Uterine Factor Infertility

Solutions for Uterine Issues

For National Infertility Awareness Week, we’re looking at common causes of infertility and what can be done to address them.  Uterine factor infertility is one of the most common reasons for difficulty getting pregnant.

Problems with the uterus affect the embryo’s ability to implant in the uterus or make it difficult to carry a pregnancy to term, leading to multiple miscarriages.  These factors include: congenital defects, known as mullerian anomalies; Asherman syndrome, which is scarring inside the uterus; uterine fibroids and polyps; and adenomyosis.

Uterine Factors and Infertility

The reproductive organs develop in a fetus before birth.  When the uterus and fallopian tubes don’t develop normally, various types of mullerian anomalies are the result.  In rare cases the uterus and tubes don’t form at all, known as agenesis.  In other cases there may be a complete duplication of the uterus, cervix, and vagina (didelphys), two uteri sharing one cervix and vagina (bicornuate),  one uterus but with a fibrous band going down the middle (septate), or a single uterus with a dent in it (arcuate).  Testing for these conditions involves using saline and a transvaginal ultrasound or another test, a type of X-ray called a  hysterosalpingogram, in order to see the formation of the organs.

Asherman syndrome is a rare disorder.  It mostly occurs in women who have had several dilation and curettage (D&C) procedures, although it can also result from a severe pelvic infection or from tuberculosis or schistosomiasis.  All of these can lead to fibrous tissue or adhesions in the uterus.

Uterine fibroids and polyps, on the other hand, are very common.  They are growths of tissue and muscle inside the uterus, and as many as 80 percent of all women have them.  Symptoms include heavy and/or irregular periods.  Fibroids and polyps are more likely to happen as a woman approaches menopause, although they can occur in younger women, too.   Uterine polyps are usually benign (not cancerous).

Adenomyosis is another condition that can happen as women approach menopause.  It occurs when the tissue that normally lines the uterus, the endometrium, grows into the wall of the uterus.  It also causes heavy periods and menstrual cramps.

Myths about Uterine Factor

A common myth is that having fibroids will prevent you from getting pregnant.  In most cases this is not true!  Fibroids only cause problems if they block the fallopian tubes or are large and affect the uterus’s ability to stretch in pregnancy.  In fact, many treatments for fibroids are more likely to cause fertility problems than the condition itself due to the chance of scarring or affecting the ovaries.  Studies show that in most cases only large submucosal fibroids that intrude into the uterus affect fertility. It’s very important to be examined by a reproductive endocrinologist to determine the optimal treatment for fibroids and infertility.

Conquering Uterine Factor Infertility

Treatments for uterine factor infertility may involve surgery in some cases.  The fibrous band in a septate uterus can be removed in a hysteroscopy.   A bicornuate uterus may not need surgical correction, but if you have recurrent miscarriages, your fertility specialist may recommend surgery.  IVF treatment may be recommended if you have blocked fallopian tubes and your uterus is determined to be able to support implantation and a pregnancy.  Even women who don’t have a uterus or have severe scarring that would prevent them from carrying a baby can have a biological child through surrogacy if they have ovaries with healthy eggs.    Assisted reproductive technology has made it possible for thousands of people to have the family they long for, helping them overcome many causes of infertility.