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Reproductive Factors That Affect Your Fertility. Part 2

The Uterine Factor

The uterine factor refers to any abnormalities of the uterus or the uterine lining that may interfere with implantation of the embryo and/or maintenance of the pregnancy. The uterus must be capable of responding to hormonal stimulation from the ovaries and capable of preparing an endometrium that is thick and healthy.

A conventional test to assess uterine functionality is an x-ray test called a hysterosalpingogram. During this test, dye is injected through the cervix, in order to visualize the uterus and fallopian tubes. This test can be helpful in identifying uterine abnormalities such as fibroids, abnormally shaped organs, and a defect resulting from DES exposure in utero known as a “T-shaped uterus.” All of these problems may contribute to problems with implantation or maintenance of the pregnancy. Another test to assess uterine functionality is a hysteroscopy. In this procedure, a small telescope is inserted in the uterus to allow direct visualization of the cavity. Many abnormalities can be treated through the hysteroscope.

An ultrasound examination is also an important tool in evaluating the uterine factor, specifically the uterine lining and the structure of the reproductive organs. This is a painless test that can detect various abnormalities within the pelvic area, including fibroids, ovarian cysts, or problems with the fallopian tubes.

During the procedure, you will lay down on an examination table. The sonographer will spread a lubricant gel on your abdomen and will then take images of various organs which will appear on a screen. In some cases, a transvaginal ultrasound may be used to obtain closer images. This too, is painless. It requires the insertion of a probe into the vagina (much like inserting a tampon). The entire procedure usually takes less than 1 hour to perform, and provides valuable information to your healthcare team regarding the structure of your reproductive organs.

The Pelvic Factor

The pelvic factor primarily refers to problems affecting the fallopian tubes and other organs within the pelvic cavity. Patent (open) fallopian tubes and a normal relationship between the organs in the pelvic cavity are essential to allow sperm to reach the egg and travel to the uterus after fertilization. Factors interfering with this process can impede pregnancy.

The pelvic factor is assessed once the other factors are examined. This is typically done with a minor surgical procedure called laparoscopy. A laparoscope is a small telescope that is inserted into the abdomen to allow direct visualization of the pelvic organs. Previous pelvic infections and endometriosis can destroy the normal relationship between the uterus, ovaries, and fallopian tubes. The tubes can be blocked or surrounded by scar tissue known as adhesions.

In most cases, pelvic adhesions, endometriosis, and tubule blockage can be successfully treated through the laparoscope. Thus, a patient should not undergo laparoscopy for infertility unless the surgeon is trained and prepared to perform such corrective surgery at the time of the procedure.