Infertility related to tubal blockage and pelvic adhesions is on the rise. An increase in sexually transmissible infections, widespread use of intrauterine contraceptive devices and the increase in elective abortions are all thought to play a role. The infections include gonorrhea and Chlamydia. Women with intrauterine contraceptive devices may have chronic low-grade infections and some may develop an acute severe infection or a pelvic abscess. Though severe pelvic infection was more common before abortions were legal, a mild infection is not unheard of after an elective abortion today. A ruptured appendix may also cause pelvic infection and scarring of the fallopian tubes. Pelvic adhesions may occur after surgery to remove ovarian cysts, fibroids and tubal pregnancies or after any other lower abdominal or pelvic surgery.

Irregularities in the shape of the uterus can occasionally cause infertility, although they are more frequently associated with spontaneous abortions than with the inability to conceive. The most common cause of irregularity in the shape of the uterus is fibroids (benign fibrous growths of the uterus). Other causes are congenital or developmental abnormalities. Recently some abnormalities in the shape of the uterus have been found in daughters of women who took the drug diethylstilbestrol (DES) during pregnancy.

Both hypothyroidism (underproduction of the hormone thyroxin that is stored in the glandular follicles and released into the bloodstream as needed for the regulation of the metabolic rate) and hyperthyroidism (overproduction of the hormone thyroxin) and other hormonal abnormalities may cause infertility by unbalancing the delicate and complex regulation of the menstrual cycle. Severe illness of any sort (diabetes, liver disease) can also affect the normal cycle and cause infertility.

A vaginal infection may alter the cervical mucus and the pH of the vagina, creating a hostile environment in which the sperm may be able to live for only a very short time. The presence of sperm antibodies in cervical mucus or vaginal secretions may cause infertility. There is controversy among physicians about how often this may be a factor because these antibodies may be found in people with normal fertility. In some couples, however, these antibodies appear to kill or inactivate the sperm.

There is a significant number of infertile couples who complete all of the standard testing without any obvious cause of infertility. Many of these couples eventually conceive. Unfortunately, some remain infertile. However, with advances infertility testing, fewer and fewer cases of infertility remain unexplained.

Timing of intercourse is important. A woman with a twenty-eight-day cycle should have intercourse daily from the tenth to the fourteenth day of her menstrual cycle. These are the days of her maximum fertility. A male with a low sperm count should get special intercourse timing instructions, as should the woman with a shorter or longer cycle.

Position during intercourse may also be important. Sperm may reach the cervix more easily when the woman, lying on her back, draws her knees up to encircle her partner's hips. After his orgasm, the woman should maintain this position for ten to fifteen minutes or relax with a pillow under her hips.

Michael Russell

Your Independent guide to Infertility

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