The uterus, or the womb, is the female pear-shaped organ where a baby develops during pregnancy. Various kinds of uterine disorders may lead to infertility, causing implantation failure or recurrent miscarriages.
Congenital uterine abnormalities
Characteristics
This group is also called Müllerian duct anomalies. They are present from birth and occur in the stage of uterus formation in the fetus. These malformations include:
- uterus didelphys (double uterus, each one with a cervix)
- arcuate uterus (uterus with a dent on the top part)
- unicornuate uterus (one-sided uterus with one horn)
- bicornuate uterus (heart-shaped uterus with two horns)
- septate uterus (uterus with a partition by fibrous or muscular septum in the center)
- and absent uterus
Link to infertility
Some of them, especially the septate uterus, may cause subfertility, preterm birth, pregnancy loss, intrauterine growth restrictions, breech delivery(the baby feet come out first), etc[1].
Treatment
The only form of treatment is surgical repair or reconstruction.
Uterine polyps
Characteristic
Uterine polyps are defined as fleshy, usually non-cancerous growths within the uterus walls. These growths vary in size and may occur at any age, but menopausal women are more likely to develop polyps. Signs and symptoms of uterine polyps include bleeding between menstruations, irregular periods.
Link to infertility
Their link to infertility is based on their location because it can prevent the embryo from implanting in the uterus, the sperm from fertilizing an egg, or block the cervical canal. Removing polyps significantly increases the success rate of natural pregnancy and assisted reproductive technologies like IUI and IVF[2].
Treatment
Therapists remove uterine polyps with a minimally invasive procedure called a hysteroscopic polypectomy.
Fibroids
Characteristics
Uterine fibroids can be characterized as benign muscular or fibrous growth from the wall of the uterus. They are also called leiomyomas. A woman can have a single fibroid or multiple ones, ranging in size. They are not related to an increased risk of uterine cancer. Many women who have fibroids don’t have any symptoms, but if they have, the signs can include heavy menstrual bleeding, pain in the pelvis, frequent urination, constipation, etc. Depending on localization, fibroids can be
- submucosal (growing inside the uterine cavity)
- intramural (growing inside this muscular wall)
- subserosal (connected to the outside wall of the uterus)
- pedunculated (mushroom-like shape, connected to the uterus with a thin stem)
Link to infertility
Fibroids, especially submucosal, can cause infertility, pregnancy loss, and pregnancy complications such as placental abruption, fetal growth restriction, and preterm delivery[3].
Treatment
Treatment of uterine fibroids may include medications and surgery (myomectomy). The treatment plan will depend on their location, size, quantity, symptoms, etc.
Ashermanʼs syndrome
Characteristics
Asherman’s syndrome is an acquired condition, and it is also known as intrauterine synechiae or intrauterine adhesions (IUA). It is described as scar tissue in the uterus or the cervix. Because of this, the walls of the womb are stuck together, and the cavity of the uterus becomes smaller. This condition can be caused by surgery like dilation and curettage, cesarean section. The symptoms which signify Asherman’s syndrome are amenorrhea, oligomenorrhea, severe cramping, or pain.
Link to infertility
For women with Asherman’s syndrome, it can be challenging to conceive. However, it is possible, but the adhesions in the uterus walls don’t give enough place for fetal development. That’s why the risk of stillbirth and miscarriages are high.
Treatment
Asherman’s syndrome is usually managed with surgery, the goal of which is to remove adhesions and scar tissue. The procedure is non-invasive and uses a hysteroscopy[4].
Endometriosis
Characteristics
Endometriosis is characterized as the appearance of endometrial tissue in areas outside the uterus (in the peritoneum or pelvic organs). According to Sampson’s theory, it is caused by the implantation of retrograde menstruated endometrial cells. Other theories say that this condition is associated with metaplasia induced by menstrual debris, or lymphatic spread. Endometrial-like tissue thickens, breaks down, and bleeds with each menstrual cycle. If this condition involves ovaries, endometrial cysts can form there. The symptoms of endometriosis may be as follows: pelvic pain, dysmenorrhea, pelvic mass, pain during urination and intercourse.
Link to infertility
Endometriosis may affect fertility in direct and less-direct ways[5]. Endometrial tissue can form an obstruction of a fallopian tube and keep the egg and sperm from uniting. This condition may also contribute to the damaging of the sperm or egg. The severeness of endometriosis will determine the impact on fertility.
Treatment
An endometriosis treatment plan can include pharmacological (combined oral contraceptives, gonadotropin-releasing hormone agonists, progestins) and surgical (performed by laparoscopy) treatment[6].
References
- Reichman DE, Laufer MR. Congenital uterine anomalies affecting reproduction. Best Pract Res Clin Obstet Gynaecol. 2010 Apr;24(2):193-208. doi: 10.1016/j.bpobgyn.2009.09.006.
- Al Chami A, Saridogan E. Endometrial Polyps and Subfertility. J Obstet Gynaecol India. 2017 Feb;67(1):9-14. doi: 10.1007/s13224-016-0929-4. Epub 2016 Aug 20. PMID: 28242961; PMCID: PMC5306103.
- Zepiridis LI, Grimbizis GF, Tarlatzis BC. Infertility and uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2016 Jul;34:66-73. doi: 10.1016/j.bpobgyn.2015.12.001.
- Dreisler E, Kjer JJ. Asherman’s syndrome: current perspectives on diagnosis and management. Int J Womens Health. 2019 Mar 20;11:191-198. doi: 10.2147/IJWH.S165474.
- D’Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003 May;21(2):243-54. doi: 10.1055/s-2003-41330.
- ESHRE guidelines for the diagnosis and treatment of endometriosis.