The cervix is located at the juncture of the vagina and uterus and the cervical glands produce cervical mucus. Once sperm are ejaculated into the vagina, they must swim in this mucus through the cervix and into the uterus. The cervical mucus must be of the correct consistency and be free of antisperm antibodies for the sperm to successfully make this passage.
The post coital test is sometimes ordered to rule out cervical factor infertility. The couple has intercourse at home and later comes to our office where we obtain a sample of the cervical mucus. The presence of many “dead” or “non moving” sperm is an indication of a cervical mucus problem.
Sometimes the female’s immune system makes antibodies to the male’s sperm. When this happens, her immune system “mistakes” sperm for invading pathogens, such as virus and bacteria, and seeks to destroy them. It is also possible, but rare, for the male to produce antibodies to his own sperm. This usually occurs as a result of a testicular trauma where blood was exposed to reproductive cells.
The “first line” treatment for cervical factor infertility is often intrauterine insemination (IUI). Using IUI, the washed, highly concentrated, sperm are placed directly into the uterus thus avoiding exposure to the cervical mucus. IVF may also be a first line treatment depending upon numerous factors such as ovarian reserve, age, coexisting causes of infertility, and others. Per cycle success rates using IVF are superior to IUI.
The developing embryo implants into the lining of the uterus, known as the endometrium. The endometrium must be sufficiently ‘thickened’ and vascular to support the embryo and developing fetus.
The uterus must also be free of large obstructions such as polyps and fibroids and it must not have serious “congenital defects” such as seen in the bicornuate uterus. Some congenital defects can be corrected by a skilled reproductive surgeon.
Polyps and fibroids can be removed surgically usually using the laparoscope and it is very important that a reproductive surgeon perform this surgery. Sometimes the obstruction can be removed using the hysteroscope. Some surgeons still rely on the open incision to remove polyps and fibroids which dramatically increases recovery time and pain.
When the uterus is severely damaged it may be necessary to use a surrogate mother to carry the baby to term. Using surrogacy, an embryo created using the genetic material of the mother and father is transferred to the surrogate mother who carries the baby to term and delivery.