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The uterus is a muscular structure that accepts an embryo and supports the development of a fetus to term and delivery. Once the eggs are fertilized (in the fallopian tubes), the resultant embryo migrates to the uterine lining where it implants.
 The lining of the uterus, known as the endometrium, grows and matures under the influence of estrogen and progesterone. The lining must become more vascular and thicken to support a developing embryo and later a fetus. Sometimes the endometrium does not develop properly and additional progesterone is administered. Progesterone is always given in IVF cycles because certain medications, as well as the process of egg retrieval, can interfere with its natural production.
The uterine cavity should be free of large obstructions caused
by polyps or fibroids and it must be normally shaped. Sometimes
a woman has a congenital uterine anomaly (abnormal uterine shape),
which can be corrected surgically. The hysteroscopy allows the fertility specialist to directly view the inside of the uterus and is performed at our Dallas, Tx Fertility clinic location.
Other causes of a poorly receptive
uterus include severe pelvic infections as well as cancer chemotherapy
or radiation.
When the uterus is severely damaged or absent, the only option for reproduction may be the use of a gestational carrier, sometimes referred to as a surrogate. In gestational carrier arrangements, the couple’s embryos, produced from an IVF cycle, are transferred into the uterus of the surrogate carrier.
Cervical factor infertility can be caused by poor
quality cervical mucus that is not present in adequate quantities
or “too sticky” to allow sperm to pass. Sometimes this is secondary
to an abnormality in the hormonal levels due to an ovulatory dysfunction.
Another condition causing cervical factor infertility is the presence
of antisperm antibodies in the mucus.
Intrauterine insemination (IUI) is an effective first line treatment for cervical factor infertility. In IUI, the specially washed and concentrated sperm are placed directly into the uterus thus bypassing the cervical mucus. If stimulated IUI is not successful, IVF is another treatment option.
Unexplained infertility is diagnosed when no clear cause for a couple's infertility can be found. This does not mean that there is no cause; rather medical technology has not advanced to the point to identify it. This is often the most frustrating diagnosis a couple can receive.
When a basic fertility evaluation fails to identify a cause, sometimes a laparoscopy is recommended to evaluate for internal causes such as endometriosis or scar tissue (adhesions) around the ovaries or fallopian tubes. While it is a frustrating situation when there is not a clear factor to “blame”, empiric treatments (including ovulation induction- IUI and IVF) can still offer benefit by improving the monthly fecundity (pregnancy) rate.
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