Understanding Structural Causes of Infertility: What You Need to Know

Dr. Sofie Desforges-Bell, ND

C’est La Vie Wellness, Oakville + Mitchell

A Calm Retreat, Sebringville

Understanding Structural Causes of Infertility: What You Need to Know

Infertility affects millions of couples worldwide, and while there are many potential causes, structural issues within the female reproductive system play a significant role. Understanding where to look and what to look for can make a meaningful difference in diagnosis and treatment.

Where Do Structural Causes Come From?

When evaluating female structural causes of infertility, clinicians typically focus on three key compartments:

• Tubal and Pelvic Region: This is one of the largest shares of identifiable female infertility factors

• Uterine Cavity: Including polyps, intrauterine adhesions, and congenital anomalies

• Myometrium: Including fibroids and adenomyosis

The Most Common Structural Causes

Here’s a breakdown of the most frequently identified structural causes of female infertility and their prevalence among identifiable causes:

• Tubal occlusion, hydrosalpinx, and adhesions: 26.1%

• Anovulatory/oligo-ovulatory cycles: 17.7%

• Bilateral tubal blockage: 14.8%

• Acquired tubal abnormalities: 11.6%

• Hyperprolactinemia: 6.7%

• Endometriosis: 4.8%

Let the Patient’s History Guide You

One of the most powerful diagnostic tools is a thorough patient history. Certain past experiences can point directly to the affected compartment:

• Prior infection, ectopic pregnancy, or surgery → Think tubes

• Bleeding, pain, or pregnancy loss → Think uterine cavity or myometrium

Tubal Risk: What to Watch For

Tubal causes are among the most common structural contributors to infertility. High-risk indicators for tubal occlusion include:

• A history of chlamydia infection

• Pelvic inflammatory disease (PID) or peritonitis

• Known endometriosis or prior pelvic surgery, including salpingectomy

Chlamydia antibody testing can be a useful tool to help differentiate between low and high-risk patients when tubal occlusion is suspected.

Uterine Cavity Issues

Structural problems within the uterine cavity can significantly impact fertility and pregnancy outcomes. Key concerns include:

• Endometrial polyps: Research has shown that resection of endometrial polyps can improve assisted reproductive technology (ART) pregnancy outcomes compared to no treatment

• Intrauterine adhesions: Often a result of prior uterine surgery or infection

• Congenital anomalies: Structural abnormalities present from birth that may interfere with implantation or pregnancy

Myometrial Causes

The myometrium, or the muscular wall of the uterus, can also harbor structural problems that affect fertility:

• Fibroids (Uterine Leiomyomas): Depending on their size and location, fibroids can interfere with implantation or sperm transport

• Adenomyosis: A condition where endometrial tissue grows into the uterine muscle, often causing pain and fertility challenges

Key Takeaway for Patients

If you’ve been struggling with infertility, it’s important to work with your healthcare provider to systematically evaluate potential structural causes. A detailed medical history, combined with targeted imaging and laboratory tests, can help identify the root cause and guide the most appropriate treatment plan.

Early diagnosis and intervention, whether through hysteroscopy, surgery, or assisted reproductive technologies, can significantly improve your chances of achieving a successful pregnancy.

Always consult with a qualified healthcare provider for personalized medical advice.

Dr. Sofie Desforges-Bell, ND

C’est La Vie Wellness | Oakville & Mitchell