Scar tissue, in particular between the serosa (surface lining) of abdominal or pelvic organs in the peritoneal cavity, which can interfere with the access the fallopian tube has to the ovary at ovulation. Adhesions can be thin and transparent (sometimes called filmy or Grade 1), a little like thin plastic wrap; thicker, and containing more scar tissue and blood vessels (Grade 2); or thick, dense and tough (Grade 3). Adhesions are caused by infections, endometriosis or a previous operation. Not all adhesions are important: it depends on where they are. See also intrauterine adhesions. The treatment of adhesions requires microsurgery, and there are special steps that have to be taken to stop them coming back again.

Adhesions inside the endometrial cavity caused by prior infection (endometritis), especially if there has been a curettage during the period of infection, or if curettage is performed in conditions of low estrogen. The circumstances in which this combination is most common are treatment for a missed abortion and treatment of a postpartum hemorrhage (bleeding a few weeks after the birth of a baby). A cause of absent periods amenorrhea, light periods (hypomenorrhea) or recurrent miscarriages.

Adhesions around the fallopian tube.

Absent menstrual periods, either because of absent ovulation (anovulation) or because of absence of, destruction of, or obstruction to the menstrual flow from the uterus, such as with intrauterine adhesions (when it's known as Asherman's syndrome).

The combination of intrauterine adhesions and amenorrhea.

Painful menstruation. Can be primary, present in teenagers, generally in spasms around the start of the period; or it can be secondary, developing as a woman gets older, and then typically lasting more than a day or so into the period, with prolonged aching as well as spasms. Primary dysmenorrhea might have no medical importance beyond the suffering the pain causes, and typically gets better as a woman reaches her 20s; severe or persistent cases, however, warrant investigation. Secondary dysmenorrhea can signify, for example, endometriosis, fibroids, adenomyosis or peritubal adhesions.

An operation performed at hysteroscopy to treat menorrhagia by intentionally producing endometrial atrophy and intrauterine adhesions.

Also "fimbriated end": the open, outside end of the fallopian tube in contact with the surface of the ovary, from which it "picks up" the ovulated egg from the ruptured follicle. It's composed of delicate fimbriae -- finger-like projections of the tube lined by cells with tiny hairs (cilia), which beat towards the inside of the tube, carrying the sticky cumulus mass containing the egg into the ampulla before fertilisation. Easily damaged by infection (salpingitis) or careless surgery, after which it may be blocked, resulting in a hydrosalpinx, or have its correct movement inhibited by adhesions.

Microsurgery of the fallopian tube's fimbrial end, involving careful dissection of fimbriae that have become stuck together from adhesions. Generally gives a better outcome than salpingostomy (which must be resorted to if the fimbriae are too damaged to dissect).

Not just the stuff of ski clothing: used in a special surgical specification as a barrier to the formation of peritoneal adhesions.

Blockage of the outer, or fimbrial end of the fallopian tube, usually as a result of chronic salpingitis (but also sometimes from peritubal adhesions, from a salpingotomy or partial salpingectomy for a tubal pregnancy, or from fimbriectomy), resulting in its distension by watery contents. An untreated hydrosalpinx (even if only one tube is affected and the other tube is normal) can cause infertility and failure to conceive even with in vitro fertilisation.

Light periods, particularly in a woman who has previously had much heavier periods. Occurs normally on the oral contraceptive (birth control) pill. Occurs abnormally with intrauterine adhesions or endometrial atrophy; see also Asherman's syndrome.

Used for minimising adhesions in the peritoneal cavity after a surgical operation involving the fallopian tubes or ovaries. The material is woven from fibers of modified cellulose and, after being placed over abdominal surfaces the serosa of which is likely to have been damaged, dissolves in about a week or two into simple sugar molecules (which are then absorbed by the body and metabolised); in the meantime, the cloth keeps the covered surfaces apart while the serosa reforms. Controlled trials have shown Interceed to be effective in preventing or reducing adhesions, but an adhesion-free result is not guaranteed. In my experience Interceed is exceptionally useful when dense adhesions resulting from previous operations are being treated. Made by Johnson and Johnson.

A miscarriage that should have happened but hasn't. As a result, the pregnancy tissue in the uterus gets tougher and more difficult to get out with a uterine curettage -- which is the only treatment for it, but risks producing intrauterine adhesions. The pregnancy test can stay positive for many weeks or even months.

Inflammation of the fallopian tubes, usually due to infection. Can be acute (e.g. gonorrhea, chlamydia and other infections) or chronic (e.g. persisting chlamydia, tuberculosis, various fungus infections). Leads to blockage of the tubes and peritubal adhesions if not treated promptly and effectively with antibiotics.

Microsurgery to remove peritubal adhesions or perifimbrial adhesions. Sometimes carried out at laparoscopy.

Infertility that is not 'absolute', or 'complete infertility' -- that is, there is a chance of pregnancy: it is not sterility (these last 3 terms are synonyms) -- but the chance of getting pregnant each month (fecundability or monthly fertility) is reduced. More or less definite causes can include oligospermia, polycystic ovary syndrome and other causes of oligomenorrhea, endometriosis, peritubal adhesions, fibroids (especially submucous fibroids) and increased age, especially of the woman. Synonymous with relative infertility.

Infertility for which no obvious cause has been found after the following tests have been done with normal results: a sperm count or postcoital test; a test of ovulation, such as a serum progesterone that is satisfactorily high; and a laparoscopy (used to show that the tubes are open and that there is no endometriosis or other obvious abnormality). Although a hysterosalpingogram (HSG) can substitute for laparoscopy in excluding blockage of the fallopian tubes, an HSG can miss peritubal adhesions and will miss endometriosis. Infertility should not be considered unexplained unless a thorough, careful laparoscopy has been done.