Inflammation of the appendix (appendicitis) usually leaves the tubes and ovaries alone.

But sometimes the inflammation is severe, an abscess forms in the pelvis, and one or both tubes and ovaries can get caught up in it.

To stop this from happening is good reason for surgeons erring on the side of caution and removing a suspect appendix early.

If the appendicitis does involve the tube and ovary, it's usually just the right tube that gets involved in the inflammation and the adhesions that follow, but if a hydrosalpinx forms, even if only on one side, then sterility can result.

More general peritubal adhesions arising from neglected or advanced appendicitis are rare in the U.S., Australia and most Western countries, where good surgeons and hospitals are easily and quickly available. It's true that many appendixes are removed that turn out to be normal; but, for fertility, this is better than a general policy of operating only when the diagnosis is certain.

What can be less fortunate, though, is mistaking a painful ovulation for appendicitis ... operating ... finding the appendix to be normal ... then removing some incidental "cyst" on the ovary (in reality almost always a normal corpus luteum), and causing peritubal adhesions -- not from the appendicitis or the appendicectomy -- but from the incautious surgical assault on an ovary ... an ovary that almost always, in these circumstances, deserves to be left alone.