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Infertility Causes > Woman > Uterus and Cervix Overview - Evaluation - Treatment Options - DiagnosisCauses of Cervical Mucus Problems There are several reasons why the cervical mucus may be poor and account for a bad post-coital test: Poor Timing of the Test. This is far and away the most common reason that a post-coital test is unsatisfactory. This test must be performed just before ovulation occurs, when the cervical mucus is optimal. Infection. The cells lining the cervix may become irritated or even infected. This will often be indicated by the presence of white blood cells in the mucus. Prior Procedures on the Cervix. The cervical mucus is produced by the columnar cells that normally line the inside of the cervix. When these cells are damaged or destroyed, the normal repair process replaces them with a type of cell known as squamous cells. These squamous cells are incapable of making cervical mucus. Therefore, destruction of enough of the columnar cells can lead to a dramatic decrease in cervical mucus production. Procedures that can result in this type of change include freezing of the cervix, laser to the cervix, lleetz or leep procedures and cervical conizations, all of which are performed to treat abnormal Pap smears. Medications. The most notable of these is clomiphene. Clomiphene can dramatically impair cervical mucus quantity and quality. Anyone on clomiphene, or anyone who has had her dose of clomiphene increased, should have a post-coital test checked. (Clomiphene is an antiestrogen. It literally blocks the effect of estrogen on cells. Estrogen induces the columnar cells in the cervix to produce mucus; clomiphene can block this effect.) ANATOMIC PROBLEMS OF THE UTERUS All of the anatomic problems of the uterus can be detected by either a physical exam, a hysterosalpingogram (an X-ray procedure, which is discussed in Chapter 7), or by hysteroscopy (a surgical procedure in which a small instrument is inserted into the uterus and the uterine cavity visualized). If the hysterosalpingogram suggests that the uterine cavity is abnormal or the history and physical exam suggest such a problem may exist, hysteroscopy should be performed. Although diagnostic hysteroscopy can be performed in the office, any procedure done to correct an abnormality is probably best done in the operating room. Under anesthesia, a small instrument that is connected to a light source is inserted through the cervix and into the uterus. The uterine cavity is distended using one of a number of different agents that affords the surgeon a better view of the inside of the uterus. Small surgical instruments can be introduced through the hysteroscope including scissors, lasers and a variety of other instruments that allow the surgeon to correct many abnormalities. Polyps, fibroids, scarring of the uterine cavity and some uterine anomalies can all be corrected this way. Anomalies When the uterus is formed, it begins as two tubelike structures that begin on the side of the pelvis and come together in the middle. When they come together, the tissue in the middle is resorbed and the cavity is formed. In a small percentage of women, this process does not occur properly, and various anomalies can result. Some of these are depicted below. While few, if any, of these are associated with infertility, they may have other consequences such as recurrent pregnancy loss. Fibroids Technically known as leiomyomas, these are benign (99+% of the time) muscle tumors that grow in the uterus. No one knows what causes fibroids, but there certainly is good evidence that there is a genetic predisposition. If your mother or sister has them, you are more likely to. Fibroids may be very small or extremely large, ranging in size from pea size to as big as a grapefruit or larger. Most fibroids do not cause difficulty conceiving. However, there are exceptions. A large fibroid that distorts pelvic anatomy so that the fallopian tubes cannot function properly can certainly be significant. Also, any fibroid that distorts the uterine cavity can be a problem. If a fibroid distorts the uterine cavity enough that it can be seen on X-ray or by hysteroscopy, it has probably compromised the blood supply to the endometrium that overlies it. If this blood supply is compromised, this tissue cannot function properly and undergo all of the changes that it should, and it may not be able to allow implantation. Fibroids can also be pedunculated, or hanging into the uterine cavity from a stalk. The uterus does not like having anything in it with the exception of a fetus. Fibroids in the uterine cavity can result in much the same effect that occurs with an IUDCthey irritate the uterus enough that it will not allow implantation to occur. Fibroids that distort the uterine cavity may be associated with bleeding at times other than the normal period. Consideration should be given to removing any fibroid within the uterine cavity or that distorts the uterine cavity. Polyps Polyps are overgrowths of the endometrium that almost resemble stalactites in a cave. They can result in effects much like an IUD, and may also be associated with abnormal bleeding. Scarring Sometimes after a D&C, particularly if it is done around the time of a pregnancy, scarring may occur. One wall of the uterus actually sticks to the other wall. This is known as intrauterine synechiae, or Asherman's syndrome. This scarring may be minimal, with one small band of scar tissue, or severe, at times almost obliterating the entire uterine cavity. © 2005 Jarrett Fertility Group |
