## Structural Causes of Female Infertility: Epidemiology **Key Point:** Tubal factor infertility accounts for approximately 25–35% of female infertility cases globally, making it the most common structural cause. Pelvic inflammatory disease (PID) is the leading preventable cause of tubal damage. ### Ranking of Structural Causes by Frequency | Cause | Prevalence (%) | Mechanism | |-------|----------------|----------| | Tubal factor (PID, endometriosis, adhesions) | 25–35 | Scarring, strictures, occlusion | | Uterine fibroids | 10–15 | Distortion of cavity, impaired implantation | | Asherman's syndrome | 1–2 | Intrauterine adhesions post-curettage | | Congenital anomalies | 3–5 | Unicornuate, septate, bicornuate uterus | **High-Yield:** PID-related tubal damage is the **most common preventable cause** of infertility in developing nations, where STI screening and early treatment are limited. **Clinical Pearl:** Tubal factor infertility presents with patent tubes on hysterosalpingography (HSG) showing filling defects, strictures, or hydrosalpinx; contrast does not spill freely into the peritoneal cavity. ### Why Tubal Factor Leads - Sexually transmitted infections (Chlamydia, Gonorrhea) → chronic PID → tubal scarring - Endometriosis → peritoneal inflammation → adhesions - Post-surgical adhesions (prior appendectomy, cesarean section) - Tuberculosis (endemic in India) → granulomatous tubal damage **Mnemonic:** **PEAT** — **P**ID, **E**ndometriosis, **A**dhesions, **T**uberculosis (causes of tubal factor infertility).
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