Uterine Abnormalities And Infertility

Perhaps the single largest factor in a pregnancy is the uterus. Many women find that having an abnormality of the uterus is a factor in their inability to carry a pregnancy or in their inability to conceive a pregnancy.

The Septate Uterus, A Congenital Anomaly

The most common congenital uterine anomaly is the septate uterus. A septate uterus is explained as a condition in which there is a wall-or septum-that either partially or fully separates the uterus into two cavities. The statistics indicate that one in four women will experience repetitive reproduction failure as a result of this factor alone.

Diagnosis and Treatment of Septate Uterus

In order to diagnose a septate uterus, clinical facts are gathered from a variety of methodologies, including a uterine X-ray called a hysterosalpingogram or HSG. The HSG procedure is regularly used to detect such abnormalities as scar tissue, polyps, fibroids or an abnormal shape to the uterus. The treatment for this condition is surgical as hormonal treatment has not proven to be very successful for women with septate uterus.

The surgical procedure is called a metroplasty and is done either through a telescope-type device which is placed into the vagina and then into the uterus, called a hysteroscope, or through a small incision in the abdomen called a laparotomy. There is typically a shorter recovery time when a hysteroscope is used to remove the septum that divides the uterus.

Di-ethyl-stilbestrol, The Effects Go On And On

Another factor in uterine anomalies is a drug which was given to women back in the 1940s and 1950s. Di-ethyl-stilbestrol, or DES, was given to women to lower the risk of miscarriage. It is a synthetic hormone which was later found to have had no effect at all upon miscarriage risk. It did, however, cause a number of embryological abnormalities in the children of the women who took the hormone over that time period.

Dr. Ricki Pollycove of San Francisco, California, says, "It can lead to abnormalities of the upper vagina, especially flattening of the cervical ‘neck' as it enters the upper vagina. 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." Dr. Pollycove explains that this generally results in spontaneous miscarriage as opposed to being infertile.

Other Reproductive Problems Associated With DES

There are other reproductive problems that have been associated with exposure to DES, including underdeveloped uterus (hypoplastic); irregular uterine lining; ectopic pregnancy; premature labor or incompetent cervix, which may result in painless cervical dilation and subsequent premature delivery.

Dr. Pollcove says, "It's hard sometimes to treat these problems. 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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