimizes the function of organs. This technique is used in Mercier Therapy and SOT (sacrooccipital technique).
Near-Infrared (NIR) Light Therapy
NIR light therapy penetrates deeper than traditional red light and helps in cellular repair and softening scar tissue. This non-invasive treatment encourages healing and reduces inflammation, creating an environment more conducive to fertility.
Anti-inflammatory Nutrition & Supplements
From a functional medicine perspective, adhesion formation reflects not only mechanical scar tissue development, but also how the body regulates inflammation, fibrin deposition, and tissue remodeling over time. When inflammation becomes chronic or resolution pathways are impaired, fibrin can accumulate more densely and contribute to scar tissue formation.
Proteolytic enzymes such as serrapeptase, nattokinase, and systemic enzyme blends can be used to support healthy fibrin balance and tissue turnover. When taken away from meals, these enzymes help modulate inflammatory signaling and support the body’s natural remodeling processes.
However, enzymes are typically just one piece of a broader strategy. Supporting inflammation resolution is equally important. This may include:
Omega-3 fatty acids (EPA and DHA), which help shift inflammatory signaling toward a more balanced state.
Specialized pro-resolving mediators (SPMs), derived from omega-3s, which actively support the resolution phase of inflammation rather than simply suppressing it.
Curcumin, which has been studied for its role in modulating inflammatory pathways such as NF-kB and supporting healthy tissue repair.
N-acetylcysteine (NAC), which supports glutathione production and may help regulate oxidative stress associated with chronic inflammation.
Optimizing vitamin D levels, which play an important role in immune modulation and inflammatory balance.
Because every woman’s inflammatory burden, immune activity, surgical history, and hormonal environment are different, there is no one-size-fits-all protocol. Personalizing the approach is essential. In our virtual Functional Lab Consultations, we review existing labs, assess patterns that may be contributing to persistent inflammation or impaired tissue repair, and recommend targeted testing when appropriate. This allows us to design a strategy that is specific to your physiology rather than relying on a generic supplement plan. Addressing gut health, microbiome balance, blood sugar regulation, and nutrient sufficiency can reduce systemic inflammatory load, which can influence how the body forms and remodels scar tissue.
When to Consider Exploring Adhesions
If you've had pelvic or abdominal surgery, endometriosis, adenomyosis, tubal blocakages, or are struggling with unexplained infertility, it may be beneficial to investigate whether pelvic adhesions are a contributing factor. Many women do not recognize how adhesions can impact their digestion, post-surgical pain, and reproductive health.
With the appropriate support and therapies, the body can heal and improve function naturally. Healing from pelvic adhesions involves not just restructuring scar tissue, but also restoring the flow, function, and harmony necessary.
Final Thoughts
Adhesions are a crucial yet often neglected factor in women's health and fertility. Understanding their causes and effects is vital for anyone facing fertility challenges or pelvic discomfort. By exploring non-surgical methods such as Mercier Pelvic Therapy, visceral manipulation, NIR light therapy, and proteolytic enzymes, women can take proactive steps to heal and restore their reproductive health.
If you suspect that pelvic adhesions may be influencing your fertility or overall well-being, consider seeking guidance from a qualified Mercier Therapy practitioner. With proper support, you can initiate a journey toward healing and reclaiming your reproductive health.
References
Ten Broek RPG, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and meta-analysis.BMJ. 2013;347:f5588.
Practice Committee of the American Society for Reproductive Medicine. Postoperative adhesions in gynecologic surgery: a committee opinion. Fertility and Sterility. 2013;99(6):1550–1555.
AAGL Practice Report. Practice Guidelines for the Diagnosis and Management of Intrauterine Adhesions. Journal of Minimally Invasive Gynecology. 2017;24(5):695–705.
Centers for Disease Control and Prevention (CDC). Pelvic Inflammatory Disease (PID) – Complications.
World Health Organization. Infertility prevalence estimates, 1990–2021. 2023 report.
American College of Obstetricians and Gynecologists (ACOG). Tubal Ectopic Pregnancy Practice Bulletin.Obstetrics & Gynecology.
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