There are a variety of problems which affect the uterus and its lining which have the potential to have a profound effect on the prospects of achieving a successful pregnancy. While these problems are relatively uncommon as a cause of infertility when they do occur they are often among the most difficult to treat. Moreover, they are usually not amenable to management with IVF.
Local conditions of the uterus which influence the prospect of embryo implantation can broadly be classified as those affecting the muscle of the uterus (myometrium) or those affecting the lining of the uterus (endometrium).
They are:
- Benign tumours of the muscle of the uterus (fibroids)
- Growth of the glands of the lining into the muscle (adenomyosis)
- Uterine polyps (usually of the lining - endometrium)
- Inflammation of the lining of the uterus (endometritis)
- Adhesions with in the cavity of the uterus (Ashermans Syndrome)
- Resistance of the lining of the uterus to normal development (endometrial atrophy)
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| Intrauterine adhesion | Uterine fibroid ( hysteroscopy) |
Uterine fibroids
Fibroids are benign (not cancerous) muscle tumours of the uterus. They are the most common benign internal tumour in the human body, occurring in 30-40% of women. Each one contains millions of cells which are an identical clone of each other cell in the fibroid. They distort the shape of the uterus and can cause heavy and irregular menstrual bleeding. If they are situated in the uterine cavity, just under the lining or next to the entrance of the fallopian tube into the uterus, they can cause infertility. Their exact cause is unknown, but they are related to the effect of the hormone Oestrogen on the uterus.
Adenomyosis
Adenomyosis is a common condition due to the in growth of the glands of the lining of the uterus into the muscle of the uterus. The symptoms of this disease are usually heavy and painful menstrual periods. It leads to an enlargement of the uterus and can sometimes produce considerable distortion which can limit fertility.
Endometrial polyps
Uterine polyps are overgrowths of the lining of the uterus (the endometrium). Most are totally benign and simply represent a thickening of the endometrium due to malfunction. Very rarely they are caused by cancerous or pre-cancerous changes in the lining. As they can act like an intra uterine contraceptive device, polyps are usually removed at the time of diagnosis.
Endometritis
As mentioned above polyps are caused by a dysfunction of the lining of the uterus. Sometimes, however, a problem of the endometrium is not reflected in the presence of a polyp but simply by the inability for a pregnancy to adhere to it. Such problems are very difficult to diagnose. It is possible that a curette (D&C) will obtain tissue that the pathologist can determine is not functioning normally and then specific treatment can be provided.
Intrauterine Adhesions
This condition involves the sticking together of the anterior and posterior walls of the lining of the uterus following a curettage which is usually performed during or just after pregnancy. It is also known as Asherman’s Syndrome. In this situation the lining of the uterus (endometrium) cannot re-grow properly and heals together. In doing so it can partially or more rarely obliterate the cavity of the uterus and thus markedly limit the prospect of further pregnancy. In addition to infertility, once treated, it can lead to recurrent miscarriage or abnormal adherence of the placenta to the uterine muscle in subsequent pregnancy (placenta accreta).
Endometrial Atrophy
Is usually causes by conditions which damage the lining of the uterus such as intrauterine adhesions, uterine fibroids endometritis or the treatment of theses problems.
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| The passage of eggs, sperm and embryo towards the uterine cavity and implantation |