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Adhesions can also obliterate normal pelvic angles and induce abnormal uterine flexion, while nodularity and thickening of pelvic ligaments (uterosacral ligaments) with fibrotic reactions further disrupt pelvic anatomy ( Mechanically, these changes impair fertility through multiple pathways: extensive adhesions can occlude the tubal ostium and embed ovaries, blocking sperm passage and oocyte release