An transabdominal cerclage is a surgical procedure called for if a vaginal cerclage fails. This is also placed around the cervix, but behind the vaginal wall. The consistency of the cervix there is much better for holding when constricted by the wrap-around nature of the cerclage. It is preferable to put it place before a next pregnancy, because there's less bleeding, no risk to a baby, and it doesn't interfere with conception. It means you need C-sections thereafter, but if that's the only way to have babies, it's worth it, remarks Dr. DiLeo. "I've had mixed results with the comfort level with an internal cerclage," he says. "Some of my patients were able to work to the day of delivery. Others had cramping throughout the pregnancy, which is a little nerve-racking, but harmless."
Previous Therapeutic Abortion
Abortions performed under sterile surgical conditions don't tend to cause complications in subsequent pregnancies. If there were an overzealous scraping of the uterus during one, says Dr. DiLeo, this could cause scarring and affect implantation. The greater the number of elective abortions, the greater the chance for scarring.
Illegal abortions, on the other hand, "have an unquestioned adverse effect on fertility and pregnancy outcome," according to a National Institute of Health article.
Adhesions, Cysts, and Varicies
Adhesions are excess tissue and scarring caused usually by previous surgery, infection, or endometriosis. If you've had no previous surgeries but are diagnosed with adhesions, then you may have had endometriosis at some point; your doctor can tell if the adhesions look like old burned-out endometriomas. If you've had neither surgery nor endometriosis, then you may have had an infection such as chlamydia in the past. " You might need a test to tell if your tubes are open," says Dr. Dileo.
Adhesions can be removed through laparoscopic surgery, but mild ones are not definite roadblocks to conception, and, notes Dr. Jarrett, "surgical treatment of mild endometriosis [adhesions] is not associated with any improvement in the chances of getting pregnant."
The most common type of ovarian cyst is a follicular cyst. They come the fluid-filled sac in the ovary that contains an egg. In some cycles, this "follicle" grows larger than normal and does not rupture to release the egg. This usually resolves over the course of days to months. Endometrial cysts are full of blood. Dermoid cysts are usually benign tumors containing a mix of cell types. Cysts can be removed from the ovaries without impairing ovarian function. After you've healed, unless you're on the pill, if your cycles are regular then it indicates that you're ovulating well.
Pelvic varices are essentially varicose veins in and around the uterus, that can occur during pregnancy as well as in nonpregnant women. According to an article in The Journal of Diagnostic Medical Sonography, they commonly involve the broad ligaments and neighboring connective tissue and are usually found adjacent to or surrounding the uterus, lower uterine segment, and cervix. Although pelvic varices can be prominent, they rarely cause obstetrical complications, the article says.