Tilted Uterus or Cervix
Many women are told, often casually, upon an annual OB-GYN exam, that their uterus is tipped. Or that their cervix is tilted (the cervix is just the bottom opening of the uterus, so this amounts to the same thing.) This means that instead of the top of the uterus sitting up straight or leaning forward toward the belly, it tilts the other way toward the back. This is also called "retroverted uterus" or "retroflexed uterus," and according to the Mayo Clinic, about 20 percent of women are built this way.
It's quite common for women with this "diagnosis" to worry that it will cause them problems in trying to conceive. If they already feel they have been trying a long time, it may seem like a logical explanation. But in itself it is unlikely to be a show stopper.
"Your tilted uterus will not cause a problem; typically this isn't a major impediment [to conception]," says Dr. Gerald M. DiLeo, an OB-GYN in private practice since 1981. "The vagina is called a 'potential space;' that is, it's not a space unless something occupies it (e.g., baby, tampon). When not occupied, the vaginal walls, roof, and floor all meet together—collapse, squishing any fluid-like substance (semen) toward the back, where your cervix—tilted or not—is." If your partner's sperm are motile, this whole arrangement is a set-up for the sperm's successful migration toward conception.
During pregnancy, the uterus tends to straighten up as it fills out and grows, so rarely does a tilted uterus or tilted cervix present a problem in fetal growth or delivery.
In some instances, the uterus is pushed out of place, or retroflexed, by endometriosis. In such a case, it's the endometriosis compromising fertility, not the position of the uterus.
Other abnormalities in uterine structure can be more problematic. Dr. John C. Jarrett, author of The Fertility Guide: A Couples Handbook for When You Want to Have a Baby (More Than Anything Else), says, "When the uterus is abnormal, the chances of miscarriage are significantly increased. Much of this is probably due to the fact that there is not a good blood supply to the abnormal uterine tissue. If the placenta begins to grow on this tissue, it cannot get the blood supply it needs to survive." Abnormalities might include the organ's shape or its being partially or completely divided; surgical correction dramatically improves the chances of a successful pregnancy, in some cases.