Uterine Anomalies Affect Fertility
Tuesday, February 23, 2021
Uterine abnormalities caused by both abnormalities of the uterus from birth and those that occur after birth, can affect fertility and the chance for conception. Both congenital and acquired uterine abnormalities are significant causes of both infertility and recurrent pregnancy loss.
Typically congenital abnormalities, present from birth and referred to as Mullerian anomalies, occur when the uterus is forming in the fetus. The most common Mullerian abnormalities include: septate uterus, bicornuate uterus, unicornuate uterus and uterine didelphys. The underlying etiology of congenital uterine anomalies is not well known, but is likely polygenic and associated with multiple causes.
In addition to the congenital uterine abnormalities described above, there are a variety of other uterine abnormalities that can develop after birth. These are referred to as “acquired abnormalities”. Examples include endometrial polyps, intrauterine adhesions, and uterine fibroids. These conditions frequently cause symptoms – such as increasingly severe menstrual cramps, heavier or irregular vaginal bleeding, or changes in bowel or bladder function. On some occasions, patients are unaware that they have these conditions and they are only discovered as part of a fertility evaluation. Typically large fibroids can be detected during a pelvic examination, however smaller fibroids, fibroids within the uterine cavity, polyps, and adhesions can only be detected by some sort of imaging technique – either a sonogram, an HSG, or a sonohysterogram.
Aside from congenital and acquired uterine anomalies, there are other (maybe more familiar) issues and conditions that affect the reproductive tracts, such as cervical ectropion, tubal subfertility and Endometriosis.
The uterus is responsible for many of the crucial steps in the process of reproduction, including sperm migration, embryo implantation, fetal nourishment, development and growth, and, finally, labor. As a result, any malformations can have an impact on reproductive outcomes. In fact, up to 25% of women who have had recurrent miscarriages and/or deliveries of premature babies have been diagnosed with a uterine anomaly. Yet, it should be noted that many women with uterine anomalies do experience normal obstetric outcomes.
Embryo implantation is affected by the shape and integrity of the uterine cavity. If a congenital uterine anomaly is present, this can possibly affect the ability of an embryo to implant, resulting in pregnancy loss. Additionally, several studies have suggested that the effects on fertility caused by uterine anomalies could be mediated through other infertility factors. For example, patients with uterine anomalies are more likely to have infrequent or no periods. They are also more likely to have endometriosis.
Aside from infertility problems from a uterine abnormality, birthing complications and child health issues may arise. These include: Miscarriage, Breech or other baby positioning problems in the womb, need for Cesarean section birth, premature birth, slower baby growth and birth defects due to restrictions on the fetus’ growth in the womb.
Treatment of an abnormally shaped uterus
It is important that infertile women who are found to have a congenitally malformed uterus be counseled and offered options including surgical treatment depending on the particular anomaly and their reproductive history. For example, women with a septate uterus can undergo surgery to correct the malformation, whereas women with bicornuate, unicornuate, or didelphic uteri rarely require surgical treatment.
Treatment of uterine scarring, or a septate uterus involves hysteroscopy. A doctor can remove the scar tissue or fibrous bands with specialized scissors or cautery devices during hysteroscopy.
There are several ways we can evaluate your uterus and endometrial cavity for scarring or a mullerian anomaly. These include:
– Saline infused sonohysterography: a specialized test using transvaginal ultrasound.
-Hysterosalpingogram: a specialized x-ray used to evaluate the fallopian tubes as well as the uterus.
– Hysteroscopy to look inside your uterus: A thin camera is passed through your cervix into the uterus. This gives your doctor a direct view inside the uterus, which will give your doctor the most accurate information about the uterine cavity.