Causes of Infertility- Cervical and Uterine Factors
Cervical Factor Infertility
The cervical glands secrete cervical fluid, which serves as a media for sperm transport. Sperm are deposited in the vagina and swim in the cervical fluid through the cervix and into the uterus. The cervical fluid is rich in nutrients and must have the correct consistency to support sperm transport. If the cervical mucus is too “thick or sticky”, the sperm cannot reach the uterus resulting in infertility.
The cervical mucus must also be free of antisperm antibodies. These antibodies are sometimes mistakenly made by the female’s immune system and can destroy sperm. The antibodies recognize sperm as invading pathogens, such as virus or bacteria, and seek to destroy them. The male may rarely make antibodies to his own sperm, as can be seen with vasectomy reversal.
When female antisperm antibodies are present, or if the cervical mucus is inadequate, intrauterine insemination (IUI) is often the treatment of choice. In IUI, the sperm are washed and concentrated and then placed directly into the uterus using a small catheter, thus avoiding sperm contact with the cervical mucus. Our North Carolina fertility clinic produces IUI success rates that exceed the national averages. The sperm used in IUI must be specially prepared by an andrology laboratory to avoid potentially serious allergic reactions.
If IUI does not prove successful, IVF may be the next treatment choice.
Once the egg is fertilized, the embryo must travel through the fallopian tube and embed in the uterine lining (endometrium). The endometrium is composed of cells that divide 
rapidly under the influence of progesterone and estrogen. Since the embryo implants in the endometrial layer, it must be thick and vascular to provide nutrients essential for embryonic development.
Sometimes the endometrium does not develop properly, and one cause can be a luteal phase defect. When a luteal phase defect is present, there is not enough progesterone to stimulate and support endometrial growth.
This condition can usually be treated by administering additional progesterone during the luteal phase or by giving fertility drugs such as Clomid, Femara, or gonadotropins.
The uterus must be free of large polyps or fibroids that could interfere with embryonic growth and development. These conditions are usually diagnosed during the initial infertility workup with a hysterosalpingogram, hysteroscopy, or laparoscopy. The obstructions are removed before any type of fertility treatment, including IVF, is attempted. Dr. Deaton is a board certified fertility specialist at Premier Fertility's, North Carolina fertility clinic. He is a skilled reproductive surgeon and can often remove fibroids and polyps using laparoscopy or hysteroscopy.
The uterus might also have congenital deformities such as a bicornuate uterus (which has “two horns”) or other problems such as a uterine septum. In many cases, the septum (a piece of scar tissue in the uterine cavity) can be successfully repaired using hysteroscopic surgery.
When the uterus is severely damaged, a surrogate mother may be the only way a couple can have a child. The couple produces embryos using in vitro fertilization that are transferred to the surrogate mother. The surrogate carries the baby to term and after delivery gives it to the infertile couple. Surrogacy laws are very complex and are often the main barrier to surrogacy.
