Sunday, September 30, 2012

Chances of Getting Pregnant

Could the position of my uterus affect my chances of getting pregnant?

Your uterus lies in the midline of your pelvis. It may be angled slightly toward your abdominal wall (anteverted) or toward your rectum (retroverted). The body of the uterus may also be angled from the plane of the cervix in either an anterior or posterior manner (anteflexion or retroflexion). Picture your forearm and hand as representing the body of your uterus and your cervix. The two parts can be aligned and tilted in a straight line, or you can bend your wrist, creating an angle between "the uterus" and "the cervix." If the uterus is mobile, there are generally no symptoms associated with the position of the uterus.

Most positional differences are anatomic variations that occur from woman to woman. Normally, the uterus is in a position of anteversion. Retroversion of the uterus may be present at birth, may be a consequence of childbirth (due to relaxation of the pelvic ligaments), or may be the result of a disease process in the pelvis.

The orientation of a woman's uterus, as determined at birth, has no relation to fertility in and of itself. In some cases, a sharp backward tilt (retroflexion) of the uterus can cause the cervix to be positioned against the anterior vaginal wall. For some couples, this prevents the cervix from being able to "bathe" in the pool of semen that naturally collects in the posterior vaginal vault after intercourse. This may prevent the sperm from swimming into the cervical canal to reach a released ovum for fertilization.

Additionally, there are certain conditions that may cause a sharp retroflexion of the uterus. These include endometriosis, pelvic inflammatory disease and uterine fibroids. Endometriosis can lead to scarring of the utero-sacral ligaments that may pull the uterus into a fixed retroverted position. As endometriosis can affect fertility, I think you should discuss this with your healthcare provider. Since you have been trying to conceive for the past year, it would be reasonable to undergo additional testing to help evaluate your fertility status. Then you may be able to determine whether or not the position of your uterus is related to a delay in conception.

Pregnancy can occur without penetration into the vagina. Pregnancy can also occur at various times during your cycle, particularly for women who have irregular periods. And yes, some women do experience bleeding at the time of their expected menstruation even though they are pregnant.

Intimacy of this nature can have serious consequences, including pregnancy and the spreading of sexually transmitted diseases (AIDS, herpes, gonorrhea, chlamydia, HPV, etc.). While it is unlikely that you conceived, it is possible. A pregnancy test may be reassuring.