Dr. Devika Gunasheela’s Article On Uterine Factors In Infertility

The reproductive tract involves the uterus along with the tubes, ovaries and vagina. There are many hormones whose interplay is essential for the reproductive system to function normally. The uterus is an organ whose main function is to carry a pregnancy to term and help in delivering a baby to the outside world.

During every cycle the lining of the uterus called the endometrium grows and becomes thick in expectation of an embryo. When there is no pregnancy the lining sheds resulting in a period. When the uterus is not in top shape, it can prevent the development of an embryo. There are a number of factors in the uterus that may contribute to this.

 Congenital 

The most common congenital uterine anomaly is the septate uterus. A septate uterus is described as a condition where a wall partially or fully divides the uterus into two cavities. It is estimated that one in four women will have repeated abortions due to this congenital factor. The initial diagnosis is made by using a uterine X-ray. Treatment is surgical. The surgical procedure that is performed to remove the septum that divides the uterus is called metroplasty. This can be done easily by an endoscopic procedure. The clinical literature indicates that approximately 80% of women who have undergone surgery have successfully become pregnant and carried the baby to term.

Asherman’s Syndrome:

Asherman’s syndrome is basically a loss of the normal lush lining of the uterine cavity which occurs after an excessive endometrial curettage which is a scraping procedure to empty the uterine cavity of pregnancy tissues during an abortion. Scar tissue is formed in the uterine cavity. In cases where there is severe scarring of the uterine cavity, women do not get their periods. In addition to preventing conception, scar tissue or adhesion inside the uterine cavity can increase the risk of miscarriage.

Endometrial Polyps:

Endometrial polyps are an excess growth of tissue on the uterine lining. Small polyps generally do not interfere with the reproductive abilities. However, if they become large or there are multiple polyps present, they can impede conception and may increase your risk of miscarriage. Irregular bleeding is the most common symptom of endometrial polyps. Women with this type of polyps can have very heavy bleeding during their period. Polyps can be diagnosed through a special type of ultrasound. A hysteroscopy is a common diagnostic procedure that many doctors use. Getting rid of endometrial polyps is fairly simple. Using a hysteroscope, polyps are scraped off the uterus.

Fibroids and Infertility:

Fibroids are benign (that is, non-cancerous) tumours of the uterus. They grow from the muscle cells of the uterus and may protrude from the inside surface of the uterus or they may be contained within the muscular wall. Although the exact cause is unknown, the growth of fibroids seems to be related to a gene that controls cell growth. Fibroid growth is affected by the reproductive hormones estrogen and progesterone. Fibroids regress at menopause. Fibroids may cause infertility in a number of different ways. A large fibroid may cause compression of the fallopian tubes resulting in a blockage of the passage of sperm or eggs. If a fibroid protrudes into the uterine cavity or causes distortion of the uterine cavity, it may present a mechanical barrier to implantation. Some studies have suggested that fibroids in the muscle portion of the uterus may cause an alteration or reduction of blood flow to the uterine lining making it more difficult for an implanted embryo to grow and develop. There is much disagreement amongst physicians about when a myomectomy (operation for removal of fibroid) for infertility should be performed. Most would agree that fibroids that are within the uterine cavity or causing significant distortion of the cavity should be removed.

However, what about a single small fibroid that is located within the muscular wall of the uterus but does not protrude into or distort the cavity? This is still left unanswered. The controversy exists because it is very difficult to do studies that prove the effect of myomectomy.

Tuberculosis:

Female genital tuberculosis is seen among 10% of gynaecological patients. It is seen mostly secondary to tuberculosis infection in the lungs. Fallopian tubes are the most commonly affected (90 %) followed by uterus, ovaries and cervix. Patients may be asymptomatic with just infertility or recurrent pregnancy loss being the reason to come to the hospital. Some patients who have severely affected uteri with tuberculosis may have no period at all. There need not be a significant history of the previous contact with tuberculosis.

There are various methods of diagnosing tuberculosis. Once diagnosed with genital tuberculosis, treatment is given for 6 months. Patients after treatment either conceive spontaneously or can come for assisted reproductive techniques (IUI / IVF). After treatment of genital T.B. pregnancy rates seem to be around 35 — 40 %.

Author: Dr. Devika Gunasheela

Contact: Dr Devika Gunasheela, Infertility Specialist,

Gunasheela Hospital & Fertility Centre

Basavanagudi, Bangalore,

Phone: +91 – 80 – 41712626