I have seen many women whose tubes were frozen in place by this nonstretchable tissue preventing the tubal movement necessary to coax the egg toward the uterus. During the pelvic examination I manipulate your reproductive organs to detect if they move freely or if they feel like rigid, plaster models. I can often restore fertility to women with adhesions by surgically removing this scar tissue. I'll discuss these procedures in chapters 16 and 17 . Wincing, tenderness, and pain during the pelvic examination may indicate an active infection.
Endometriosis can cause adhesions and impair ovulation.
When I examined Shelley T., I could feel the telltale beading or bumps on the surface of her reproductive organs and supporting uterine ligaments, but I followed up with a laparoscopy to confirm my diagnosis. Endometriosis may respond to medication or, failing that, surgery. I'll discuss more about endometriosis in chapter 17 . Depending on their size and location, fibroids and ovarian cysts can also interfere with egg transport. These conditions will usually respond to surgery.