Cervical Stenosis: Impacts on Fertility and Treatment Options

Cervical stenosis

Hello: After trying to conceive for over a year without success, I went for an examination: 1.
Ovulation is normal 2.
Fallopian tubes are normal 3.
Sperm motility is slightly below normal but still within acceptable limits.
However, I did not undergo blood tests, laparoscopy, or post-coital tests (the doctor did not recommend them).
Recently, I underwent artificial insemination (AIH), but the catheter could only enter the cervix halfway and could not proceed further.
I have a few questions: 1.
Can a retroverted uterus prevent the catheter from advancing? 2.
If I have antibodies in the cervical mucus causing infertility, would the catheter only reaching halfway render the procedure ineffective? 3.
After this unsuccessful AIH and the onset of my menstrual cycle, what should be my next step? Should I continue with further testing or focus on intrauterine insemination (IUI)? Thank you for your response.

Penny, 20~29 year old female. Ask Date: 2002/01/15

Dr. Wu Zongcheng reply Obstetrics and Gynecology

Obstetrician and Gynecologist Dr.
Wu Tsung-Cheng, Tainan Hospital, Department of Health, Executive Yuan.
1.
Artificial insemination (ATH) is typically used in cases of low sperm count or poor cervical mucus secretion during ovulation.
2.
In cases of pregnancy, if there is an antigen-antibody reaction, please perform the intercourse test first.
3.
ATH delivers sperm directly into the uterus.
It can be done at the internal or external cervical os, depending on your specific situation.
4.
The cervix can be dilated beforehand.
Any issues with access can be easily resolved.

Reply Date: 2002/01/15

More Info

Understanding cervical stenosis and its implications on fertility is crucial for couples trying to conceive. Cervical stenosis refers to the narrowing of the cervical canal, which can impede the passage of sperm into the uterus and may complicate assisted reproductive techniques such as intrauterine insemination (IUI).

1. Cervical Position and Access: The position of the uterus, such as anteversion (forward tilt), can indeed affect the ability of instruments to navigate through the cervical canal. However, the primary concern in your case seems to be the cervical stenosis itself, which could be the reason why the catheter could only be inserted halfway. If the cervical canal is narrowed, it can obstruct the passage of sperm, making natural conception more challenging.

2. Cervical Antibodies and Fertility: If cervical antibodies are present, they can create an inhospitable environment for sperm, potentially leading to infertility. However, if the catheter could only reach halfway into the cervical canal, it raises concerns about whether sperm could effectively reach the uterus. If cervical stenosis is significant, it may hinder the success of IUI, as the sperm may not be able to travel through the narrowed canal to reach the uterus. Therefore, it is essential to address the cervical stenosis before proceeding with further IUI attempts.

3. Next Steps After Failed IUI: After a failed IUI, it is advisable to consult with your fertility specialist about the next steps. Continuing with IUI without addressing the underlying issues may not be effective. You might want to consider further diagnostic tests, such as a hysterosalpingogram (HSG) to evaluate the patency of the fallopian tubes and the condition of the uterus, or a hysteroscopy to directly visualize the cervical canal and uterus. These tests can help determine if there are any anatomical issues that need to be addressed.

If cervical stenosis is confirmed, treatment options may include dilation of the cervical canal, which can be performed in a clinical setting. This procedure can help facilitate easier access for future IUI attempts or natural conception. Additionally, if there are underlying issues such as cervical inflammation or infection, those should be treated as well.

In summary, cervical stenosis can significantly impact fertility and the success of assisted reproductive techniques. It is essential to address this issue before proceeding with further IUI attempts. Consulting with a fertility specialist who can provide a comprehensive evaluation and tailored treatment plan is crucial for improving your chances of conception.

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