Sometimes one of the fallopian tubes becomes completely blocked and it can swell and fill up with watery fluid.
This is known as a hydrosalpinx, and is usually caused by previous infection or surgery. The fluid tends to collect at the end of the tube that is closest to the ovary. Women who have a hydrosalpinx may experience very severe pelvic pain, but it is possible to have no symptoms at all.
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| Causes Of Infertility In Women |
Sometimes only one tube is affected, but it can occur in both at the same time (bilateral hydrosalpinges). If both tubes are completely blocked, the only way to get pregnant is with IVF. There is evidence that a hydrosalpinx can reduce embryo implantation rates and increase the risk of miscarriage. For this reason, women who have hydrosalpinges often have their fallopian tubes removed before starting IVF.
'The consultant said our only chance of having a baby was through IVF, but that our chances of IVF working were halved because I had bilateral hydrosalpinges. We were distraught. He said l would have to have my tubes removed, I knew they didn't work, so I thought I might as well do it right away, but there is a stigma to being sterilized at 31.' Mikaela, 32
Physical problems with the womb or ovaries
There can be physical problems with the ovaries or the womb that make it difficult for a woman to conceive. Sometimes the outer surface of the ovaries may be scarred, usually after some kind of surgery, and this makes it difficult for follicles to develop normally. The womb is sometimes oddly shaped, and depending on how serious this is, it can lead to infertility and miscarriage.
Asherman's syndrome
The name Asherman's syndrome is given to a rare condition where scar tissue is found inside the womb. It sometimes causes the front and back walls of the womb to stick together, although in milder cases the scarring is found in just a small portion of the womb. It can be the result of a D and C (dilatation and curettage) or an ERPC (evacuation of the retained products of conception), which involve clearing the womb after a miscarriage, to remove a retained placenta or to terminate a pregnancy. Scarring can also be caused by a caesarean section or other surgery, or by infection.
The symptoms of Asherman's are usually changes to the menstrual cycle, which may become shorter or lighter than before, and sometimes stops altogether. Some women feel period pain but don't bleed. This can be a sign that although menstruation is taking place, the blood can't get out of the womb because the cervix is blocked by scar tissue.
'I had a retained placenta when I had my daughter, and I was told I had to have emergency surgery, but after the ERPC, I had more and more problems. The pain I was having was quite incredible and I didn't have a bleed. They finally referred me to a consultant and we had tests that showed my cervix was completely closed up, and I had 90-95 per cent obliteration of the uterine cavity.' Abbi, 31
Problems with cervical mucus
Usually cervical mucus reaches a special consistency around the time of ovulation, which makes it easier for sperm to swim through it into the womb. If this doesn't happen and the mucus is thick or very scanty, it may be impossible for the sperm to swim through it and get into the womb. This is now considered to be a very rare cause of infertility.
Immune problems
There is growing interest in reproductive immunology, which is concerned with looking at whether a woman's system may reject sperm or embryos, and prevent the implantation of a fertilized egg. Usually, your body rejects any kind of unrecognized material that starts growing inside it, but when you get pregnant, special blocking antibodies stop your immune system attacking the foetus.
Some doctors believe that sometimes this blocking system fails, that the body may reject sperm or embryos, or start producing too many natural killer cells that attack growing cells in the body. Reproductive immunology is still a controversial area, and although some clinics now offer tests, others believe they are of limited use and question the validity of both the tests and the treatments offered, as most are not scientifically proven and are often expensive. To find out more, you can check out Causes Of Infertility In Women.
