Tissue/adhesions around ovaries after a c section? Suspected endo

[ajc1994]

I am 30 and have been TTC for 3 months with no success yet but obv still early days. However my doctors put me in for an internal ultrasound and bloods to check for Endo and PCOS as I wasn’t ovulating for a few months. I have now had two successful regular cycles since taking inositol CoQ10 and various other supplements aimed at helping fertility. My bloods came back normal however my scan has shown that my ovaries are stuck due to adhesions to the bowel. So my ovaries aren’t moving but no pcos and my ovaries look healthy inside. It’s just they wouldn’t move when she tried to nudge them. She asked if I had any pain during periods, heavy ones, pain during sex all of which were a no. They have written to the hopsital fertility clinic for advice and guidance on next steps, given usually you have to wait a year but because I have this diagnosis can I be seen quicker basically. I am wondering if it’s not endo and rather scar tissue from my c section 4 years ago as I’ve read thats common. No idea how long it’ll take to hear back from the hospital.
Any one had anything similar? Any fertility success stories? I conceived my daughter no issues 4 years ago and no idea how long I’ve had these ‘frozen’ ovaries. Just feeling really down and wondering if any one else is or was in a similar position. TIA x

Hello. I had similar, although from operations to resection my bowel rather than a c-sec. IVF didn't work for me, but I did eventually manage to conceive and have my child at age 36, after several years of trying. I had to have a c-sec and didn't manage to get pregnant again. I have a diagnosis of endometriosis, but like you I wonder if it's more sue to scar tissue than "classic" endometriosis. Best wishes.

If you don't have the symptoms of endometriosis, which are:
• Irregular or heavy periods
• Severe pelvic pain
• Severe pelvic pain on opening bowels (dyschesia) and wider gastrointestinal symptoms (diarrhoea and constipation)
Diarrhoea or constipation or other bowel issues
• Pain with sex and insertion
• Pelvic pain on passing urine (dysuria) and bladder symptoms sometimes
• Referred pain to the tops of the legs or back
• Consistent pain across the whole month

Then it's much more likely to be scar tissue issues, which formed and pushed your ovaries to your bowels. So after you transvaginal ultrasound, will you be having an MRI? Or a laparoscopy to have a more detailed look around, once they do that, they can put a plan in place to help conceive. It's more likely the PCOS is still causing issues as well. When do you see fertility clinic?

Thank you, I have none of those symptoms and they didn’t find any PCOS, just when they pushed on my ovaries they wouldn’t move and she said there’s some adhesions to my bowel but I have no symptoms. I have no idea what comes next. My Drs have written to the hospital fertility clinic to see if they will accept me as a referral given it’s not been a year of TTC yet but that can I be seen earlier due to their findings so will see what they say.

thanks both for your replies and sorry @MujeresLibressounds like you had a tough time and glad you managed to concieve eventually x

For a PCOS diagnosis you only need 2 out of the 3 symptoms, so excessive male hormones (that can be found through a Hormone panel), polycystic ovaries and lots of small follicles (seen through ultrasound or MRI) and Irregular or absent periods. So not having lots of follicles doesn't mean you don't have it.

Those adhesions may need to be removed to help you conceive. Is the waitlist for fertility clinic up to a year. Is there not anything else they can try in the meantime.

Sorry I should have said I had blood tests as well to check all hormone levels and all were normal. My periods are regular and fairly light two medium flow days at the beginning and two lighter days after, it comes the same day each month. The NHS wont see me until we’ve been trying without success for a year as I’m under 35, hopefully they will make some kind of suggestions or out me on a waiting list for further scans x

So it's likely the main barrier could be idiopathic secondary infertility or the adhesions needing to be removed. Is there any other medications you can try whilst you get up to the 1 year mark? What else has your GP suggested?

Well we’ve only been trying for two cycles so far so I’m hoping it’s not infertility just yet, but yes I suppose it’s an investigation into whether I need the adhesions removed or if I have endo or not. I suppose big factor is if my tubes are blocked since my ovaries look healthy inside. Nope, been told to take ibuprofen if I get any pain and to go on birth control to help symptoms 😅 sure, that’ll help me get pregnant!

Yes I'd be looking into the adhesions, I doubt you have endo as you'd have symptoms, which should be long-term, endo is a debilitating chronic illness and so only having issues getting pregnant wouldn't be the main flag for it, it should be the symtpoms the issues it causes, with pain, mobility, diarrhoea and constipation, vomiting/nauesa, lots of severe pain etc. So I doubt the fertility clinic will go down that route. The adhesions may need removal but it's likely the scans you've had should have caught a blocked tube.

If you're only on two cycles I'd just keep trying, either it works or you meet the year threshold and get referred to fertility clinic. They are unlikely to accept it earlier, particularly as they've rules out things like PCOS which would have gotten you an earlier referral. I'd be asking about anything else medical as even eith adhesions you likely don't have that many, if it's just 1 C-section, so it's unlikely to be the only issue. Perhaps see your GP for next steps, but it's likely you need to keep on going for up to the year mark. Hopefully if all works before that.

Every time they open you up I believe there is about a 60% chance of adhesions. There are lots of medical papers on it. That can be a simple as a laparoscopy for endo diagnosis or c section. I have had both and I definitely have adhesions as something rips inside me when I turn over in bed in my sleep or if I don't brace myself to sneeze. I do have endo though so I think it is a combination of both. Endo has the ability to mat down the abdominal cavity.

Endo can be painless it depends where the deposits are and your pain levels from it. Sometimes they see it everywhere.

Most women present with symptoms, mine are painful ovulation, horrific period pain, numb legs and chronic fatigue. I did used to have horrific bowel pain and used to think I would pass out from the pain. I have never experienced painful sex or gastro problems.

You could try to push for a laparoscopy which would be able to confirm if you have endo they can see and would be able to flush your tubes, my laparoscopy had that as part of it.

Thanks for your replies. I am remaining hopeful, they are just worried since my ovaries aren’t ‘free’ and moving at all, but in my mind if they are working inside and that’s the only problem then it wouldn’t matter that much in terms of fertility. I do get cramps and they were worried I went ages without ovulating after IUD removal, but since I have been on supplements I’ve had a regular cucle and they cramps aren’t awful I don’t need pain relief or anything

I'd be considering more that the ovaries aren't functioning as much since you have delayed ovulation. When you do see fertility clinic my main issue would be freeing the adhesions and them, freeing the ovaries. The ovaries may just be far aware and tethered too much so it won't help loads but definitely freeing adhesions should depending on the amount and a more general laparoscopy to flush out tubes etc.

Surely the GP knows some different medications you can try? Or is it just repeat being TTC till the year mark. To be honest that's probably your best bet, fertility clinic depending on waitlists may see you earlier or may say get back to us in a year, I'd be making sure your GP is trying everything they can in terms of meds from their side. Perhaps see if there's a GP who knows more about fertility stuff. You are young so you definitely have time it may just be the first few cycles weren't for you and then it will happen. Have you got any future follow up appointments with the GP?

@TheLivelyViperthank you. Yes I think they are waiting to hear back from the fertility clinic for advise, maybe they will give me some medication to try in the meantime. I suppose if I was having pain they’d push me through faster. Then once theyve heard from them they will get back to me, hopefully with a plan. They suggested supplements but I’ve been taking them all since June anyway.

I think I went 2-3 months without ovulation but since end of June I have ovulated CD18 on the dot and had a 11/12 day Luteal Phase so I’m hoping it’s just taking a few months and that’s all their is to it. But I have had a c section and my gallbladder removed in the last 4 years so chances of adhesions is going to be high I imagine

That's good then, hopefully fertility clinic have some useful advice of a few things they can try and if they mention the ovaries being more on the bowels and also the adhesions they may see you quicker as well. It likely is that your body is getting more used to it as well especially if you are ovulating later and then still having quite extended luteal phases, hopefully it gets more in gear over time. Oh if you've also had the gallbladder removed then yes I imagine you do have more adhesions with the both of them combined so definitely make sure your GP mentions it to the fertility clinic, as they may get involved or see you faster.

Thank you :) I will keep you updated x