Uterine Factor Infertility

Uterine factor infertility is a term used to describe abnormalities of the uterus that are linked to infertility. These abnormalities can make it difficult to conceive or carry a pregnancy to term.

Uterine factors linked to infertility

• Fibroids – non-cancerous tumors that can interfere with implantation or distort the uterine cavity or lining
• Polyps –endometrial tissue growths that can prevent implantation or block the fallopian tubes
• Congenital abnormalities – such as uterine septate, a condition where a band of tissue divides the uterus; Bicornuate uterus, a heart-shaped uterus with two endometrial cavities; Unicornuate uterus, a condition where only half of the uterus has developed; Didelphys, double uterus
• Adhesions –scar tissue that can block the fallopian tubes or interfere with implantation
• Cervical issues – previous cervical surgeries, abnormal cervical mucus and the presence of antibodies can kill or hinder sperm

Diagnosing the cause of uterine factor infertility

Fertility specialists typically diagnose uterine problems through a battery of tests, including:

• Hysterosalpingogram (HSG) – a procedure that utilizes x-ray and liquid contrast dye. A catheter is inserted through the vagina and cervix into the uterus to deliver the special dye. The dye fills the uterus and flows through the fallopian tubes to identify obstruction of the tubes
• Transvaginal ultrasonography – an ultrasound performed using a probe that is inserted through the vagina. The test is used to evaluate the uterus for fibroid tumors, cysts and other abnormalities.
• Magnetic resonance imaging (MRI) – helpful in evaluating the condition of the uterus and identifying structural abnormalities.
• Sonohysterography – a transvaginal ultrasound where the uterus is filled with saline, making it easier to identify uterine polyps and fibroids
• Hysteroscopy – a lighted camera called a hysteroscope is inserted into the uterus to look for abnormalities
• Laparoscopy – a surgical procedure where a small, lighted instrument is inserted through an incision in the abdomen and into the pelvis to look for signs of endometriosis, adhesions, polyps, fibroids or other abnormalities.

Treatment of uterine factor infertility

Careful evaluation by a reproductive endocrinologist is needed in the case of suspected uterine factor infertility. Some conditions can be corrected surgically, including the removal of polyps or fibroids, but caution must be taken to minimize scarring. Polyps or fibroids that do not interfere with fertility usually do not require removal.

Surgical correction of uterine malformations is not always necessary, since many women with these disorders can still conceive. With or without treatment, there may still be a higher risk of miscarriage and preterm delivery for these patients.