First of all, there are 2 kinds of adhesions that form in the abdomen, endo adhesions and fibrous adhesions. Nobody really knows what causes endo, but the current theory is that there is some mistake in fetal development where some of the cells that are supposed to be inside the uterus, and whose job it is to grow endometrial tissue, somehow end up getting placed outside the uterus. (Almost like if you got a few stray kidney cells in your knee or something.) When you reach puberty these colonies of out-of-place cells bleed and cause irritation to the surrounding tissues. Then there are fibrous adhesions. These are the body's natural response to some sort of injury. A pelvic injury could be from an infection, or from a massive blow to the abdomen (think car crash), or from surgery, or, in fact, from endometriosis. So yes, it is possible to have BOTH endometriosis AND fibrous adhesions. The only way to say definitively that you do have endo is if they send suspicious tissue to the lab and it truly is endo. You can't actually say definitely that you don't have it, though. It's possible that you have it and they just didn't find it. How confident you can be of their negative finding on the endo really depends on the surgeon's skill.
Most fibrous adhesions are caused by surgery. The only way to detach an adhesion is to do surgery on it -- in other words to cut it. But doing surgery on it causes a new adhesion to form where you did the surgery. Plus a couple of brand-new adhesions on the path that they used to cut down to the spot. If you are familiar with greek mythology, think of the hydra. This is the mythical beast where if you cut off one head then 2 more heads would grow back in its place. So we come to the misleading part of what your doctors told you. Yes, the moment that they pulled the instruments out of your belly and started sewing you up, you had about 2/3 of the adhesions that you started the surgery with. But the part your docs obviously didn't tell you -- by the time they wheeled you out of the operating room and down the hall to the recovery room you were already sprouting dozens if not hundreds of more adhesions. The general opinion here is that there are 4 surgeons in the entire world who are capable of doing an adhesion operation and that causes fewer adhesions than it cures. And it sounds like the surgeon who told you the part obut the "other 2/3" couldn't have been one of those 4...
Adhesions can certainly cause all sorts of gyne problems including infertility. They can pinch your tubes shut so that a fertilized egg can't make it down. They can totally encapsulate an ovary so that no eggs can escape to get fertilized. In fact they "typical" in-vitro fertilization case is a woman with scar tissue. The particular technique with in vitro is they use a needle to get an egg out, fertilize it in a test tube or petri dish ("in vitro" is latin for "in glass") and then deposit the fertilized egg into the uterus. This is an effective way to bypass the scar tissue. But that is actually a last resort -- what they do first is to try to clear the scar tissue via laproscopic microsurgery. I think that Dr Reich ( http://www.adlap.com ) (he's one of the 4. The best of them, probably.) has had pretty good success rates with clearing scar tissue well enough so that women can get pregnant without needing IVF.
I don't know what your financial/insurance situation is, but I think it would be reasonable at this point to call Dr. Reich and at least get a phone consultation and figure out what your options are. You are absolutely right to worry that your fertility could be ticking away, and to figure out what your options are earlier rather than later...
At Wed, 9 Jan 2002, Kim wrote:
>
>Hi everyone. A few years ago, I had a diagnostic laparoscopy. I
>thought I had endometriosis, and my doctors agreed. (Don't get me
>started on them missing the diagnosis completely and just putting me on
>birth control pills.) After the surgery, I was told that I had
>adhesions, not endo, and was told that most likely the adhesions were
>from a fallopian tube infection a few years back. Now, I'm only 21 now
>and had no surgeries before this, so the adhesions aren't a result of a
>surgery. They figure they formed when I was about 16 (when the pain
>started). My surgery, at 18 or 19, only reduced my pain a little, since
>they could only remove about 1/3 of my adhesions because they're on a
>whole lot of parts on my left side (tube, bowels, etc.). After I have
>children, I'm told to have laser surgery to remove the other 2/3. My
>questions are: Are there any infertility statitics available on
>adhesions? And does my risk of infertility rise considerably as I age? I
>don't want to wait too long before I have children, anyway, because I'm
>dying to get the other 2/3 removed. Also, should I get a second opinion
>on whether the adhesions can be removed now? Thanks, and I look forward
>to reading and posting here. Kim
-- cathy :-)