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BOOK TITLE: Principles and Practice of Assisted Reproductive Technology
This chapter will focus on the factors that contribute in the distortion of pelvic and uterine anatomy and will highlight the surgical procedures used to correct this distortion aiming to increase fertility. Intra-abdominal surgery is among the most important contributing factors for the development of peritoneal adhesions. The incidence of adhesions is higher after laparotomy rather than laparoscopy, with increasing number of laparotomies and midline incisions rather than suprapubic incisions. Abdominal hysterectomy and myomectomy (especially after a posterior uterine wall incision) have high associations with pelvic adhesions. Patency of the fallopian tube and normal function of its lining mucosa are mandatory for the transport of ovum, sperm and embryo. It is in the ampulla of the fallopian tube where fertilization takes place. Blockage of this conduit will impair fertility and may cause ectopic pregnancy. The most common causes for tubal damage or occlusion are tubal infection and tubal sterilization.