However, most practitioners believe that cervi cal mucus abnormalities, in combination with other factors, may contribute to subfertility and should be evaluated. Structural problems are often iatrogenic and result from surgical procedures, such as conization. In such cases, destruction of the endocervical epithelium or stenosis leads to inadequate mucus production and sperm transport and, thus, disturbance of the function of cervical crypts for sperm storage. A variety of uterine conditions have been implicated in infertility. These include chronic endometritis, leiomyomata, intrauterine synechiae, congenital malformations, and polyps.
Foreign bodies can also affect implantation.
Most of these abnormalities can also cause recurrent abor tion. Tuberculous endometritis is clearly associated with infertility. Several factors are thought to cause infertility by distort ing the uterine cavity, which prevents implantation either mechanically or by affecting endometrial development. Most of these factors are detected by hysterosalpingography and confirmed by hysteroscopy. There is also increasing inter est in the use of ultrasonography in combination with fluid distention of the uterus to evaluate uterine anomalies.