Physiological

The female reproductive system is highly complex and has many organs which each have a specific function. Sperm need to be able to swim all the way to the Fallopian tubes to fertilise the egg released from the ovaries. The resulting embryo then needs to implant itself successfully in the lining of the uterus. There are therefore a range of potential physiological causes of female infertility: these may be identified by fertility tests such as a hysterography or a coeliscopy/laparoscopy.

A (fairly) normal uterine cavity and endometrium are necessary in order to conceive successfully and maintain a pregnancy. There are several physiological conditions related to the cavity or the lining that can cause female fertility problems.

• Uterine polyps
• Uterine fibroids
• Adenomyosis
• Intrauterine adhesions
• Congenital uterine malformations, such as a bicornuate uterus, a T-shaped uterus, or a uterine septum
• Thin endometrial lining
• Inflammation of the uterine mucosadenomyosis

It is usually very difficult to get pregnant without properly-functioning Fallopian tubes, as this is where fertilisation usually occurs. Tubal factors account for 20% to 25% of all cases of infertility and is usually caused by endometriosis, PID (Pelvic Inflammatory Disease), surgery, birth defects or an ectopic pregnancy. There are various physiological problems that can develop with the Fallopian tubes and these include:

• Tubal blockage (complete or partial)
• Tubal scarring

Just as it is crucial that the sperm meet the egg through unblocked Fallopian tubes, it is equally important for the lining of the uterus to be welcoming to the embryo so that it can implant itself properly. Endometriosis is a condition where the tissue that would normally grow inside the uterus grows on other organs of the body. This could cause Fallopian tube blockage, scar tissue or disrupt the shape of your uterus which would make pregnancy difficult to achieve. Around 15% of women suffer from endometriosis and it is thought that between 30% to 40% of infertile women suffer from this condition. The causes of endometriosis are not fully understood. It is thought that endometriosis could be due to:

• Genetics: Endometriosis appears to run in families
• Menstrual fluid backup: Endometriosis may be the result of retrograde menstruation when blood flows back towards the Fallopian tube during a period
• Problems with the immune system: Endometriosis may be caused by a problem with the immune system, in which case the distribution of endometrial cells around the body cannot be prevented

Read more about ovulatory causes of infertility

Read more about hormonal causes of infertility

Read more about infertility treatments