Causes of Infertility (Structural)

Hydrosalpinx

A hydrosalpinx is a fallopian tube that is filled with fluid. Injury to the end of the fallopian tube (the ampulla) and its delicate fingers (the fimbria) — often from infection or trauma, causes the end of the tube to close. Glands within the tube produce a watery fluid that collects within the tube, producing a sausage shaped swelling. The fluid can be toxic to early embryo development or may mechanically flush out the embryo from the uterus. New studies also suggest the fluid may activate harmful genes.

Presence of hydrosalpinx creates or worsens a number of fertility barriers. It prevents ovulated eggs from meeting with sperm. When conception does occur within the good tube, hydrosalpinx can affect embryos in the uterus. The commonly performed diagnostic hysterosalpingogram (HSG) can inadvertently introduce bacteria into the tubes, possibly resulting in serious infection if hydrosalpinx exists. Hydrosalpinges can interfere with fertility treatment and decreases chances for successful in vitro fertilization. Use of fertility drugs can unwittingly increase the fluid build-up within undetected hydrosalpinx.

The most common causes of hydrosalpinx are the undiagnosed or untreated sexually transmitted diseases chlamydia and gonorrhea. Other possible causes are use of IUDs, endometriosis and abdominal surgery.

Other Blockages

Natural conception cannot occur when the fallopian tubes are blocked.

Hydrosalpinx is one specific form of fallopian tube blockage. Previously undetected or untreated infection of the tubes (salpingitis), including sexually transmitted infections, can cause adhesions and scarring within the tubes. Endometriosis lesions can also block tubes, as can pelvic inflammatory disease (PID)-a general term for infection and inflammation of the upper reproductive organs, including the uterine lining (endometriosis), the fallopian tubes (salpingitis), and the ovaries (oophoritis).

When one or both fallopian tubes are blocked, the egg cell and sperm cells cannot meet and natural conception cannot occur. In addition to barring conception, blocked fallopian tubes can also cause ectopic pregnancy, a dangerous condition in which a fertilized egg is unable to move to the uterus for implantation and starts to grow within the tiny fallopian tube, ovary or abdominal cavity.


Ovarian Cysts

Women of any age can have cysts-a fluid- filled sac- on one or both ovaries. Most ovarian cysts are benign, meaning they are not cancerous. The normal ovary can have small cysts remaining from ruptured egg follicles. On ultrasound, these simple cysts appear as bubble-like structures filled with fluid. They usually disappear on their own and produce no symptoms.

Some ovarian cysts are associated with problems such as abdominal or pelvic pain, spotting in between menstrual periods, and/or infertility. Various types of cysts include:

  • Hemorrhagic cyst — occurs when bleeding is also present.
  • Dermoid cyst — comprised of the same tissue as skin, fat, bone, hair, or cartilage; may become inflamed or cause ovarian torsion (twisting).
  • Endometrioid cyst — caused by endometriosis, a common cause of female infertility.
  • Polycystic ovary — usually twice its normal size with many small cysts on the outside; seen in women with and those without polycystic ovary syndrome.

Fibroid Tumors

Many women have benign (non-cancerous) tumors in their uterus called myomata uteri or fibroids. These may be undetected and cause no problems. In some women, however, fibroids can cause excessive and frequent menstrual periods, pelvic pain, infertility, and recurrent pregnancy loss. For a few, severe anemia can result from excessive uterine bleeding. Other symptoms can include pelvic pressure on the woman’s bladder or rectum, which may result in frequent urination or constipation. Some women will experience pain during sexual intercourse due to an enlarged uterus.

Benign fibroids can be removed through surgical procedures known as laparoscopic or hysteroscopic myomectomy.

Learn more about fibroids from the American Society of Reproductive Medicine’s video below:

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