In severe endometriosis the ovaries and fallopian tubes are often tightly bound to the nearby organs and enveloped in a dense network of adhesions. Occasionally, adhesions may even be found on the inside of the fallopian tubes.
Adhesions can hinder the process of conception in several ways. Adhesions around the ovary, especially if there are also large endometriomas present, can make it difficult for the ovum to be expelled from the ovary. If the fallopian tube is bound down by adhesions, the ends of the fallopian tube cannot move around to pick up the ovum when it is released from the ovary thus preventing the ovum entering the tube to be fertilised by the sperm. Adhesions within the fallopian tube may obstruct the tube and therefore block the passage of the ovum through it. Similarly, if there are adhesions on the outside of the fallopian tube they may bend the tube into a tight U-shape which may also block the passage of the ovum.
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