Sometimes, it is the uterus that gets in the way. Malformations, unsuitable cervical mucus, all these disorders can cause more or less severe infertility.
Infertility: when the uterus acts up
There are several types of problems with the uterus that can lead to infertility. Some women may have a malformation of the uterus: an abnormality of its shape or size, uterine formations such as a septum, a fibroid, or a polyp. Synechia, for example, is a scarring of the uterine cavity resulting from the two walls of the uterus coming together. All of these abnormalities can interfere with the proper implantation of the embryo. They are sometimes congenital or linked to the use of certain drugs, such as distilbene.
- What tests should be performed if there is any doubt?
As with the fallopian tubes, the doctor can carry out a hysterography to visualize the uterine cavity’s state and identify any abnormalities. A flexible optical fiber is introduced into the cervix; a product is injected to visualize the uterine cavity shape. This examination takes a few minutes and does not require hospitalization. Hysteroscopy is also increasingly used. In this case, the specialist explores the uterine cavity directly with an optical fiber inserted into the cervix. It is recommended that these procedures be performed at the beginning of the cycle to make sure that pregnancy has not started.
Infertility: insufficient cervical mucus
During sexual intercourse, sperm is deposited in the vagina. To allow them to pass into the uterine cavity, the glands of the cervix produce a substance called cervical mucus during the pre-ovulatory phase. However, sometimes this mucus is not produced in sufficient quantity or is non-existent. The sperm cannot reach the uterus and then the fallopian tubes. Pregnancy is impossible. This problem can easily be solved with a simple hormonal treatment to increase the secretion of mucus. When the vaginal environment is too acidic, the mucus can be improved by vaginal injections of sodium bicarbonate. In general, any treatment to stimulate ovulation has a positive impact on the quality of mucus.
- Which test should be used in case of doubt?
The post-coital Hühner test is prescribed in every infertility assessment. This test determines whether the cervical mucus is permeable for sperm. In other words, whether it can easily transport them to the uterine cavity. This is a vaginal swab taken in a laboratory within hours of sexual intercourse. The doctor examines how the sperm behave in the mucus. The test is positive if the sperm are numerous and mobile. However, if the cervical mucus is of good quality (translucent, transparent) and if the sperm is considered normal (after a spermogram), while there is low mobility or an absence of sperm, there may be a “mucus-sperm incompatibility. However, there is nothing definitive about this phenomenon; it can vary from cycle to cycle. In cases where the mucus-sperm incompatibility persists, inseminations with the spouse’s sperm can be considered.
Conclusion
In the uterus, several types of problems can lead to infertility. Some women may have a malformation of the uterus: an abnormality in its shape or size, uterine formations such as a septum, fibroid, or polyp.