This can be caused by infections, Dilation and Curettage (D and C's), development problems, adenomyosis, foreign bodies, uterine fibroid and polyps. Polyps unfortunately are often not seen on ultrasound and are often hidden for a long time. They act like a family planning agent thus preventing pregnancy. Two years ago, I met a woman who had been trying to get pregnant for several years. I discovered during an ultrasound that she had a remnant of a baby's bone in her uterus which was causing her infertility and offered to take it out. After a year’s hiatus, we took it out by operative hysteroscopy (entering the uterus through the vagina and cervix with a camera and surgical instruments to remove polyps, fibroids, scar tissue, foreign bodies, etc. without cutting the body). She promptly got pregnant afterwards with no further intervention. Uterine fibroids in the endometrial cavity may cause heavy bleeding or painful periods and also act like a family planning method preventing pregnancy. Ladies who may have had D and C's may have suffered endometrial damage causing a fertile land to become like gravel. These problems need to be corrected with Hysteroscopic Surgery before they can conceive or get relief from their symptoms. For women whose uterus cannot carry a pregnancy successfully despite all attempts, surrogacy is an option. Written by: Dr. Padi Ayertey MB,ChB. FWACS Obstetrician Gynecologist Resolve Medical Services Accra Source: Glitz Africa Magazine issue 19