Uterus, ovaries and fallopian tubes lay in the small pelvic peritoneal cavity. The peritoneal cavity anatomical defects or physiological dysfunction, including infections, adhesions, and formations, may be the reason for infertility. Pelvic inflammatory disease, adhesions secondary to surgical procedures, endometriosis or ovarian cyst rupture may change oviduct motility or even clog fimbria (oviduct end).
Large myoma nodes and any other formations cause disturbances to the normal peritoneal fluid exchange and naturally interfere with the normal process of the egg grabbing mechanism.
Adhesions around ovaries can interfere with the normal ovulation mechanism.
Pelvic inflammatory disease
Two of the most common pelvic inflammatory disease-causing agents are gonorrhoea and chlamydia infections. With inflammatory relapse episodes, the tubal damage risk increases, respectively, from 34% the first time to up to 54% after the second and third episode. Inflammatory agents are diagnosed from material from cervical secretions and determination of specific antibodies in blood serum.
The patient often does not remember the acute pelvic inflammatory episode; however, tubal patency disorders are diagnosed during hysterosalpingography (HSG) or laparoscopy. 21% of cases are diagnosed laparoscopically.
Endometriosis is a condition where tissue, such as the lining of the uterus (endometrial stroma and glands, which are located only in the uterine cavity), are found in other parts of the body.
Endometriosis affects 10% of women of reproductive age (from the beginning of menstruation to menopause). Endometriosis in 26% of cases is the cause of primary infertility and in 13% of cases secondary infertility.
Endometriosis lesions vary from microscopic to macroscopic. Classic endometriosis is black-violet and located on the ovaries, fallopian tubes, bladder and bowel peritoneal surface.
The hypothesis of mild and medium stages of endometriosis as the cause of infertility is still controversial. The hypothesis that confirms that mild and medium endometriosis contributes to infertility is based on the following mechanisms:
Increased number of macrophages in the peritoneal fluid that promote phagocytosis of sperm;
Decreased sperm adhesiveness to the zona pellucida;
Increased cytokine levels;
Increased immunoglobulin synthesis;
The peritoneal fluid has become toxic to the foetus;
Decreased activity of natural killer cells (NK).
Endometriosis is related to ovulation disorders – luteal phase deficiency (LPD), oligo-ovulation, or luteinized unruptured follicle (LUF).