Uterine Abnormalities and Infertility

One of the factors affecting fertility and the ability to carry a pregnancy to term is uterine abnormalities. There are a variety of abnormalities affecting women, some congenital, some drug induced. We will explore a couple of them here.

Congenital Abnormalities

The septate uterus is the most common congenital uterine anomaly and is a condition where a wall or septum partially or fully separates the uterus into two complete cavities. This congenital factor is suspected of affecting one in four women who have reproductive failure repeatedly.

A uterine x-ray, called a hysterosalpingogram or HSG, along with gathering clinical facts, is used to make the initial diagnosis. The HSG procedure is often used to detect scar tissue, polyps, fibroids or a uterus which is abnormally shaped. Treatment for septate uterus is surgical since hormones are not of much benefit in this instance.

A metroplasty, the surgical procedure used to remove the septum which divide the uterus, can be done either through a hysteroscope (a telescope-like device that is placed in the vagina and then into the uterus) or via a small incision in the abdomen, called a laparotomy. There is less time involved in recovery using the hysteroscope than the laparotomy.

The success rate of this surgery indicates that about 80 percent of women who have undergone the surgery to remove the septum and reshape their uterus have gone on to become pregnant and to carry the baby to term.

DES - a Drug Induced Problem

A drug prescribed in the 1940s and 1950s which was supposed to lower the risk of miscarriage has since proven to have no effect on miscarriage prevention. DES, di-ethyl-stilbestrol, is a synthetic hormone which was eventually shown to cause a number of embryological abnormalities in the children born to women who had taken the drug over the 20 years it was being prescribed.

"DES can lead to abnormalities of the upper vagina, especially flattening of the cervical "neck" as it enters the upper vagina", says Dr. Ricki Pollygrove of San Francisco, Ca. "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 development." This generally ends in a spontaneous miscarriage as opposed to being infertile, Dr. Pollygrove explained.

Other difficulties resulting from the effects of DES include hypoplastic uterus (underdeveloped); irregular uterine lining; ectopic pregnancy; premature labor or incompetent cervix which may result in painless, cervical dilation and subsequently a premature delivery.

Sometimes a special stitch placed surgically around the neck of the cervix can help a woman with a weak cervix, but the "T" shaped uterine cavity, if quite severe, will not hold a pregnancy.

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