Medical Conditions

Sometimes, an underlying medical problem can prevent conception from happening.

And since some conditions have symptoms so subtle that you may not even notice, a diagnosis may not always be apparent. The best thing to do is to empower yourself with knowledge.

Get the facts on several common conditions and their treatment.

• Although diagnosed with endometriosis, Davina was able to have the family she wanted.

Endometriosis

Endometriosis is a disease in which cells that normally line the uterine cavity also implant outside the uterus on the ovaries, fallopian tubes, or other pelvic organs. This condition is found in about 35% of women who have no other diagnosable infertility problem.¹ Women with endometriosis may experience painful cramps during menstruation, painful intercourse, or heavy periods. But other women experience few or no symptoms other than having difficulty conceiving.

Endometriosis can result in adhesions, certain endocrine or ovulatory abnormalities and impaired implantation, all of which may be associated with infertility.

Adhesions

The cause of infertility can sometimes be traced to adhesions in a woman's pelvic cavity or uterus. Adhesions, also known as scar tissue, often occur in the pelvic cavity after pelvic surgery and can lead to pain in the affected area. Adhesions formed in the uterus (intrauterine adhesions) can be associated with menstrual dysfunction, and some women may not experience any symptoms.²

Intrauterine adhesions may be caused by trauma to the uterine cavity, such as dilation and curettage (a procedure done to scrape away tissue or growth, often done after a miscarriage). Other less common causes include the prolonged use of an IUD (intrauterine device) for contraception and infections of the endometrium.

Adhesions can also be associated with endometriosis.

Fibroids

Fibroids are relatively common. These benign (not cancerous, or non-malignant) tumors grow in the uterine wall.

Although fibroids are common, only about 3% of infertility is caused by fibroids.³ Most fibroids are very small and don't have an impact on a woman's ability to conceive. In some cases, they can cause no symptoms. In others, they can cause abnormal menstrual patterns or difficulty conceiving.

When fibroids push into the cavity of the uterus, they can make it difficult for the embryo to implant in the uterine wall.

Uterine malformation

A small percentage of women have some sort of malformation in the uterus that can make it difficult to conceive and successfully carry a pregnancy. In some cases, women are born with an abnormally developed uterus. ³

Many uterine malformations can be traced all the way back to the fetus. Early in a pregnancy, a female fetus develops a tubular system called Müllerian ducts. These ducts are supposed to fuse together to form a uterus in the fetus. If this does not happen, the female can be born with a malformed uterus:

• A bicornuate uterus is the most common congenital uterine malformation. A normal uterus is shaped like a pear. But in this case, the uterus is shaped more like a heart. This means that the embryo has less space to grow than in a normally shaped uterus. Surgery to create a larger uterine cavity can usually correct this condition. ⁴

Cancer

A woman who was treated for cancer before age 30 has the best chance of becoming pregnant after treatment. But physicians usually advise women not to get pregnant in the first six months after chemotherapy, since the treatment could have damaged maturing eggs, possibly resulting in miscarriage or a baby with a genetic problem.

The following treatments can affect a woman's fertility:

• Chemotherapy: Many chemotherapy drugs can damage eggs housed in the ovaries. Talk to your physician about the risks associated with cancer treatments and their effects on fertility.
• Bone marrow or stem cell transplant: This treatment usually involves high chemotherapy doses and possibly radiation prior to the transplant. This procedure can permanently prevent a woman from producing eggs. Talk to your doctor or nurse before starting treatment.
• Radiation treatments: This treatment uses high-energy rays to kill cancer cells. Unfortunately, depending on the amount of radiation that is administered, the rays can also damage a woman's ovaries and/or lead to premature menopause. This can even happen when the rays are not aimed at the stomach or pelvis. Radiation to the brain can also affect the pituitary gland, which can interfere with egg production.
• Surgery: A hysterectomy is surgery to remove the uterus either through the vagina or through a cut made in the abdomen. This is sometimes part of treatment for certain kinds of cancers in women. In some cases, small cervical cancers can be removed through a new technique called trachelectomy. This surgery removes the cervix but leaves the uterus behind so a woman can become and stay pregnant.

Other treatments: Hormone therapies that treat breast cancer or other cancers can affect fertility.

Cancer treatments that can affect men

The following treatments can affect a man's fertility:

• Chemotherapy: Sperm production can stop or slow after chemotherapy. Some men start making sperm again in one to four years, but in other men, it can take up to a decade to get back to normal.
• Bone marrow or stem cell transplant: Since this usually involves chemotherapy and high doses of radiation, it can often permanently stop sperm production.
• Radiation treatments: Radiation to the testicles can affect a man's fertility, because the rays can kill cells that make sperm. Radiation to the stomach or pelvis can also affect sperm production. Radiation to the brain can affect the pituitary gland, which has a negative effect on the hormone balance needed to produce sperm.
• Surgery: Several types of surgery can affect a man's fertility. These include the removal of one or both testicles, prostate or bladder surgery, or surgery that interferes with ejaculation

Other treatments: Hormone therapies that treat certain cancers can affect a man's fertility. Doctors still do not know the full effect that newer treatments have on fertility, including vaccines, immune therapies or biological response modifiers.

• 1. American Society for Reproductive Medicine. Infertility: an overview: a guide for patients. Birmingham, Alabama: American Society for Reproductive Medicine; 2003.
• 2. IBID p-10 & 14
• 3. Pui MH. Imaging diagnosis of congenital uterine malformation. Comput Med Imaging Graphics. 2004;28:425-433.
• 4. Acién P. Reproductive performance of women with uterine malformations. Hum Reprod. 1993;8:122-126.