Several factors can influence a tilted uterus and pregnancy. It may be congenital, where a woman is born with a naturally tilted uterus. Pelvic scarring from previous surgeries or infections like pelvic inflammatory disease (PID) can lead to adhesions that pull the uterus backward. Conditions like endometriosis and uterine fibroids can also affect the uterus’s position. Additionally, weak ligaments or changes from previous pregnancies may contribute to the tilt. While a tilted uterus is often harmless, these factors can influence its position.