physical differences

As women, we are encouraged to celebrate our differences. But some of us have physical differences that it may actually prevent us from getting pregnant. Such physical, or structural, differences in our reproductive organs, sometimes referred to as organic pelvic disease, are often not even apparent to us. They are caused by a variety of factors, including endometriosis, infection, birth (congenital) defects, inflammation, trauma, tumors and disease.

Physical differences that may affect your potential to get pregnant include:

• endometriosis
• immune system
• occluded fallopian tubes
• ovarian scarring
• uterine abnormalities

endometriosis

Endometriosis occurs when endometrial tissue – which normally lines the inside of the uterus – builds up outside the uterus. There are many theories about why this may happen in some women. The most widely accepted theory is that during menstruation, blood that normally flows out of the vagina instead moves backwards into the fallopian tubes and enters the pelvic and abdominal cavities. There, fragments of endometrial tissue contained in the menstrual flow end up in unusual places and begin to grow.

Endometriosis can cause painful, heavy periods as well as painful sex, although some women don’t realize they have it until they try to get pregnant – and can’t. This physical condition may make it difficult for women to get pregnant in different ways:

• Tissue overgrowth on the fallopian tubes, the outside of the uterus or the ovaries cause obstructions or distorsions that impair a woman's ability to conceive.
• The build-up of endometrial tissue may release toxic substances that reduce the egg's potential to ber fertilized. If there's a small amount of excess of endometrial tissue, the capacity for fertilization might merely be diminished, bot not entirely eliminated.
• An unproven theory suggests that a woman may have an inappropiate immune response to the endometrial tissue fragments in her body. Macrophages – the cells released by your immune system to destroy excess endometrium – drift through the pelvis and fallopian tubes where, in theory, they may destroy eggs, sperm or embryos.

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immune system

Normally, sperm and embryos are the only two foreign entities the female immune system will not attack. The immune system produces an allo-immune response to the embryo, effectively quarantining it in the uterus and protecting it from attack. However, an unproven theory suggests that some women’s immune systems behave quite differently, attacking the sperm or embryo as if it were an invading cell.

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occluded fallopian tubes

Fallopian tubes play an important role in your reproductive process, acting as the egg’s pathway from the ovaries to the uterus. Scarring or blockage within the fallopian tubes can make it harder for the egg to reach the uterus or for the sperm to reach the egg. Blockages in the fallopian tubes are usually the result of a sexually transmitted disease (STD), scarring from pelvic surgery or pelvic inflammatory disease (PID) or from endometriosis. Women with occluded fallopian tubes may still get pregnant with no medical help if only one tube is blocked.

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ovarian scarring

Your ovaries can suffer scarring from an infection, PID, endometriosis or surgery. The medical term for scarring is "adhesion”, and it accounts for about 15% to 25% of female cases of infertility. Scarring may cause the ovaries to be oddly placed, making it hard for the finger-like projections at the end of the fallopian tubes (fimbriae) to gather released eggs and move them into the fallopian tubes. This effectively traps the eggs inside the ovary. Polycystic ovaries can have a thickened outer coating or capsule that may prevent the egg from ovulating as well.

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uterine abnormalities

Abnormalities in the shape or position of the uterus are unlikely to prevent fertilization, but may interfere with the ability of the embryo to implant or a woman to carry a pregnancy to term. It’s possible to be wrongly diagnosed as infertile when what’s really wrong is a uterine abnormality. This can be found in – but is not limited to – women whose mothers took the anti-miscarriage drug diethylstilbestrol (DES).

Abnormalities include:

• Malposition: The uterus may be sinking into the vaginal canal (prolapsed).
• Growths: Fibroid tumors (benign growths that form on the uterus wall) and polyps (growth of endometrial tissue) can prevent the healthy development of the embryo.
• Bicornuate uterus: The uterus is divided into two chambers, divided by a septum (wall of tissue).
• Unicornuate uterus: The uterus is one-sided.
• Asherman syndrome: Scarring (adhesions) on the inside of the uterus that can occur after uterine surgery or, more rarely, infection.

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