Uterine
factor disease can cause infertility and is usually
a result of pelvic inflammatory disease, endometriosis,
fibroids, previous surgery, or it can be congenital.
In cases of severe uterine damage, surrogacy (another
female who can carry the pregnancy) is the only treatment.
Fortunately, uterine factor infertility is relatively
uncommon.
Treatment options are
available based upon each couple's diagnosis. Surgery
to remove fibroids or endometriosis is sometimes effective
and some structural defects can be corrected. Medications
such as Lupron are often effective in reducing the
amount of endometriosis.
Endometriosis
Endometriosis is a common
cause of pelvic pain and pain during menstruation
or intercourse. Endometriosis is common and affects
more than 12% of women of reproductive age and up
to 40% of infertile women.
The uterus is lined with
endometrial tissue that divides and thickens rapidly
during the menstrual cycle to prepare for the embryo.
Blood flow increases and more nutrients are carried
to the area. These endometrial cells retain their
capacity to divide even if they enter areas such as
the pelvic cavity. The cells will attach to organs
in these areas, continue to divide, and produce the
complications of endometriosis. Endometrial tissue
has been found on most internal organs. Normally,
the immune system will identify and destroy the errant
endometrial cells.
Endometrial tissue is
dependent upon estrogen for its growth. Drugs such
as Lupron lower the amount of circulating estrogen
and are often effective in treating the disease. If
Lupron is not effective, surgery is usually indicated.
A reproductive surgeon should treat severe cases of
endometriosis. Endometriosis can adhere to many organs
such as the tubes and surgical precision is needed
to prevent adhesions or scarring.
Cervical
Factor
Sperm must travel through
the environment of the vagina and cervix to reach
the eggs. Problems with sperm/cervical mucus interactions
can cause infertility. The cervical gland produces
mucus, which provides nutrients and support for the
sperm.
Antibodies in the female
(and rarely in the male) can destroy sperm. The immune
system "mistakes" the sperm for foreign
invaders (allergens) and destroys them.
The post-coital (after
intercourse) test is used to diagnose cervical factor
disease. The couple has intercourse at home, within
eight hours, the cervix is examined, and mucus is
collected. The number of sperm present, their shape,
ability to swim, the thickness of the mucus, and other
factors are assessed.
Intrauterine insemination
is often the treatment of first choice in couples
where the only cause of infertility is cervical factor.
The sperm is specially prepared, concentrated, and
passed into the uterus via a catheter thus avoiding
the cervix. A physician using washed sperm should
perform this procedure as unwashed sperm can cause
serious allergic reactions.
Unexplained
Infertility
Sometimes,
even after exhaustive testing of both partners no
specific cause of infertility can be identified. There
are certainly "causes" but medical science
may not have progressed to the point where they can
be identified. Hopefully, the incidence of unknown
infertility will decrease as more research is conducted.
IVF is often
the best treatment option for couples with this condition.
IVF allows the eggs, sperm, fertilization process,
and incubation to be visualized. Sometimes problems
with egg quality or sperm function are seen that were
not evident in the initial evaluation. If this is
the case specific treatments, such as donor
egg, can be recommended.
