Infertility Causes, Endometriosis, Cervical, Unexplained
Endometriosis is a common cause of pelvic pain and pain during menstruation, intercourse, or bowel movements. Endometriosis is common and affects more than 12% of women of reproductive age and up to 40% of infertile women. The prevalence of endometriosis is higher in daughters or women who have the disease.
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 because of their extensive training in delicate microsurgical techniques. Endometriosis can adhere to many organs such as the tubes and surgical precision is needed to prevent adhesions or scarring.
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 male should also have a semen analysis.
The post-coital (after intercourse) test is sometimes 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.
Sometimes, even after exhaustive fertility 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 unexplained 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.