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Structural problems and reproductive disease

A woman's reproductive organs, such as ovaries, tubes or uterus, may have structural problems or disease, that can affect fertility.

Fibroids and fertility problems

Structural problems
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Fibroids are benign muscle tumours, anything from the size of a pea to a tennis ball, that form anywhere within the uterine wall. They don't necessarily affect fertility, but can make the uterus misshapen and may compress one or both of the Fallopian tubes.

Effects and structural problems on fertility

Fibroids very near to the surface of the uterine lining can interfere with the normal implantation of the embryo in the uterus. If they are near the junction of the uterus and the Fallopian tubes, they may stop the fertilized egg from reaching the uterus at all.

Fibroids are most common in women over the age of 35 and around 50 per cent of women develop fibroids by the time they are 45. There's often no cause for concern, but if fibroids do cause problems they can be removed in an operation called a myomectomy. This operation should not be undertaken lightly, however, as it carries a high risk of bleeding and may require a blood transfusion in as many as 50 per cent of cases.

Structural problems

Tubal damageA previous ectopic pregnancy, previous surgery, pelvic inflammation, endometriosis, or an infection, particularly chlamydia, may cause blocked or damaged tubes that will prevent natural conception.
Problems with fertilization In order to reach an egg and fertilize it, sperm must swim through the mucus in the cervix. If there is too little mucus, or if it’s very thick, sperm cannot get through the cervical canal. If the mucus contains antibodies that attack the sperm directly, the sperm will never reach the egg so fertilization won’t happen.
Damage to the ovaries The ovaries may fail to produce mature eggs. Scarring, caused by surgery, infection, or as a side effect of radiation treatment, can damage the ovary. Alternatively, the supply of eggs may become exhausted earlier than normal. This can be due to the menopause or its premature onset, surgical damage, or radiation therapy.
Uterine conditions The uterus may be congenitally abnormal in shape (although this does not necessarily cause infertility); contain scars, polyps, or fibroids; or be subject to adenomyosis (the inner lining of the uterus grows inside the middle layer, causing bleeding and cramps).

Polycystic ovary syndrome

Many women have benign ovarian cysts that don't affect fertility. But polycystic ovary syndrome (PCOS) interferes with ovulation and can therefore cause fertility problems.

PCOS is caused by FSH and LH not functioning properly, which is often linked to high levels of male hormones. The ovary becomes filled with “cysts” - actually immature follicles that fail to generate eggs. Sufferers have infrequent periods, a tendency to obesity, and excessive body hair.

Endometriosis reproductive disease

If you suffer from very painful periods (dysmenorrhoea), it's possible that you're suffering from endometriosis and this will need to be checked.

Endometriosis is a common condition in which cells from the endometrium (the lining of the uterus) spread to other sites in the ovaries, pelvis, and tubes. These respond to the cyclical changes of ovarian hormones and so they bleed internally when you're menstruating, causing severe abdominal and pelvic pain.

Endometriosis may affect fertilization, thus causing fertility problems. Ovarian cysts, known as endometriomas or “chocolate cysts”, may also form and affect the woman's fertility.

Posted 16.11.2010

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