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Causes For Infertility In The Uterus

Written and reviewed by
MBBS, MD - Obstetrics & Gynaecology, FICS, FICOG
Gynaecologist, Mumbai  •  42 years experience
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Hello everybody.

 I am Dr. Shubhada Sanjiv Khandeparkar and I'm here to discuss one more important organ of the female genital tract which contributes to causes for infertility in the uterus.

Now uterus in the female is the main important organ of the female genital tract and it has two parts, the upper part of the uterus is called the body of the uterus and the lower part is called the cervix. Now both contribute to infertility, the upper part of the uterus has from outside to inside three parts. The outermost layer is called the serosa, the middle layer is the myometrium and the inner layer is the endometrium.

Now every month we shed off the endometrium during the menstrual cycle. The endometrium is an extremely important structure of the uterus which helps in implantation of the embryo, so the endometrial pathology contributes to about 20 to 30 percent of infertility.
Now what is the commonest causes for infertility due to endometrial reasons is the infection again. The commonest infection is again tuberculosis, tuberculosis affects the endometrial lining which prevents the implantation and therefore the lady becomes infertile.

Other infections again are the sexually transmitted diseases gonorrhea, chlamydia. other pelvic or inflammatory diseases, infections also can cause infertility like staph and also leukorrhea, the excess white discharge also carries infections and causes infertility. Now because of endometrial infections, even multiple abortions can cause infertility I will come to that later. Now because of endometrial infection the endometrium sometimes after the healing takes place sometimes goes and forms adhesions inside and therefore the embryo cannot implant so that is another important reason.

Now anatomically also sometimes a uterine development is at fault and the uterus can have a septum inside or multiple septae or a small cavity, hypoplastic uterus which again prevents the embryo from implantation. The other common causes of endometrial pathology are fibroids which are occurring from the myometrium of the uterus and protruding into the endometrial cavity. Now these fibroids again project inside the endometrial cavity and the cavity becomes obliterated and the embryo cannot implant or it implants over that fibroid however it cannot.

Now what is a fibroid, a fibroid is Myometrial overgrowth of the muscle which overgrows inside the uterine wall and grows in whirls and forms rounded structures, now fibroids per se cannot cause infertility but if they are at certain situations then only they affect the implantation of the embryo and cause infertility, so fibroids near the internal tubule opening they can cause infertility cornual fibroids. Fibroids near the cervix which is at the mouth of the uterus they can cause infertility so these fibroids also are important and about 40% of the causes for infertility in females, the uterine cause is fibroids.

The other important cause for the uterine infertility is the mouth of the uterus. Now if the mouth of the uterus is unhealthy it is enlarged, hypertrophic then also we see infertility. If the opening is stenosed, it's extremely narrow then also the sperm cannot go up and we see infertility. If the mouth has a huge erosion which is also another physiological problem but still because of an erosion we see sometimes this excessive white discharge. mucus is affected and we see that as infertility. So these are a few of the causes because of the uterine reason, why the patient cannot conceive.

How do we diagnose this? the best way to diagnose the uterine causes, the endometrial causes is a procedure called hysteroscopy. Hysteroscopy can be done as a daycare procedure, it can be done by very small scope which is only 3 mm and it can be done in-office procedure, so one does not even many times require anesthesia but one can do it. It's better done under anesthesia, but one can do it without.

Now through the hysteroscope again we connect it to the camera and project it on the monitor and we see internally all the different areas of the uterus. We can pick up adhesions.

one more thing which I forgot to tell about the endometrial pathologies are polyps, so polyps are thick endometrium only which forms into globular structures and it can affect sometimes implantation of the embryo, so we can treat polyps through the hysteroscope, we can resect, can take them off, we can release the adhesions, cut the adhesions inside, we can expand the cavity, we can do so many things through the hysteroscope itself, once we have diagnosed the problem, so hysteroscopy is a gold standard again to diagnose the endometrial causes of the infertile lady, so this is the uterine part of the causes for infertility.

So I think I have covered most of infertility causes and the next sessions will be the treatment for infertility. So thank you very much and yes thanks to Lybrate and any doubts or questions or if you wish to speak to me or contact me you can please do so through Lybrate.

Thank you very much.

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