Structural abnormalities in a woman are usually detected at the time of puberty when a girl fails to menstruate. These may be congenital (present from birth) or as a result of injury, and can range from a simple-to-treat imperforated hymen to the more serious, absence of vital female organs.
Functional abnormalities are common and may include pain during intercourse or failure to achieve full intercourse. The cause for this may include pelvic inflammation, vaginal infections and even a retroverted uterus. Psychological problems also play a major part, leading to a decrease in sexual desire.

Pattern Abnormalities

Irregular and unpredictable menstruation will indicate that hormonal production is inconsistent, thus suggesting that ovulation is failing to occur on a regular monthly basis.
Absent or irregular ovulation is responsible for between 10 to 15 percent of infertility, and the cause for this being, problems affecting the ovaries, sudden weight loss, a hormonal imbalance or simply stress and anxiety.
Excessively heavy menstrual bleeding accompanied by severe abdominal pain may indicate that there are fibroids present in the uterine wall, which in this case will prevent implantation and pregnancy eventhough ovulation and conception may have previously occurred. Severe pain in the lower abdominal region may also suggest endometriosis, which through scar formation blocks off the ovaries, tubes and parts of the pelvic cavity.
Persistent 'spotting' or dark red to brown discharge may also indicate certain problems such as a disease of the cervix. This would prevent the sperm from gaining access to an egg cell which is higher up in the uterine tubes.
So after taking all these into consideration one can see how important a women's menstrual history is in initially assessing the problem of apparent infertility.

Tubal Irregularities

Tubal abnormalities result in 15 to 20 percent of the cases of infertility, and although many of the above can on most occasions be effectively treated, this definitely remains one of the more difficult conditions to 'cure'. The fallopian tubes are necessary for sperm to pass through to the egg and once fertilisation has taken place, the fertilised cell then makes it's journey towards the uterus. Therefore, if there is a disease or blockage of the tubes, pregnancy is unlikely to occur.

The uterine tubes are narrow and relatively small in length thus being exceedingly liable to infection, resulting in scars that could seal it completely. This may sound horrendous, but in actual fact tubal infections are not all that uncommon. The use of intra-uterine devices, sexually transmitted diseases and other infections which ascend through the cervix and uterus can all result in tubal blockage. An ectopic pregnancy, where the egg implants in the tube rather than the uterus, can cause a tube to burst and requires surgery, but if the other tube is healthy, pregnancy can still occur, however in the case of any second such pregnancy, the removal of the second tube will effectively render the woman sterile.

Fibroids

Sometimes abnormalities of the womb can prevent the fertilised egg from implanting itself. The most common problems are fibroids (non-malignant tumours in the womb), adhesions (old scars in the womb lining, which are often the result of previous infections) or an abnormally shaped womb.

Fibroids can over time occur through the constant shedding of the previously prepared uterine lining. These fibroids can vary in size from tiny and multiple to single and large, and since they are not shed along with menstrual losses they can inevitably cause the uterus itself or the lining to bulge, thus preventing successful implantation of the fertilised egg cell, or resulting in a miscarriage if pregnancy is not prevented. In the case of the fibroids being exceptionally small, it may be possible for a pregnancy to proceed as per normal, with them often 'dissolving' with the hormonal softening influences and stretching of the uterus during pregnancy, thus rendering the woman 'cured'. Fibroids are more likely to occur in the older woman who has not yet had children, but there is still hope as large fibroids can be detected through vaginal examinations and uterine X-rays and successfully removed so restoring the woman's fertility.

Ovarian Cysts

A woman has two ovaries situated in the lower abdomen on either side of the womb. Their purpose is to produce eggs on a monthly basis from the commencement of periods during puberty through to cessation during menopause. Sometimes the follicle which releases the egg, fails to rupture, remaining intact and filling with fluid during each cycle. These fluid-filled blisters, called cysts are fairly common, with the vast majority being small and benign, however a recurrence of these cyst formations can lead to a disorder known as polycystic disease of the ovary (PCDO), where the normal ovary then becomes surrounded by a thickened area consisting of multiple cysts, through which no egg cell can 'escape'.
Ultrasound scanning can be used to diagnose this condition, where effective medical or surgical treatment will hopefully restore normal fertility.

Endometriosis

The endometrium is the medical name commonly used for the lining tissue of the uterus. This lining, just prior to the onset of the next menstrual period is approximately five millimeters thick, and at this stage is 'ready' for the implantation of the products of conception. In the case of endometriosis some of the cells that are present in the uterine lining, for some unknown reason seem to migrate up the uterine tubes, attaching itself to the pelvic organs or lining membrane of the pelvis where it will grow during the next cycle, just as it would in the lining of the uterus. Therefore pieces of endometrium exist in places where they shouldn't, and bleeding during menstruation they cause severe abdominal pains eventually resulting in scar tissue within the pelvis. This in turn may block the tube or release substances which are toxic to sperm.
In severe cases large blood-filled cysts form, causing heavy and painful bleeding during menstruation, pain during intercourse (particularly in the case of deep penetration) and extreme discomfort during vaginal examinations. The diagnosis for this condition will be confirmed through a laparoscopy, where depending on the severity and timing, effective treatment for endometriosis can be offered.

Anxiety and Stress

The desire to become pregnant can in many cases become an obsession, and as each month results in 'failure' so the woman concerned becomes depressed feeling somewhat cheated and less of a woman. Sexual intercourse then becomes more like an exam with great expectations, and the onset of a period bringing about bitter disappointment resulting in stress both within herself and her marriage. The 'play-off' of these emotions are intense, and as a result the chances of ovulation occurring are diminished further. Unlike other related problems, these can fortunately be healed through personal practice, by adopting a more positive outlook and enjoying relaxing sexual relations rather than the pressured passion you may have become accustomed to. This old-fashioned 'rest therapy' may be the hardest thing to accomplish given your situation of wanting to conceive so badly, but it may be helpful to note that in the past, many apparently infertile women went on to adopt a child, only to conceive a couple of months later.

Prolonged use of Contraceptive Methods

The Intra-uterine device (IUD) prevents pregnancy by producing physical irritation of the uterine wall, and in so doing it may give rise to infections of the tubes, uterus or cervix. Therefore prolonged use of the IUD is not recommended for those women who are hoping to conceive as even after it's removal it could take many months before the normal fertile functions are effectively restored.
The oral contraceptive's functions are to suppress ovulation through altering the hormone levels that are needed for successful implantation, and in this case even after 'stopping the pill' it could take a good few weeks/months before the normal hormonal levels are restored.

HOME