Infertility Factors - Uterine Anomalies

When a couple decides to have a baby and then discovers the task is easier said than done, many factors come under scrutiny to determine causes for infertility. One factor which can affect fertility in women is abnormalities of the uterus. Such abnormalities can cause infertility and can be implicated in the inability of a woman to carry a pregnancy to term.

Congenital Uterine Anomalies

Congenital uterine anomalies, uterine inconsistencies present at the time of birth, account for many of the problems women have with infertility. The most common of these anomalies is the septate uterus. This condition is described as having a wall or septum either partially for fully dividing the uterus into two cavities. The estimates indicate that one in four women will have repetitive reproductive failure as a result of this congenital factor.

The Septate Uterus, Diagnosis and Treatment

Diagnosis of septate uterus is made through clinical facts and the use of a procedure called hysterosalpingogram or HSG. HSG is a uterine X-ray often used to detect such things as uterine fibroids, scar tissue, polyps or an abnormally-shaped uterus. The treatment for septate uterus is surgical, since hormones do not seem to be beneficial for women with this anomaly. The surgery is called metroplasty and is performed in order to remove the septum which divides the uterus. It can be performed either hysteryoscopically, using a telescopic type of device that is placed in the vagina and then into the uterus; or through a laparotomy - a small incision in the abdomen. There is a much shorter recovery time when the hysteryoscope is used.

The success rate for pregnancy after the procedure to correct septate uterus is very encouraging, with about 80 percent of women successfully conceiving and carrying their babies to full term.

Di-ethyl-stilbestrol, or DES, and Its Net Effects

A drug given to women in the 1940s and 1950s with the intent of lowering miscarriage risks has turned out to be a cause of uterine abnormalities in the children born to women taking the drug. Di-ethyl-stilbestrol, or DES, is a synthetic hormone which, as it turned out, does not have any effect at all on miscarriage prevention.

Dr. Ricki Pollycove of San Francisco, California, says, "It (DES) can lead to abnormalities of the upper vagina, especially flattening of the cervical ‘neck' as it enters the upper vagina." She continues, "Infertility associated with DES exposure is infrequent, usually due to either an abnormal ‘T' shape to the uterine cavity or inadequate strength of the cervix due to its abnormal developments." Dr. Pollycove went on to explain that this generally results in spontaneous miscarriage as opposed to being infertile.

Problems, Problems and More Problems

Other DES associated reproductive abnormalities include hypoplastic uterus, which is an underdeveloped uterus; irregular uterine lining; ectopic pregnancy; premature labor or incompetent cervix, which may in turn result in painless cervical dilation and as a result, premature delivery.

"It's hard sometimes to treat these problems," Dr. Pollycove says. "A cerclage (a special, sturdy stitch placed surgically around the cervical neck) can often help the woman with the weak cervix, but the ‘T'-shaped cavity does not hold on to a pregnancy long enough if quite severe.


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