Biomaterials in Obstetrics and Gynecology - Biomaterials Science: An Integrated Clinical and Engineering Approach - page 154

tubal occlusion is assessed 3 months after device placement. Adiana ® matrix
is not visible by X-ray, but can be seen by ultrasound [7, 8].
Trying to Conceive
Biomaterials used for Prevention and Treatment of Infertility
Infertility is generally defined as one year of unprotected intercourse without
conception. This is a common condition that affects 10-15% of couples and has
important psychological and medical, as well as economic and demographic,
implications. During the last three decades there was no change in the
prevalence of infertility, but the demand for infertility treatment has grown
substantially. During this period, new emerging technologies, mainly ART
(assisted reproductive technologies), inflicted a dramatic change in the field of
infertility treatments and improved the prognosis for many infertile couples.
Pelvic Adhesions
About 60% of infertility cases are attributed to the female factor. One of the
most common identifiable female causes of infertility is the presence of pelvic
adhesions causing tubal blockage. This factor constitute up to 23% of female
causes. Pelvic adhesions occur in 60-90% of women following major gyne-
cologic surgery. They cause infertility by preventing the normal transport of
the oocyte, sperm, or fertilized egg through the fallopian tube. Apart from
preventing conception, adhesions can cause considerable acute or chronic
pelvic and abdominal pain and small bowel obstruction. They may also
complicate future surgeries by causing difficulties in access and dissection,
prolongation of operative time, increase in blood loss, and predisposition to
injury to the bowel or urinary system [9-11].
Adhesions usually result from the normal peritoneal inflammatory wound
healing response and develop in the first five to seven days after surgery
[12]. They are composed of fibrous tissue but also contain blood vessels, fat,
and nerves. Several factors involved in mechanisms of adhesion formation
include peritoneal injury, the attendant inflammation, imbalance in the plas-
min system, and the proximity of injured surfaces [9].
Hence, preventive strategies have been designed in order to target these
steps individually or in combination. Limiting the injured area, a vital aspect
of prophylaxis, is largely a surgical endeavor achieved by meticulous atten-
tion to operative technique and tissue handling as well as by using mini-
mally invasive techniques when possible.
However, since injury can only be minimized but not completely avoided,
adjuncts to injury limitation techniques are necessary to reduce the risk of
adhesions [9].