For some women who are struggling to become pregnant, the obstacle may be a tipped uterus, though experts say the data on the topic is sparse and inconclusive.
The normal uterus is shaped like a pear and sits in a straight vertical position. The term "tipped" or "tilted" describes the abnormal positioning of the uterus, in which the organ is shifted backwards toward the back of the pelvis. A tilted uterus can be congenital — something a woman is born with — but it can also occur after childbirth, when the ligaments holding the uterus in place stretch and lose their tension during pregnancy. Scarring from adhesions as a result of endometriosis or pelvic inflammatory disease, or fibroid tumors can also cause the uterus to shift backwards.
Many women experience no symptoms and therefore don’t even know their uterus is tilted. However, the primary symptoms are uterine pain during sexual intercourse or menstruation. Other symptoms include back pain during intercourse, minor incontinence, urinary tract infections, and difficulty using tampons.
A doctor can diagnose a tilted uterus during a routine pelvic exam.
Some women wonder if having a tilted uterus will prevent them from getting pregnant, but the answer to that question, according to Dr. Lin Vikner, Obstetrician/Gynecologist and Fertility Specialist in Paramus, New Jersey, is there is no conclusive evidence to suggest it has an impact on a woman’s fertility.
"It might vary from one person to another on whether it prevents you from getting pregnant," said Dr. Vikner.
And she added that many women with a tilted uterus have become pregnant and do go on to have normal pregnancies and healthy babies.
Most clinicians agree that a tipped uterus is only thought to be problematic after all possible reasons for infertility are ruled out. The reason a tilted uterus can be a barrier to pregnancy is that in some women the backward tilt causes the cervix to be positioned against the front of the uterus or towards the pubic bone. A uterus in this position may prevent the semen that naturally collects in the posterior vaginal region and washes over the cervix, from swimming into the cervical canal to fertilize an egg.
There is a surgical procedure performed to reposition a tilted uterus called a uterine suspension. However, doctors usually recommend the procedure for women who experience pain during intercourse or menstruation, and not as a treatment for infertility.
Dr. Vikner said based on the research "it’s not justified to have the surgery" as a cure for infertility.
A newer version of the uterine suspension procedure — called the UPLIFT procedure — is proven to have fewer postoperative complications. It involves shortening and strengthening the ligaments holding the uterus so that it falls back into a more normal position.
There have been no formal clinical trials showing a connection between the UPLIFT procedure and an increased rate of pregnancy. However, the manufactures site individual case studies that show a higher success rate in women who have undergone the procedure.
Less invasive treatments for a tilted uterus are "knee-chest" exercises, which may reposition the uterus temporarily. But experts say these are not effective in women who have developed a tilted uterus as the result of endometriosis, fibroids, or other pelvic infections.
There is also temporary treatment with a pessary — a plastic or silicone device that is placed in the vagina to reposition the uterus. However long-term use is discouraged because the devices can lead to vaginal infections.
Again, most obstetrician/gynecologists believe a tilted uterus will not prevent a woman from becoming pregnant, but if it does pose a problem, there are options that can help.