By Jackie

March is endometriosis awareness month, and one of the main issues that women are promoting is early detection and diagnosis of endometriosis. Because endometriosis can only be diagnosed through laparoscopic surgery, many women live with significant pain and dysfunction for years without being diagnosed or treated.

Laparoscopic surgery

The good news is that the same procedure to diagnose endometriosis can also be used to treat it. During laparoscopic surgery, the physician inserts a tube in or near the belly button, then pumps carbon dioxide into the pelvic cavity. As the gas expands, it creates a space between all of the pelvic organs. The surgeon then inserts a tiny camera to observe and film any mechanical anomalies, such as endometriosis. If she finds endometriosis, she may burn it with a laser. If she finds adhesions (which are commonly found with endometriosis), she will also burn the adhesions.

A significant amount of women find pain relief after the procedure. However, some women continue to experience pain. In our clinical experience, we have found that many women who still experience pain after laparoscopic surgery have a significant amount of adhesions. (For more information about adhesions and endometriosis, please see our post An Option for Women who are Still Infertile after Laparoscopic Surgery for Endometriosis.)

Some doctors also note that pain recurs because endometriosis has re-grown. In a study published by the Journal of Minimally Invasive Gynecology (2005), researches retrospectively evaluated 115 women who underwent laparoscopic surgery for deep endometriosis. Deep endometriosis can be defined as “rectovaginal lesions as well as infiltrative forms that involve vital structures such as bowel, ureters, and bladder” (Journal of minimally Invasive Gynecology). The researchers evaluated these women to find predictors of deep endometriosis recurrence after surgery.

Of the 115 women, 28 experienced pain recurrence and 15 patients presented with recurrent clinical findings of deep endometriosis. From this group, the researchers were able to determine that the following predicted recurrence:

• Age: Younger patients had a greater risk of recurrence
• Obliteration of the pouch of Douglas: The pouch of Douglas is the space between the rectum and back wall of the uterus. When this cavity is closed during surgery, patients experience a higher risk of recurrence.
• Surgical Completeness: The study found that surgical incompleteness was the only predictor of a necessary second operation for deep endometriosis

If you are considering undergoing laparoscopic surgery for endometriosis, you may ask your doctor about the procedure and how she will minimize the risk of recurrence. If you have already undergone laparoscopic surgery, you may obtain a copy of the surgical report or speak with your doctor to determine if you had any significant risks for recurrence.

To learn more about pain or dysfunction after laparoscopic surgery, see endometriosis pain.

By Jackie

Each month, an egg grows in a tiny fluid-filled sac that bursts open during ovulation to release an egg. Sometimes, the sac doesn’t break open and continues to fill with fluid, forming a functional cyst (the most common type of cyst). A functional cyst generally goes away after one to three months, but if it doesn’t, a doctor made need to surgically remove the cyst. A doctor may also choose to operate if the cyst is painful, large, continues to grow, or is present with several other cysts.

Cysts can be removed through laparoscopic surgery or through laparotomy (open surgery), both of which can preserve a woman’s fertility. However, adhesions can form as a direct result of surgery. Adhesions are tiny strands of collagen that form after any injury to the body. Collagen rushes to the site to contain the area and help it heal. As the collagen builds, it forms an adhesion that remains throughout life. Adhesions that form near the ovaries or fallopian tubes can constrict these structures, causing multiple complications and infertility (please see adhesions and infertility). Thus, the surgery to remove ovarian cysts can cause a woman to experience infertility.

However, women who elect to not undergo surgery or whose cysts go away, may still experience infertility due to adhesions that formed as a response to the inflammation caused by the ovarian cyst.

At CPT, we specialize in reducing and breaking-apart adhesions with manual physical therapy techniques. We have been able to help numerous women become pregnant after years of infertility, previous surgeries, ovarian cysts, endometriosis, and other conditions.

One such patient was Jacqueline, who came to us for treatment after two surgeries to remove ovarian cysts. During her first surgery at age 22, her doctor removed 10% of one ovary and 60% of the other due to complex cysts. When Jacqueline and her husband later tried to conceive, they were dismayed to find they couldn’t become pregnant.

One year later, Jacqueline began experiencing severe pain in her abdomen. She went to the hospital and was rushed to emergency surgery to remove a peritoneal cyst. After the surgery, her surgeon told her, “We were able to remove the cyst, but your ovaries and fallopian tubes were buried by adhesions.”

After this startling diagnosis, Jacqueline searched for alternative treatments and found our clinic. We began treating her with our 20 hour treatment protocol, but she had to leave before treatment was finished due to a family emergency.

Before she returned to our clinic, she completed a few tests with her doctor. She had an ultrasound and learned that she no longer had any visible adhesions since our treatment. Her second test, an HSG, showed that her tubes were blocked with liquid (hydrosalpinx).

When Jacqueline returned for treatment, our therapists focused on her fallopian tubes. Afterward, Jacqueline finally became naturally pregnant and later gave birth to a full-term baby.

To learn more about our treatment for adhesions and infertility, please visit our female infertility page.

By Jackie

Endometriosis is one of the most common causes of female infertility. In this condition, the endometrium (the lining of the uterus) is found in places outside of the uterus. It can cover the ovaries and prevent their proper function, such as the release of an egg. It can also squeeze the fallopian tubes shut from the outside or block them from the inside. Endometriosis that attaches to the outside of the uterus can also constrict or pull it. To confound the problem, endometriosis can also cause painful inflammation. Inflammation causes the body to produce and form adhesions. These “sticky” adhesions can restrict tissues and bind them to neighboring structures – which can also cause infertility.

When a woman who has endometriosis is trying to conceive, a doctor may recommend laparoscopic surgery to clear as much endometriosis and adhesions as possible. Many women are able to conceive after this procedure, but a large percentage of women are still unable to conceive afterward. Two possible explanations for this include:

1. A surgeon cannot remove adhesions or endometriosis in areas where the removal of tissue might compromise a woman’s fertility – such as the delicate fimbriea.
2. The surgery itself can cause adhesions to form. Thus, even though the endometriosis might be gone, the resulting adhesions can prevent fertility.

For women who are unable to conceive after laparoscopic surgery, a second surgery may be a risky option due to subsequent adhesion formation. Our treatment uses solely manual techniques to break apart, detach, and deform adhesions.

One of our former patients, Amania, learned she had endometriosis at age 18. Years later, Amania married and struggled to conceive. She underwent laparoscopic surgery but still couldn’t become pregnant. She tried a second laparoscopic surgery, followed by two IUIs – but with no luck. Amania told us, “I changed specialists three more times and had a laparotomy that cleared 80% of the endometriosis but left scarring.” She tried IVF afterwards, but it was unsuccessful.

After reading an article about our therapy, Amania decided to attend treatment. Two weeks later, she was feeling “off” and took a pregnancy test. “Lo and behold,” she told us, “The test was positive!”

Amania’s full story and those of 75 other CPT patients will be featured in the upcoming book, Miracle Moms, Better Sex, Less Pain. Please visit our endometriosis page to learn more about our treatment for endometriosis.

By Jackie

Chlamydia, often know as the “silent” STD, can cause extensive scarring and adhesions within the female reproductive tract. Because Chlamydia produces relatively few noticeable symptoms, women are often unaware they have it until they struggle with infertility and undergo extensive diagnostic testing. Although doctors can cure Chlamydia with pharmaceuticals, the adhesions and scar tissue caused by the disease will remain in the body.

The only option conventional medicine can offer women with adhesions is laparoscopic surgery. However, surgery to open blocked fallopian tubes is not always successful. Furthermore, laparoscopic surgery itself can cause more adhesions and scar tissue to form.

Nicole, one of our former patients, struggled with just this problem. When Nicole and her husband couldn’t become pregnant after three years, they sought the help of a reproductive endocrinologist (RE). Her RE performed a series of tests. Nicole told us, “That when I found out I had an undetected STD, Chlamydia. It had caused scar tissue to form around and block my fallopian tubes.”

Her specialist recommended surgery to open the tubes or IVF. Nicole sought a second opinion with another RE who suspected she had fibroids in her uterus in addition to blocked tubes. He suggested she undergo a myomectomy to remove the fibroids and he would also try to open her blocked fallopian tubes at the same time. He successfully removed the fibroids, but he couldn’t open her tubes.

Nicole then tried three IVFs, all of which were unsuccessful or ended in miscarriage. Afterward, she heard about our clinic on an infertility chat site and decided to attend. After treatment, her HSG test showed her fallopian tubes were clear!

However, Nicole’s doctor encouraged her to undergo IVF. Nicole, concerned about her biological clock, she chose to undergo the procedure and told us, “At nine weeks, I discovered I had twins, but one passed away early in the pregnancy.” Nicole later gave birth to her baby girl, Joy.

Everyone was later surprised when Nicole became unexpectedly pregnant after the birth of Joy. Nicole exclaimed, “We didn’t try anything and we got pregnant!” Nicole’s tubes had indeed opened and she later gave birth to a little boy.

If you would like to read more about treatment for blocked fallopian tubes, please visit our blocked tubes page. Nicole’s story, along with the stories of 75 former patients, will be showcased in our upcoming book, Miracle Moms, Better Sex, Less Pain.