Uterine Factor Infertility

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Once an egg is fertilized and becomes an embryo it implants in the lining of the uterus or the endometrium. The uterus expands to accommodate the growth of a developing fetus and it must be free of serious defects. If defects exist, it can cause infertility or miscarriage.

What Are the Types of Uterine Infertility?

Developmental uterine anomalies have long been associated with pregnancy loss and obstetric complications, but the ability to conceive is generally not affected. However, abnormalities of the uterus, while an uncommon cause of infertility, should always be considered. The anatomic uterine abnormalities that may adversely affect fertility include congenital malformations, fibroids, intrauterine adhesions or scarring, and endometrial polyps. These same abnormalities can also adversely affect pregnancy outcome with recurrent pregnancy loss.

• Some women are born with congenital abnormalities of the uterus such as the septate or bicornuate (two-horned) uterus which is heart shaped and divided into two cavities. Pregnancy can occur in many of these women; however, the miscarriage rate is much higher if a septum is present.
• Fibroids, also known as fibromyomas, leiomyomas or myomas, are non cancerous tumors that are outgrowths of the muscular wall of the uterus. Many times these tumors produce no symptoms and are discovered when the patient undergoes an HSG (hysterosalpingogram), sonohysterograms, or hysteroscopy. Fibroids can become large enough to obstruct the uterus thus interfering with embryo implantation and the ability to carry a child to term.
• Polyps are caused by an overgrowth of the glandular tissue lining the uterus called the endometrium. Much of the current scientific data reports that even small polyps (<1 cm) in specific locations within the uterus may interfere with embryo implantation and development and should be removed prior to attempting pregnancy. Therefore, depending on the location of the polyp, Dr. Zoneraich takes a very aggressive approach to making sure the uterine cavity is normal prior to proceeding with any fertility treatment.

How is Uterine Infertility Diagnosed?

There are three main ways a woman can be evaluated for uterine factor infertility:

• HSG (Hysterosalpingogram): While many practitioners rely on the HSG X-ray test to provide all the information necessary regarding the uterine cavity, the reality is that the uterus is a three dimensional organ and a two dimensional X-ray image is not sufficient to identify all lesions within the uterine cavity. However, the HSG is an extremely useful tool to diagnose congenital uterine anomalies such as uterine duplication (bicornuate or septate uteri) and should incorporated into the initial uterine evaluation.
• Sonohysterogram: This test uses transvaginal ultrasound with sterile saline that is inserted into the uterine cavity to separate the top and bottom layer of the uterus in order to better evaluate the endometrial cavity. This test allows the physician to obtain an accurate view of the endometrial lining as well as the muscle wall of the uterus in order to determine if there are any abnormalities such as polyps, fibroids, or scar tissue that is disturbing the overall contour or lining of the uterus.
• Office hysteroscopy: This test uses a very thin lighted fiber optic telescope that is inserted through the vagina and cervix into the uterine cavity and provides an extremely high resolution view of the inside of the uterus. This is the gold standard for evaluating the uterine cavity.

What is The Treatment For Uterine Infertility?

In many cases, Dr. Zoneraich can surgically remove polyps and fibroids with a quick outpatient surgical procedure, with minimal risk of injury or scarring. Some congenital abnormalities such as a uterine septum can also be corrected easily using hysteroscopic surgery. Some other uterine anomalies may require more advanced surgical reshaping of the uterus.

In rare cases when there is severe uterine damage or adhesions, the only alternative for creating a genetically related child is to use a gestational surrogate who offers her uterus to carry the embryo derived from the parents. In these situations, the infertile couple undergoes an IVF cycle and the resultant embryo is implanted into the surrogate who carries and delivers the baby.

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