Retroverted Uterus and Fertility: Causes, Symptoms, and Treatment Options
By Dr. Elizabeth Dilday, CCRM Fertility of Newport Beach
What Is a Retroverted Uterus?
A retroverted uterus, also called a tilted uterus, is a common anatomical variation where the uterus tilts backward (posteriorly) toward the spine instead of forward (anteriorly) toward the bladder. This condition affects about 1 in 4 women and is usually harmless.
However, if a retroverted uterus is linked to conditions like endometriosis, pelvic inflammatory disease (PID), or fibroids, it could impact fertility. 
“A retroverted uterus is a normal anatomical variation that rarely impacts fertility on its own. The analogy I use with patients is that a retroverted or anteverted uterus is like being left- or right-handed.” says Dr. Dilday. “However, when conditions like endometriosis or fibroids are present, evaluation by a fertility specialist can help determine the best course of action to help you meet your goals.”
Causes of a Retroverted Uterus
A tilted uterus can be congenital (from birth) or develop due to:
- Endometriosis – Adhesions ((scar tissue) in endometriosis, if severe, can pull the uterus into a retroverted position.
- Pelvic Inflammatory Disease (PID) – Pelvic infections (e.g. chlamydia) may cause adhesions (scar tissue) and affect uterine positioning.
- Fibroids – Benign (noncancerous) growths of smooth muscle tissue in the uterus may push it into a backward position, if large.
- Pregnancy & Childbirth – Ligaments supporting the uterus may become lax and may not return to their original position after pregnancy.
Does a Retroverted Uterus Affect Fertility?
A tilted uterus alone does not usually cause infertility. However, certain complications may arise if associated conditions are present:
✅ Sperm Transport Issues – In rare cases, a severely retroverted uterus may affect sperm movement.
✅ Pain During Intercourse (Dyspareunia) – Some individuals experience discomfort in certain positions, which may reduce the frequency of intercourse.
✅ Endometriosis or Adhesions – Scarring from endometriosis or PID can impact fallopian tube transport of sperm and oocytes, embryo development and embryo implantation.
Symptoms of a Retroverted Uterus
Most people with a tilted uterus have no symptoms. However, some may experience:
- Painful periods (dysmenorrhea)
- Lower back pain
- Pain during sex (dyspareunia)
- Urinary issues (frequent urination or difficulty emptying the bladder)
Can a Retroverted Uterus Be Treated?
In most cases, no treatment is necessary unless it causes pain or fertility concerns. Options include:
- Pelvic Exercises
- Kegel exercises and pelvic tilts may help reposition the uterus over time.
- Pessary Device
- A vaginal pessary is a removable device that helps support the uterus in a forward position.
- Surgery for Underlying Conditions
- Laparoscopy can remove endometriosis, adhesions or fibroids to improve fertility.
Fertility Treatments for a Retroverted Uterus
If conception is challenging, fertility treatments may improve your ability to conceive:
✅ Intrauterine Insemination (IUI)
- Sperm is placed directly into the uterus, bypassing potential sperm transport issues.
✅ In Vitro Fertilization (IVF)
- Fertilization occurs outside the body, and embryos are transferred directly into the uterus, making uterine positioning less of a concern.
✅ Surgical Intervention
- If endometriosis or adhesions are affecting fallopian transport of gametes or embryo implantation, a minimally invasive laparoscopic surgery may improve fertility.
Key Takeaways
✔️ A retroverted uterus is normal and does not usually cause infertility.
✔️ It can be congenital or caused by conditions like endometriosis, fibroids, or PID.
✔️ Most people don’t need treatment, but if fertility is a concern, IUI, IVF, or laparoscopic surgery may help.
✔️ If you’re struggling to conceive, a fertility specialist can evaluate your options.
Need Fertility Guidance? Contact CCRM Today!
If you’re concerned about uterine positioning and fertility, our experts at CCRM Fertility can help. Schedule a consultation to explore your options and take the next step toward growing your family.
