Prior Surgery Causing Infertility

December 14, 2007

Q & A: I had an appendectomy for appendicitis five years ago. Could this have anything to do with infertility?

The appendix sits in the right lower quadrant of the abdomen, fairly close to the ovary and the opening of the fallopian tube on that side. If there were peritonitis, then this involved an infection which could have caused pus to collect in the area. The body tends to wall off pus-containing areas of infection. It's a defense mechanism to isolate the infection from the rest of the body. We can see this mechanism in action with skin abscesses and even with pimples. The intestinal tract, especially fat attached to the intestines and stomach, is referred to as "the policeman of the abdomen," because of its tendency to gravitate toward these areas and wall them off.

So far so good.

But when the area being walled off contains the opening end of the fallopian tube, that portal that receives an ovulated egg, there can be a mechanical blockage at that site, making conception in that tube less likely. If the infection from appendicitis was particularly widespread, there can even be blockage or scarring involving both tubes. Such scarring is called adhesions.

Any mechanical blockage of this sort can be diagnosed with a test called a hysterosalpingogram (HSG), in which dye is squirted up through the cervix to demonstrate easy spillage of both tubes on X-Ray (actually, fluoroscopy). If one or both are blocked, it will be evident with this test. The test is somewhat uncomfortable, causing brief cramping during it, but it's an out-patient procedure. Of course, other easier explanations should be sought before resorting to this type of invasive, expensive test.

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