09.08.2020 Mind | Body

Infertility Illusion: Tilted Uterus

Dr. Habib Sadeghi
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According to the Centers for Disease Control and Prevention (CDC), a woman is considered infertile if there is no conception after 12 months of unprotected sex with her male partner.  Women with multiple miscarriages who have never carried a baby to term are also considered infertile.  Among women of child-bearing age between 15 and 49 in the U.S., 13.1% have impaired fertility.  

As if the devastating news and emotional struggle weren’t enough, couples facing fertility challenges are left with the option of assisted reproductive technology (ART) and the exorbitant costs that come with it.  After an initial examination, blood tests and workup costing about $5,000, the choices include everything from intrauterine insemination (IUI) from about $1,500 per trial to in vitro fertilization (IVF), which starts at around $12,000 per trial.  This doesn’t include required medications that run between $3,000 and $7,000.  While most insurance companies will pay for tests to determine fertility status, they usually don’t cover ART services.  

One of the more common reasons for infertility is a tilted uterus.  Because most physicians and patients are entirely unaware that such a condition can exist, couples often end up financially spent and emotionally drained after years of unsuccessful ART attempts. 

When a uterus is tilted, even the chances of conceiving through IVF are almost nil. The good news is that in many cases, a tilted uterus can be corrected in a painless procedure that greatly improves the chances of conception, saving couples a small fortune and years of heartbreak.  

Obvious Answers

There’s an old adage that says, “When you hear hoofbeats, look for horses, not zebras.”  This means that when there are signs of a problem, look for the simplest, most logical explanation; don’t go off on an exotic tangent looking for some complicated, far-fetched reason.  I would add and unnecessarily stressing yourself out in the process.  

If you or a woman you know is struggling with conceiving or maintaining a pregnancy, the first place to look is the uterus.  It’s the environment where the fertilized egg or zygote needs to attach itself and grow.  Assuming the father is fertile and the mother is in good health, any fertilized egg they produce will be viable.  In such cases, suspicion needs to be shifted to the zygote’s environment, the uterus.  Until the uterus is properly examined, all attempts at ART will be wasted time and money because it’s highly unlikely an embryo will be able to attach itself and grow in a tilted uterus regardless of the fertility method used. 

Gravity of the Situation  

Normally, the uterus rises from the cervix and folds forward to partially rest on the bladder.  With the uterus in this position, a fertilized egg can easily travel and come to rest on the inner wall of the flat portion overlaying the bladder, which provides a stable base for it to firmly attach and grow.  This location also protects the fertilized egg from being disturbed by anything else that might be introduced into the vaginal canal.   

Due to a number of reasons, the uterus can end up curving backward at the cervix toward the pelvis.  Most physicians refer to this condition as a retroverted or tilted uterus where the severity of the tilt is measured as either first, second or third degree.  In rare cases known as a retroflexed uterus, the tilted uterus can actually fold backward on itself putting pressure on the rectum and creating problems with elimination.  

Out of its natural placement, the tilted uterus will either be in a perfectly vertical position behind the bladder or leaning backward at an angle.  When this happens, it’s very difficult for the fertilized egg to find a proper place to come to rest, attach, and grow.  With the uterus now creating a straight channel downward toward the vaginal opening, it’s very common for the fertilized egg to lose its grip and slide right out of the body.  I believe this happens to most of the sperm cells, as well, with gravity playing a prominent role.  

In its normal position folded over the bladder, the uterus is like a cul-de-sac with a soft bend in the road and pocket at the end where the fertilized egg can sit and develop.  In contrast, the tilted uterus is like a vertical, straight, one-way street where the fertilized egg has to hang on for dear life, fighting the forces of gravity where all the traffic moves in one direction: down and out.    

Although most women with a tilted uterus experience no pain or symptoms, some have reported vaginal pain (dyspareunia) or lower back pain during sexual intercourse, menstrual pain (dysmenorrhea), trouble inserting tampons, urinary tract infections, and mild incontinence.  

Maladies & Misalignment

There are a number of reasons why the uterus can become tilted.  Scarring from adhesions due to endometriosis or fibroids often pull it backward and hold it there.  When left untreated, sexually transmitted diseases like chlamydia and gonorrhea lead to pelvic inflammatory disease (PID) and can cause scarring that results in similar effects to endometriosis.  Any scarring from a history of pelvic surgery can also be a cause.  Sometimes a prior pregnancy can over-stretch the ligaments holding the uterus in place, leaving it unable to maintain its natural position, falling backward. 

If none of these conditions exist and yet the uterus is still tilted, most doctors will insist that the condition is genetic. Based on the patients I’ve seen, I have to disagree.

Any internal scarring in the pelvic region as a result of injury can cause the uterus to be misaligned.  In many cases, women are completely unaware that such an injury has even occurred.  This happens most in female athletes involved in sports that have a high risk of them repeatedly landing on their buttocks such as cheerleading, figure skating, and gymnastics.  Although seemingly harmless, the repeated impact from these falls often forces the pelvic floor upward into an unnatural position, throwing the uterus out of alignment.

I had a patient, “Kathy”, whose doctors told her that a tilted uterus wouldn’t be a problem in getting pregnant.  After more than a year of trying to conceive naturally with her husband, she’d spent tens of thousands of dollars on multiple rounds of IVF only to experience a miscarriage with every attempt.  I soon discovered that decades earlier, she’d been a cheerleader in college and broken her tailbone in a hard fall one day in practice.  An exam quickly showed she indeed had a tilted uterus, and that’s why she couldn’t get pregnant, regardless of what her previous doctors had told her.  

Incomplete Interventions 

Ordinarily, a tilted uterus is diagnosed through a pelvic exam.  Initially, patients may be prescribed various exercises like knee/chest lifts, pelvic contractions, and Kegels to strengthen ligaments and realign the uterus.  In most cases, success with exercises is limited and temporary.  If scarring is an issue, exercises won’t work at all.  Another option is the pessary device, a plastic or silicone application that can be inserted into the vagina to prop the uterus into a better position.  Again, the effect is temporary, and the device, if left in long-term, has been associated with infections.  

The only permanent solution that conventional medicine offers for a tilted uterus is surgical.  A uterine suspension can be performed to realign the uterus.  More recently, a laparoscopic version of the same procedure known as a uterine uplift is also available.  

A Better Choice

Fortunately, integrative medicine offers a non-surgical intervention to realign the uterus that’s effective in over 90% of cases.  Treatment involves having the patient lie face down on the examining table.  Because the uterus is tilted toward the back of the body, the physician must enter through the rectum to perform a number of osteopathic manipulations in order to guide it back into place.  Initially, this involves releasing tension in the pelvic floor, allowing it to relax and move back into its original position, creating more vertical space in which the manipulations can take place.  During this phase of the treatment, patients sometimes describe a mild sensation in the pit of their stomach as if they were going over a small roller coaster hill.  Others might experience a phantom urge to urinate since the work is being done in the vicinity of the bladder.  If scarring is present, Procaine and homeopathic injections are administered into the nerve plexus to release the rigidity of the tissue and increase its flexibility.  

The entire procedure takes between 30 to 90 minutes depending on each patient’s condition.  For cases with none or mild scarring, success rates are high.  In Kathy’s case, she conceived naturally with her husband just weeks after treatment.  Depending on the severity of the tilt, scarring and other issues, more than one session is sometimes necessary.  In rare cases where scarring is excessive, surgery may be the best option.           

For more health insights from Dr. Sadeghi, please visit beingclarity.com to sign up for the monthly newsletter or check out his annual health and well-being journal, MegaZEN here. For daily messages of encouragement and humor, follow him on Instagram at @drhabibsadeghi. 

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