Uterine Causes of Infertility

Cervical and Uterine Causes of Infertility

The uterus is a muscular organ that accepts an embryo and supports/protects the development of a fetus to term. Following fertilization of the egg in the fallopian tube, the resulting embryo migrates to the uterine cavity, where it implants.

The lining of the uterus, known as the endometrium, grows and matures under the influence of estrogen and progesterone. The lining must thicken and become more vascular to support a developing embryo. Sometimes the endometrium does not develop properly, in which case additional progesterone is administered. Progesterone is always given in IVF cycles because certain medications, as well as the process of egg retrieval, can interfere with progesterone’s natural production.

In order for the embryo to properly implant, the uterine cavity should be free of large obstructions caused by polyps or fibroids, and must be normally shaped. Sometimes a woman has a congenital uterine anomaly (abnormal uterine shape), which can be corrected surgically. A hysteroscopy allows the fertility specialist to directly view the inside of the uterus. This procedure is performed at our Dallas Fertility Center.

Other causes of a poorly receptive uterus include severe pelvic infections and past exposure to chemotherapy or radiation treatments.  Sometimes when the uterus is severely damaged or absent, the only option for reproduction may be the use of a gestational carrier, sometimes referred to as a surrogate. In gestational carrier arrangements, the couple’s embryo(s), produced during an IVF cycle, are transferred into the uterus of a surrogate carrier.

Cervical Factor Infertility

Cervical Factor Cervical factor infertility can be caused by poor quality cervical mucus that is not present in adequate quantities or is too “sticky” to allow sperm to pass. Sometimes this is secondary to an abnormality in the hormonal levels due to ovulatory dysfunction. Another condition causing cervical factor infertility is the presence of antisperm antibodies in the mucus.
Intrauterine insemination (IUI) is an effective first line treatment for cervical factor infertility.  In IUI, the specially washed and concentrated sperm are placed directly into the uterus, thus bypassing the cervical mucus. IVF is another treatment option if IUI is unsuccessful.