The Impact of Postoperative Intra-Abdominal Adhesions on Female Infertility

Objective: To evaluate the impact of postoperative intra-abdominal adhesions resulting from prior abdominal and gynecologic surgeries on female infertility. Methods: A retrospective case-control study was conducted among 764 fertile and 506 infertile women in Ulaanbaatar, Mongolia. Data were collected on prior abdominal and gynecological surgeries, including surgical approach (open vs. laparoscopic) and frequency. Baseline characteristics were compared with Chi-square test and Fisher’s exact test. Logistic regression was used to calculate adjusted odds ratios (ORs), 95% confidence intervals (CIs), and P-values. Results:Infertile women were older (32.1 ± 4.5 vs 30.8 ± 3.9 years, P= 0.02), had higher BMI (25.1 ± 3.3 vs 23.5 ± 2.8 kg m², P= 0.03) and were more likely to report a previous sexually transmitted disease (19.5 % vs 8 %, P < 0.001). Prior surgeries such as salpingectomy (OR =16.5), ovarian cystectomy (OR = 7.3), and ectopic pregnancy surgery (OR = 4.67) were significantly associated with infertility. Open surgical approach was associated with a higher risk (OR = 2.8, P= 0.015), while laparoscopy was protective (OR = 0.45, P = 0.021). The risk increased further with multiple open surgeries (OR = 2.96, P = 0.029). In multivariable analysis, the strongest predictors of infertility were salpingectomy (OR = 13.2,95 % CI 2.2–78.5, P= 0.005), ≥ 2 open abdominal surgeries (OR = 2.96, 1.11–7.91, P= 0.029). The model showed acceptable fit (Hosmer–Lemeshow P= 0.48; AUC = 0.78; Nagelkerke R² = 0.23). Conclusion: Postoperative intra-abdominal adhesions, particularly following open gynecologic and abdominal surgeries, significantly contribute to female infertility. Minimally invasive surgical techniques and adhesion prevention strategies may reduce this risk.