1) Vaginal issues
Rarely a couple might be unable to complete intercourse due to vaginismus. In such cases, adequate psychological support or even intrauterine insemination (IUI) with sedation may lead to the desired result.
2) Cervical issues
Cervixes that have undergone a Loop Electro-Excision Procedure or Cold-Knife Conization or that are surrounded by inflammatory vaginal environment can either produce a small amount of mucus or be hostile to sperm.
3) Uterine issues
These problems are responsible for 10-15% of infertility cases. Some of the uterine problems are mentioned hereby:
• Intrauterine adhesions, usually as a result of scratching or abortion or in general injuries in the uterus
• Intrauterine infection, which is the most common and hidden enemy of the modern woman in my opinion, as it never gives any symptoms other than unexplained implant failures or even six miscarriages while being diagnosed only by an experienced doctor during hysteroscopy.
• Endometrial formations such as polyps or fibroids – In my opinion polyps can rarely cause infertility in cases of spontaneous conception. On the other hand though, in cases of in vitro fertilization they seem to reduce success rates. Likewise, fibroids that are located in or near the uterine cavity seem to play a huge role in achieving pregnancy and its continuation as it has been shown to cause miscarriages
• Presence of uterine septum. The international community is particularly interested in the importance of a possible barrier to achieving pregnancy. So while, until recently, the common belief was that it played absolutely no role, newer studies want the removal of the diaphragm to increase natural conception rates and reduce miscarriage rates. My personal experience is that the hysteroscopic surgical transection of the diaphragm really helps to achieve pregnancy in the next cycles.
4) Issues with the fallopian tubes
- Absence of fallopian tubes, either congenital or acquired through surgery
- Tubal obstruction due to inflammation, surgery or endometriosis
- Decreased fallopian mobility as a result of inflammation, endometriosis or other pelvic inflammation such as appendicitis. The most common microbial enemy of the fallopian tubes is chlamydia, which in about half cases invades the female reproductive system completely silently and corrodes it from the interior.
